Bishop Meghan E, Patel Heli, Erickson Brandon J, Dodson Christopher C
Rothman Orthopaedic Institute, New York, NY, USA.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Ann Jt. 2022 Jan 15;7:10. doi: 10.21037/aoj-20-33. eCollection 2022.
Multidirectional instability (MDI) of the shoulder is characterized by generalized shoulder capsular laxity and symptomatic shoulder instability in more than one direction with one direction of instability as inferior. Generalized ligamentous laxity and specifically shoulder laxity, has been associated with female athletes. While males are at a higher risk of shoulder instability due to a number of extrinsic risk factors including participation in higher risk contact/collision activities, females are particularly susceptible to MDI due to their association with increased joint laxity. Patients with MDI often have a loose patulous capsule and display altered glenohumeral and scapulothoracic mechanics. The mainstay of treatment is physical therapy focusing on strengthening the dynamic stabilizers of the shoulder. In cases of failed rehabilitation, operative management most frequently includes either open or arthroscopic capsular shift with reasonably good outcomes and return to sport. Sex-related differences concerning shoulder instability risk and pathophysiology may influence treatment decisions and outcome measures. An understanding of the factors concerning shoulder instability specific to the female athlete is important in management and prevention of injury.
肩部多向不稳定（MDI）的特征是肩关节囊普遍松弛，且在多个方向上出现有症状的肩部不稳定，其中一个不稳定方向为下方。普遍的韧带松弛，特别是肩部松弛，与女性运动员有关。虽然由于包括参与高风险接触/碰撞活动在内的多种外在风险因素，男性发生肩部不稳定的风险更高，但女性由于与关节松弛增加有关，特别容易发生MDI。MDI患者通常有一个松弛、扩张的关节囊，并表现出盂肱关节和肩胛胸壁力学的改变。治疗的主要方法是物理治疗，重点是加强肩部的动态稳定器。在康复失败的情况下，手术治疗最常包括开放或关节镜下的关节囊移位，效果相当不错，且能恢复运动。与性别相关的肩部不稳定风险和病理生理学差异可能会影响治疗决策和结果指标。了解女性运动员肩部不稳定的特定因素对于损伤的管理和预防很重要。
