Best Matthew J, Tanaka Miho J
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Sports Med Arthrosc Rev. 2018 Sep;26(3):113-119. doi: 10.1097/JSA.0000000000000199.
Multidirectional instability (MDI) is a debilitating condition that involves chronic subluxation or dislocation of the shoulder in >1 direction. Numerous proposed mechanisms of MDI exist, which occurs in the setting of redundant capsular tissue. Symptoms can range from recurrent dislocations or subluxations to vague aching pain that disrupts activities of daily living. Magnetic resonance imaging is often performed during evaluation of this condition, although magnetic resonance arthrography may provide more detailed images of the patulous capsule. In the absence of a well-defined traumatic cause, such as a labral tear, initial treatment for MDI is a structured rehabilitation program with exercises aimed at strengthening the rotator cuff and periscapular muscles to improve scapular kinematics. Patients with recalcitrant symptoms may benefit from surgical stabilization, including open capsular shift or arthroscopic capsular plication, aimed at decreasing capsular volume and improving stability.
多向性不稳定（MDI）是一种使人衰弱的病症，涉及肩部在一个以上方向的慢性半脱位或脱位。存在多种关于MDI的发病机制假说，其发生于关节囊组织冗余的情况下。症状范围从反复脱位或半脱位到干扰日常生活活动的模糊隐痛。在评估这种病症时通常会进行磁共振成像，尽管磁共振关节造影可能会提供关于松弛关节囊更详细的图像。在没有明确的创伤原因（如盂唇撕裂）的情况下，MDI的初始治疗是一个结构化的康复计划，通过锻炼来加强肩袖和肩胛周围肌肉，以改善肩胛运动学。症状顽固的患者可能从手术稳定中获益，包括开放性关节囊移位或关节镜下关节囊折叠术，目的是减少关节囊容积并提高稳定性。
