• Neer and Foster¹ described multidirectional instability (MDI) of the shoulder as instability in two or more directions.

• Individuals with generalized joint hypermobility may be at increased risk of sport-related injuries.²

• MDI often affects athletic individuals who participate in repetitive overhead movement sports.3

• The most frequent complaint is generalized shoulder pain with worsened activity performance and loss of strength.⁴

• The surgical treatment options are open and arthroscopic procedures.³,⁵,⁶

• Arthroscope, 30-degree

• Trimano arm holder (Arthrex, Naples, FL)

• Scorpion suture passer (Arthrex, Naples, FL)

• Lasso suture passer (Arthrex, Naples, FL)

• Knotless SutureTak anchors (Arthrex, Naples, FL)

• SwiveLock anchors (Arthrex, Naples, FL)

• FiberTape + FiberWire sutures (Arthrex, Naples, FL)

• The patient is positioned in a beach-chair position with the Trimano arm holder holding the arm (Fig. 6-1).

• A deltopectoral approach is made. (For cosmetic reasons, an axillary approach can be used.)

• The cephalic vein is exposed and retracted laterally with the deltoid; the pectoralis major is medialized.

• The axillary nerve is palpated inferiorly, and a retractor is placed below the conjoint tendon to expose the subscapularis muscle (Figs. 6-2 and 6-3).