SYNOPSIS: Congenital instability of the shoulder is a form of multidirectional instability not caused by a traumatic event. It is believed that excess laxity may be responsible for an overly elastic capsule and, therefore, can contribute to multidirectional instability. Minor microtraumatic events can progressively lead to the development of pain and lead to instability. The current preferred treatment is largely nonoperative with extensive rehabilitation of the dynamic restraints of the shoulder complex. In recalcitrant cases, operative intervention to restore stability may be necessary. It is of paramount importance to notice the directions of instability and to address each of them. Surgical procedures include open capsular shift, as well as arthroscopic capsular plication. Because multidirectional instability can be difficult to diagnose, this article will attempt to provide the clinician with a better understanding of the pathophysiology involved in this condition, the necessary steps for diagnosis, and considerations for treatment. A comprehensive guide to both nonoperative and operative treatment is reviewed in this article, as well as the surgical techniques used to decrease the capsular volume. LEVEL OF EVIDENCE: Level 5.

J Orthop Sports Phys Ther. 2009;39(2):124-134, Epub 15 December 2008. doi:10.2519/jospt.2009.2860

KEY WORDS: capsular plication, inferior capsular shift, multidirectional instability, rotator interval closure, shoulder