Abstract

GONCALVES, Pedro AC  and  GUTIERRES, Manuel AP. Instabilidade multidirecional do ombro: como actuar?. Rev. Port. Ortop. Traum. [online]. 2017, vol.25, n.2, pp.102-113. ISSN 1646-2122.

Goal: Review of the current literature on the diagnosis and treatment of multidirectional shoulder instability. Sources of data: The information was researched on the PubMed data basis, using the following keywords: “instability”, “multidirectional”, “shoulder”, “diagnosis”, “treatment” and “surgery”. The survey was restricted to articles in English, published after 2000. Other papers were researched from the previous references. There were included articles with an earlier publication date due to their particular relevance, resulting in 64 references. Summary of data: Multidirectional shoulder instability is a characteristically atraumatic and bilateral pathology, caused by the failure of the glenohumeral joint static and dynamic stabilizers, resulting in subluxations or even dislocations. The diagnosis is mainly clinical and it can be complemented with imagiology through magnetic resonance imaging with or without contrast. The therapeutic approach should mainly be conservative as it presents with 90% success rate. In case it fails, open or arthroscopic surgical treatment through capsular shifts and plicatures may be indicated, resulting in success rates higher than 80%. Conclusions: Although the gold standard treatment for multidirectional shoulder instability is conservative, through a muscular and proprioceptive rehabilitation program, the present review suggests that, in case of persistence of the symptoms, surgical treatment, open or arthroscopic, is indicated, as it presents with high success rates (except for thermal capsulorraphy) when complemented by a proper post-operative rehabilitation, even though the follow-up periods are less than 5 years.

Keywords : multidirectional shoulder instability; diagnosis; treatment; surgery.

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