Multidirectional Shoulder Instability

Lennard Funk & Kathleen Roney, 2008

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Definition (Neer)
 = Abnormal amount of excursion of the humeral head on the glenoid in all directions 

Classification - Neer
Group I   Antero-inferior dislocation / Posterior subluxation
Group II   Postero-inferior dislocation /Anterior subluxation
Group III   Global dislocation


  • Instability = a symptom, usually one direction
  • Laxity = a sign, usually multidirectional
  • Multidirectional Instability - VERY Rare

Stanmore Classification (Bayley Triangle)


  • Laxity - using Cofield's technique
  • Gagey Test for Inferior capsule
  • Muscle Patterning
  • Kinetic Chain
  • Generalised Hypermobility (Beighton Score)


In all cases: X-Ray (AP and axillary views), MR Arthrogram

If indicated: CT scan, EMG's, EUA & Arthroscopy

Decision Making

  • Polar Type I = Surgery (+ rehab)Management
  • Polar Type III = Specialist Shoulder Physiotherapy
  • Polare Type II = combination of above (needs skillful and careful management)

Shoulder Therapy
Concentrates on:

  1. Core stability
  2. Scapula Stability
  3. Muscle patterning
  4. Proprioception
  5. Functional Rehab.

Combined Rehab exercises incorporate Core stabilty, Proprioception, Scapula, ROM, Strength
See more here

Treat ALL Pathology present:

  • Labral (Anterior, Posterior, Superior)
  • Capsule Laxity
  • HAGL
  • Bone Defects (Humeral Head, Glenoid)
  • Cuff tears


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