AANA/SOMOS Enduring Shoulder Program 2024-26 y/o Active-Duty Navy Diver- Champion Swimmer with Symptomatic Posterior Inferior MDI:

26 y/o Active-Duty Navy Diver- Champion Swimmer with Symptomatic Posterior Inferior MDI:

Video Transcription

Video Summary

The discussion centers on managing symptomatic posterior inferior multidirectional instability (MDI) in swimmers, highlighting evaluation, rehab, and surgical options. MDI involves inferior glenohumeral subluxation/dislocation with anterior/posterior components and often relates to hyperlaxity or trauma. Assessment includes checking for traumatic onset, hypermobility (using Beighton score and sulcus sign), scapular dyskinesis, and labral status. Rehabilitation focusing on scapular stabilization is first-line but has mixed evidence; some athletes do not fully improve, leading to surgery. The “shoulder pacemaker” device shows promise by retraining scapular muscles. Surgical outcomes show around 80% stability at long-term follow-ups but vary based on trauma history and hyperlaxity presence, with overhead athletes having lower return-to-sport rates. Arthroscopic capsulolabral repair techniques involve posterior portals and tensionable anchors to restore labral integrity and humeral head centering. Postoperative rehab is gradual, emphasizing careful patient selection, especially excluding collagen disorders like Ehlers-Danlos syndrome. Overall, treatment is individualized, balancing rehab and surgical intervention for optimal function.

Asset Caption

Rehab, Rehab and Then More Rehab with Pacemaker (Aaron E. Barrow, M.D.) vs. Capsular Plication (Jeffrey S. Abrams, M.D.)
Discussion, moderated by Cassandra A. Lee, M.D.
Technique Video: Daniel J. Song, M.D., FAANA

Keywords

posterior inferior multidirectional instability

swimmers

rehabilitation

surgical repair

scapular stabilization

arthroscopic capsulolabral repair