Multidirectional instability: medial T-plasty and selective capsular repairs.

Multidirectional instability of the shoulder present a unique challenge in management. The patient with multidirectional instability classically is seen without a history of significant trauma to the shoulder; however, posttraumatic multidirectional instability may be encountered in the athletic population. Patients with an atraumatic etiology often respond to nonoperative rehabilitative measures, whereas those with a traumatic etiology are more likely to require surgical intervention. Standard operative stabilization procedures for unidirectional instability are likely to fail in the patient with multidirectional instability.