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Multidirectional instability of the glenohumeral joint: an unstable classification resulting in uncertain evidence-based practice
  1. Kajsa Johansson
  1. Correspondence to Dr Kajsa Johansson, Head of the division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Sweden; kajsa.johansson{at}

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The aim of this editorial is to discuss the pros and cons of some of the current classification systems of shoulder instability, with special emphasis on instability in more than one direction, and to summarise the basis for future clinical reasoning and research.

The term ‘multidirectional instability’ (MDI) is commonly used in adolescents and young adults, who can sometimes voluntarily subluxate their glenohumeral joints. They report pain, instability and shoulder disability, and present with symptomatic abnormal movement of the joint in two or more directions; the abnormal movement may predominate in one direction. The joint laxity may be congenital (in which case, it is often bilateral), or may due to the microtrauma of highly repetitive end-range movements, for example, in overhead athletes.


Classifying patients with shoulder instability is a challenge. Rockwood1 described four types of instability and patients with MDI fit into type 3, voluntary subluxation with no history of trauma, or type 4, atraumatic involuntary subluxation. Later, Kessel and Bayley …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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