Structured Rehabilitation Program for Multidirectional Shoulder Instability in a Patient with Ehlers-Danlos Syndrome

Abstract

Patients with Ehlers-Danlos syndrome (EDS) present many musculoskeletal disorders. The purpose of this case report was to describe the effectiveness of a scapular motor control program for a patient with multidirectional severe shoulder instability due to EDS, with 6-month follow-up. The patient was a 14-year-old female with EDS hypermobile type who suffered recurrent shoulder dislocation. Her chief complaints were bilateral shoulder discomfort and instability during writing motion. In the early part of intervention, she was prescribed exercise therapy for multidirectional instability (MDI) with orthosis. In the latter part of intervention, she was instructed in the scapular motor control program. Active and passive range of motion (ROM), sulcus sign, and Rowe score for shoulder instability were measured at baseline and at 3, 6, and 12 months after interventions. The shoulder ROM and instability score were improved after 6-month intervention. The findings from this report indicate that the scapular motor control program for shoulder instability would be effective even for patients with EDS hypermobile type. A patient who could not increase passive ROM due to dislocation is also able to achieve fair function of the shoulder joint instead of increasing active ROM. These positive outcomes indicate the possibility of benefit from the scapular motor control program for an MDI patient with EDS as a conservative treatment.

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

“…Active ROM of the shoulder may be above average or restricted by pain. 3 , 45 , 78 Patients also may demonstrate signs of joint subluxation during active elevation or abduction. Many times, altered scapulohumeral rhythm can manifest with scapular dyskinesia during shoulder elevation movements.…”

Cambios en la función y calidad de vida en paciente con ehlers-danlos mediante un programa de ejercicio terapéutico y práctica

“…Con respecto al objetivo secundario, la literatura hace referencia al uso de tratamientos mediante ejercicios de control motor y propioceptivos, mejorando la estabilización del hombro y la función en esta población (Kitagawa et al, 2020). En otro estudio realizaron ejercicio graduado, incluyendo sesiones en piscina, en dos pacientes con SED, mostrando una mejora CCR en la intensidad del dolor medida con la escala EVA, pero no realizaron mediciones de la función del miembro superior.…”

Rationale and Feasibility of Resistance Training in hEDS/HSD: A Narrative Review

“…Zhou et al [ 66 ] published a brief presentation of two EDS Type III cases, both adult females (23 and 41 years of age, respectively). While it was stated that exercise was prescribed to both patients, little detail was provided about the exercise program, which lasted 6–8 weeks.…”