Treatment of the athlete with multidirectional shoulder instability

Treatment of multidirectional instability in the athlete continues to be a challenging problem. Nonoperative treatment remains the initial treatment of choice in most athletes. However, some patients will fail nonoperative treatment and might require operative intervention. An open capsular shift procedure is indicated in nonoverhead athletes, most contact athletes and in most revision situations. However, the advances in thermal treatment of the capsule have made arthroscopic electrothermal capsulorrhaphy increasingly attractive as an alternative to the open approach for the primary treatment of multidirectional instability. Longer follow-ups will be necessary before definitive statements can be made regarding the arthroscopic techniques.