AANA Middle East Arthroscopy Master Course (International)-Shoulder Instability Micro to Macro Laxity

Shoulder Instability Micro to Macro Laxity

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This presentation by Dr. Joseph C. Tauro addresses shoulder instability, focusing on the continuum from micro to macro laxity and key diagnostic and surgical considerations. Shoulder instability can arise from repetitive microtrauma or collagen disorders such as multidirectional instability (MDI). Diagnosis involves a comprehensive history, physical exam, and evaluation under anesthesia (EUA), using a "diagnostic triangle" approach. Key exam components include inspection for muscle atrophy, deformities, and scapular motion, palpation for capsular or biceps groove pain, specific tests like Speed’s and O’Brien’s, and instability tests targeting anterior, inferior, and posterior directions.<br /><br />Rotator interval laxity, often present mainly in MDI cases, requires careful assessment through sulcus sign on physical exam and arthroscopic observations to decide on interval closure. Capsule laxity may present as plastic deformation or partial Bankart lesions evidenced by the "skybox sign."<br /><br />Surgically, arthroscopic shoulder stabilization uses four portals for access and repair. Capsular plication techniques employ specialized instruments and sutures (such as PDS or Ethibond) to "tuck" the capsule to itself, the labrum, or anchors, thus restoring tension. Interval closure varies in extent depending on laxity severity.<br /><br />The ultimate goal of treatment is to restore joint stability while preserving range of motion and function. Arthroscopically, the repaired soft tissues should maintain the humeral head centered in the glenoid without traction. Patients with MDI, especially in their 20s and early 30s, should be counseled about the possibility of needing revision surgery. Overall, this protocol emphasizes precise diagnosis and tailored arthroscopic techniques to manage the spectrum of shoulder instability effectively.

Keywords

shoulder instability

micro laxity

macro laxity

multidirectional instability

diagnostic triangle

rotator interval laxity

capsular plication

arthroscopic shoulder stabilization

Bankart lesions

revision surgery