AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Too Tight, Too Loose_ Arthroscopic Management of MDI & Adhesive Capsulitis-Drew Lansdown, M.D.

Too Tight, Too Loose_ Arthroscopic Management of MDI & Adhesive Capsulitis-Drew Lansdown, M.D.

Pdf Summary

This presentation by Dr. Drew A. Lansdown focuses on arthroscopic management of multidirectional instability (MDI) and adhesive capsulitis of the shoulder. The shoulder joint, inherently unstable, relies on balance between static and dynamic soft tissue stabilizers; instability can result from either excessive looseness or excessive tightness.<br /><br />For "Too Loose" shoulders, Dr. Lansdown discusses a 17-year-old football player experiencing multidirectional instability without dislocation but with pain and instability. MDI involves instability in at least two directions (anterior, inferior, posterior), with exam maneuvers like apprehension, relocation, load and shift tests, and Gagey hyperabduction sign used for diagnosis. Treatment includes arthroscopic labral repair and capsular plication to restore stability, followed by immobilization and phased rehabilitation over 6 months. A contrasting case showed a patient with voluntary dislocations and extreme laxity better managed non-surgically with physical therapy and behavioral health support.<br /><br />For "Too Tight" shoulders, the focus is on adhesive capsulitis (frozen shoulder), typically presenting with pain, progressive stiffness, and limited range of motion without trauma. This condition passes through freezing, frozen, and thawing phases, often lasting 1-2 years. Initial treatment emphasizes NSAIDs, intra-articular corticosteroid injections, and hands-on physical therapy. Surgery is considered after at least 3-6 months if stiffness persists. Arthroscopic release involves capsular lysis with caution to protect neurovascular structures, followed by intraoperative manipulation to restore motion.<br /><br />In summary, MDI requires careful differentiation between traumatic and atraumatic causes, with arthroscopic capsular plication effective for many. Adhesive capsulitis mainly responds to conservative care, but persistent cases benefit from arthroscopic capsular release and manipulation under anesthesia. Individualized treatment plans consider age, activity level, and patient preferences.

Keywords

arthroscopic management

multidirectional instability

MDI

adhesive capsulitis

shoulder instability

capsular plication

labral repair

frozen shoulder

physical therapy

intra-articular corticosteroid injections