Severe Multidirectional Instability in the Multiply Operated Shoulder: The Last Stand Before Arthrodesis

Multidirectional instability is symptomatic inferior instability with instability in at least one other direction. Patients presenting with recurrent multidirectional instability despite prior surgical stabilization present a difficult challenge for shoulder surgeons. Patients who have had multiple failed stabilizations with continued symptomatic instability may go on to require gleonhumeral arthrodesis. The kitchen sink procedure combines an inferior capsular shift, Nikola biceps tenodesis, and CHL reconstruction in a salvage type procedure in an effort to avoid glenohumeral arthrodesis.