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.
Highlights
The Ehlers-Danlos syndrome (EDS) is a connective tissue disorder that presents as skin extensibility, tissue fragility, and articular hypermobility [1]
The patient had a slight build with a height of 156 cm and weight of 44 kg. To evaluate her bilateral shoulder function, her active range of motion (ROM) (Table 1), sulcus sign, and shoulder instability in each direction were measured on the time point at the beginning of intervention A
A fair outcome was achieved by the final evaluation. The results from this case report are significant for the conservative treatment of multidirectional instability (MDI) due to EDS
Summary
The Ehlers-Danlos syndrome (EDS) is a connective tissue disorder that presents as skin extensibility, tissue fragility, and articular hypermobility [1]. The physical activity level and quality of life of patients with EDS are affected by the severe musculoskeletal symptoms [4]. The results from a high-quality randomized control trial showed that there has been an established stage-based rehabilitation program for multidirectional instability (MDI) to achieve better shoulder function with the usual treatment [7]. There are few studies that have investigated rehabilitation for patients with shoulder instability due to EDS. The purpose of this case report was to describe the possibility of the effectiveness of a stage-based exercise program for a young female patient with multidirectional severe shoulder instability due to EDS with 6-month follow-up. The AB design was incorporated to compare the usual conservative treatment and the stage-based program
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