Multidirectional shoulder instability and open surgical procedures

The principles and procedures for multidirectional insta - bility do not substantially differ from those for anterior instability. Correct diagnosis is difficult, but it is impor - tant for a successful treatment. Conservative treatment should be attempted before surgery. Open surgical treat - ment using the inferior capsular shift procedure is the gold standard. It can be carried out either anteriorly or posteriorly. We prefer a laterally-based capsular shift because it facilitates capsular plication.