Multidirectional Instability: Natural History and Evaluation

Miguel García Navlet1, *, Cristina Victoria Asenjo-Gismero2
1 Shoulder and Elbow Unit, Upper extremity department at ASEPEYO Hospital Coslada, Madrid, Spain
2 Orthopedic Resident at ASEPEYO Hospital Coslada, Madrid, Spain

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Creative Commons License
© 2017 Navlet and Asenjo-Gismero

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the ASEPEYO Hospital, Calle Joaquín de Cárdenas nº.2 Coslada 28823, Madrid, Spain; Fax: +34644214437; E-mail:



Multidirectional instability (MDI) represents a great challenge to the orthopedic surgeon. When treating these patients we must be aware that instability refers to a symptomatic situation, thus multidirectional instability is defined as symptomatic involuntary instability in two or more directions, and should be clearly differentiated from asymptomatic hyperlaxity.

It may be associated with hyperlaxity, either congenital or acquired following repetitive stress, but also may be present without hyperlaxity, which is rare.


We searched in the online data bases and reviewed the relevant published literature available.


Many differences can be seen in the current literature when identifying these patients, unclear definitions and criteria to be included in this patient group are common.


Understanding the complex shoulder biomechanics as well as being aware of the typical clinical features and the key examination signs, which we review in this article, is of paramount importance in order to identify and classify these patients, allowing the best treatment option to be offered to each patient.

Keywords: Multidirectional instability, Laxity, Hyperlaxity, Shoulder instability, Scapular dyskinesia.