Management of shoulder instability in hypermobility-type Ehlers-Danlos syndrome

Abstract

Shoulder instability in hypermobile Ehlers-Danlos syndrome can result in lifelong pain and functional disability. Treatment in this population is complicated by the severe degree of instability as well as the underlying abnormalities of the joint connective tissue. Appropriate care for these patients requires a thorough understanding of the natural history of their disease, knowledge of the available treatment options, and certain special considerations. This article reviews the pathoanatomy, recognition, and management of shoulder instability in the patient with hypermobile Ehlers-Danlos syndrome.

Keywords: Ehlers-Danlos syndrome; Shoulder instability; hypermobility; multidirectional instability; recurrent instability; shoulder arthroscopy.

Figure 1

Illustration of capsular redundancy of the glenohumeral joint as seen commonly in hEDS. hEDS, hypermobile-type Ehlers-Danlos syndrome.

Figure 2

Demonstration of positive sulcus sign in a patient with hEDS. hEDS, hypermobile-type Ehlers-Danlos syndrome.

Figure 3

Radiographic demonstration of inferior subluxation of the humeral head in hEDS on Grashey views in patients with mild (A) and severe capsule laxity (B), indicating poor capsular integrity.

Figure 4

Magnetic resonance arthrography demonstrating capsular redundancy in a patient with hypermobile Ehlers-Danlos syndrome on coronal (A) and axillary (B) views.

Figure 5

Illustration of Neer open capsular shift demonstrating the creation of two flaps using a T-incision (A) and tightening of the capsule via overlap of the flaps to provide reinforcement (B).

Figure 6

Arthroscopic capsulorrhaphy using PDS suture to reduce capsular laxity.