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Multi-Directional Instabiliy


There is sudden or gradual onset of localised pain in the shoulder, usually during overhead activity. Typically, pain occurs in specific positions or during different movements. Sometimes there is a sense of weakness or instability.


Multi-directional laxity is a hereditary condition caused by a loose shoulder joint capsule. In many sports, such as ballet, gymnastics and figure-skating, this increased laxity is essential for performance. Some of these athletes may develop instability, which is a subjective problem.


A positive sulcus sign is the most important reflection of multi-directional laxity. General joint laxity may or may not co-exist. Functional tests, such as the ‘press against the wall test’, tests of thoraco-scapular control and a thorough examination of the cervical spine should complement the examination.


This is a clinical diagnosis; a painful shoulder and a positive sulcus sign without preceding trauma are the main indicators of the diagnosis. MRI is not helpful since it is a static examination and the syndrome is a dynamic problem.


Multi-directional instability and related impingement can often be cured by physiotherapy. However, in this group of athletes other problems can co-exist and exercise fail to cure the symptoms.


Refer to Dr Kevin Yip (+65 6664 8135) senior consultant orthopaedic surgeon. In almost all cases, a thorough rehabilitation programme including, thoraco-scapular control training, strength, flexibility and posture training is required. Refer to Dr Kevin Yip (+65 6664 8135) senior consultant orthopaedic surgeon if this regime fails, in particular if trauma is involved.


Most sports and activities without an overarm action are possible but secondary symptoms due to compensatory muscle activation are common and must be addressed. Swimming should also wait for around three months. The specific rehabilitation should aim at a full range of controlled motion, good posture and thoraco-scapular control by three months followed by functional training before resuming overhead sports.


Normal clinical symptoms and signs. Sulcus sign will remain positive. Functional strength, control and flexibility should be comparable with the other shoulder.


Internal impingement caused by structural damage.


Excellent-Good. Usually athletes in overhead sports can return to play within three months.

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