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Spanhove V1, De Wandele I2, Hougs Kjær B3, Malfait F2, Vanderstukken F1, Cools A1
1Ghent University, Ghent, Belgium, 2Ghent University Hospital, Ghent, Belgium, 3Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
Background: The key problem in both Hypermobility Spectrum Disorders (HSD) and the hypermobility type of the Ehlers-Danlos syndrome (hEDS) is joint hypermobility leading to joint dislocations. These dislocations cause musculoskeletal symptoms, with painful areas particularly in the shoulder region. To date, muscle strengthening exercises are a main element in the current rehabilitation of patients suffering from joint hypermobility. However, little is known about the impact of these rehabilitation exercises on the shoulder with multidirectional instability (MDI) in patients with hEDS/HSD.
Purpose: This study aims to examine whether patients, diagnosed with hEDS or HSD, with MDI have increased glenohumeral translations compared to healthy persons during five static exercises. Furthermore, it aims to describe the direction of the translation, in order to contribute to guidelines for exercise therapy in patients with shoulder joint hypermobility.
Methods: Twenty-seven female patients (aged 34.8 ±13.11 years) with hEDS/HSD and MDI and 20 female healthy controls (aged 34.3 ± 11.17 years) participated in this study. The acromiohumeral (AHD) and humeralglenoid distance (HGD) were measured using ultrasound during five isometric exercises: shoulder external rotation, shoulder extension, shoulder flexion, elbow extension and holding a 2 kg dumbbell. To assess the influence of each exercise on the AHD and HGD, repeated measures ANOVA (mixed-design) was performed.
Results: During isometric shoulder extension, elbow extension and dumbbell loading, patients had a significantly larger change in AHD compared to controls. In patients, the AHD was significantly smaller during isometric shoulder flexion, extension and elbow extension compared to the AHD measured in rest. By contrast, the AHD was significantly larger during isometric external rotation and dumbbell loading compared to the AHD measured in rest. Regarding the HGD, no significant differences between patients and controls were observed. However, significantly smaller HGD values were found in patients during isometric shoulder flexion compared to the HGD in rest.
Conclusion(s): Isometric external rotation and holding a 2 kg dumbbell caused an inferior translation in patients with hEDS/HSD and MDI, whereas isometric shoulder flexion and shoulder/elbow extension respectively led to an anterior-superior and superior translation.
Implications: Although the conclusions from this study may only be taken as tentative, the results of our study may enhance the insight of the clinician in designing exercise programs for patients with MDI. Isometric external rotation exercises can be used in the rehabilitation of subacromial impingement related symptoms. Furthermore, caution should be warranted when using isometric flexion, extension and elbow extension exercises in the rehabilitation of patients with impingement-related symptoms since superior humeral decentralization may be responsible for increased compression on subacromial tissues. Nevertheless, isometric shoulder flexion as well as isometric shoulder and elbow extension exercises may be beneficial in patients with a manifestly posterior-inferior and inferior shoulder instability. At last, our findings reinforce the need for rehabilitation guidelines that discourage the use of dumbbell weights of 2 kg or more in exercises for patients with hEDS/HSD and MDI, especially in the early phase of rehabilitation, due to the risk of inferior (sub)luxation of the humeral head.
Keywords: Ehlers-Danlos syndrome, Hypermobility Spectrum Disorders, Multidirectional shoulder instability
Funding acknowledgements: This work was supported by a grant from Ghent University [BOF17/DOC/220].
Purpose: This study aims to examine whether patients, diagnosed with hEDS or HSD, with MDI have increased glenohumeral translations compared to healthy persons during five static exercises. Furthermore, it aims to describe the direction of the translation, in order to contribute to guidelines for exercise therapy in patients with shoulder joint hypermobility.
Methods: Twenty-seven female patients (aged 34.8 ±13.11 years) with hEDS/HSD and MDI and 20 female healthy controls (aged 34.3 ± 11.17 years) participated in this study. The acromiohumeral (AHD) and humeralglenoid distance (HGD) were measured using ultrasound during five isometric exercises: shoulder external rotation, shoulder extension, shoulder flexion, elbow extension and holding a 2 kg dumbbell. To assess the influence of each exercise on the AHD and HGD, repeated measures ANOVA (mixed-design) was performed.
Results: During isometric shoulder extension, elbow extension and dumbbell loading, patients had a significantly larger change in AHD compared to controls. In patients, the AHD was significantly smaller during isometric shoulder flexion, extension and elbow extension compared to the AHD measured in rest. By contrast, the AHD was significantly larger during isometric external rotation and dumbbell loading compared to the AHD measured in rest. Regarding the HGD, no significant differences between patients and controls were observed. However, significantly smaller HGD values were found in patients during isometric shoulder flexion compared to the HGD in rest.
Conclusion(s): Isometric external rotation and holding a 2 kg dumbbell caused an inferior translation in patients with hEDS/HSD and MDI, whereas isometric shoulder flexion and shoulder/elbow extension respectively led to an anterior-superior and superior translation.
Implications: Although the conclusions from this study may only be taken as tentative, the results of our study may enhance the insight of the clinician in designing exercise programs for patients with MDI. Isometric external rotation exercises can be used in the rehabilitation of subacromial impingement related symptoms. Furthermore, caution should be warranted when using isometric flexion, extension and elbow extension exercises in the rehabilitation of patients with impingement-related symptoms since superior humeral decentralization may be responsible for increased compression on subacromial tissues. Nevertheless, isometric shoulder flexion as well as isometric shoulder and elbow extension exercises may be beneficial in patients with a manifestly posterior-inferior and inferior shoulder instability. At last, our findings reinforce the need for rehabilitation guidelines that discourage the use of dumbbell weights of 2 kg or more in exercises for patients with hEDS/HSD and MDI, especially in the early phase of rehabilitation, due to the risk of inferior (sub)luxation of the humeral head.
Keywords: Ehlers-Danlos syndrome, Hypermobility Spectrum Disorders, Multidirectional shoulder instability
Funding acknowledgements: This work was supported by a grant from Ghent University [BOF17/DOC/220].
Topic: Musculoskeletal: upper limb; Disability & rehabilitation
Ethics approval required: Yes
Institution: Ghent University Hospital
Ethics committee: Commissie voor medische ethiek
Ethics number: 2017/0941
All authors, affiliations and abstracts have been published as submitted.
