Arthroscopic Posterior/Multidirectional Instability

Posterior and multidirectional instability can result from either repetitive microtrauma or as a result of an identifiable traumatic event. Oftentimes, congenital or acquired capsular laxity contributes to the pathology. Pathologic lesions may include labral detachment from the glenoid, glenohumeral ligament disruption and capsular insufficiency. While some patients report instability, more commonly their chief complaint is pain. The clinical exam is critical at distinguishing normal glenohumeral joint laxity from the pathological motions that elicit symptoms, subluxation or even dislocation.For both diagnoses, the vast majority of patients respond to a physical therapy regimen of strengthening the rotator cuff musculature, deltoids, and scapular stabilizers, as well as improving proprioception. However, arthroscopic techniques offer excellent results for recalcitrant cases of pain and instability, and for those patients with high demands such as overhead athletes. Management is aimed at strengthening the supporting structures of the joint as well and surgical tightening of the areas of weakness.