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The Journal of Bone and Joint Surgery, Vol 74, Issue 10 1516-1521, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
The inferior capsular-shift procedure for multidirectional instability of the shoulder
RA Cooper and JJ Brems
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Ohio 44195.
Thirty-eight patients (forty-three shoulders) who had disabling
multidirectional instability of the shoulder were managed with an inferior
capsular-shift procedure through an anterior approach. All of the patients
were followed for a minimum of two years. The postoperative range of motion
of the shoulders was well maintained. The mean forward elevation was 172
degrees; external rotation, 77 degrees; and internal rotation, to the level
of the eighth thoracic vertebra. Four patients (four shoulders) had
recurrence of symptomatic and disabling multidirectional instability, but
thirty-nine (91 per cent) of the shoulders continued to function well with
no instability. Nine patients (24 per cent) continued to have episodes of
apprehension, which correlated with the residual inferior and posterior
translations found at the postoperative physical examination. Thirty-four
patients (thirty-nine shoulders) stated that they were subjectively
satisfied with the status of the shoulder, but four patients, in whom the
instability had recurred, were not satisfied. Thirty-seven (86 per cent) of
the shoulders were judged to have been improved by the procedure, the
initial postoperative stability had been maintained, and the result had not
deteriorated with time. Six shoulders, however, including the four with
recurrent instability, were thought by the patient to have deteriorated
with the increased duration of follow-up. It was our experience that if
non-operative treatment of multidirectional instability of the shoulder
failed, the inferior capsular-shift procedure provided satisfactory
objective and subjective results. Failures and recurrences of symptomatic
instability occurred early in the postoperative period. There appeared to
be no deterioration of the results with follow-up to seventy-one months.
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