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CommentaryThe Diagnostic Definition of Multidirectional Instability of the Shoulder: Searching for Direction
Robin R. Richards, MD, FRCSC
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The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2003 Nov 01;85(11):2145-2146
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The article by McFarland et al.1 represents a provocative call to action. Most clinicians agree that there is a group of patients with markedly symptomatic shoulder instability in more than one direction. There is also general agreement that this group is difficult to treat, that the patients are less likely to benefit from surgical intervention than are other patients with shoulder instability, and that the primary pathological entity in this group is capsular laxity. Use of the term multidirectional shoulder instability when describing these patients has achieved wide acceptance. Although there is consensus regarding the concept of multidirectional instability, the innovative investigation performed by McFarland et al. demonstrates that the literature on the subject is flawed.
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