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Management of Shoulder Instability in Patients with Underlying Hyperlaxity

  • SHOULDER INSTABILITY (J DINES AND C CAMP, SECTION EDITORS)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Shoulder instability in patients with underlying joint hyperlaxity can be challenging to treat. Poorly defined terminology, heterogeneous treatments, and sparse reports on clinical outcomes impair the development of best practices in this patient population. This article provides a review of the current literature regarding optimal management of patients suffering from shoulder instability with concomitant hyperlaxity of the shoulder, from isolated shoulder joint hyperlaxity to congenital hypermobility spectrum disorders (HSD).

Recent Findings

Current research shows specialized physiotherapy protocols focused on strengthening of periscapular muscles and improvement of sensorimotor control are a promising non-surgical therapeutic avenue in certain patients, which can be augmented by device-based intervention in select cases. If surgical treatment is warranted, arthroscopic techniques such as pancapsular shift or plication continue to demonstrate favorable outcomes and are currently considered the benchmark for success. The long-term success of more recent innovations such as coracoid process transfers, conjoint tendon transfers, subscapularis tendon augmentation, and capsular reconstruction remains unproven. For patients affected by connective tissue disorders, treatment success is generally less predictable, and the entire array of non-operative and operative interventions needs to be considered to achieve the best patient-specific treatment results.

Summary

In the treatment of shoulder instability and concomitant hyperlaxity, specialized physiotherapy protocols augmented by device-based interventions have emerged as powerful, non-operative treatment options for select patients. Successful surgical approaches have been demonstrated to comprehensively address capsular redundancy, labral lesions, and incompetence of additional passive stabilizers in a patient-specific fashion, respective of the underlying connective tissue constitution.

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Authors and Affiliations

  1. The Steadman Philippon Research Institute, 181 West Meadows Drive, Suite 400, Vail, CO, USA

    Marco-Christopher Rupp, Joan C. Rutledge, Patrick M. Quinn & Peter J. Millett

  2. Department of Orthopaedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Munich, Germany

    Marco-Christopher Rupp

  3. The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, USA

    Peter J. Millett

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The authors report the following conflicts of interest not relevant to the work:

Peter J. Millett, MD, MSc receives royalties, is a paid consultant, and receives research support from Arthrex, Inc, and owns stock in VuMedi.

Patrick Quinn, BA, Marco C. Rupp, MD, and Joan C. Rutledge are employed through the Steadman Philippon Research Institute (SPRI): During the past calendar year, SPRI has received grant funding or in-kind donations from Arthrex, Canon, DJO, Icarus Medical, Medtronic, Ossur, Smith + Nephew, SubioMed, Stryker and Wright Medical.

Marco C. Rupp, MD additionally reports grants from an AGA Fellowship, supported by Arthrex, Inc.

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Rupp, MC., Rutledge, J.C., Quinn, P.M. et al. Management of Shoulder Instability in Patients with Underlying Hyperlaxity. Curr Rev Musculoskelet Med 16, 123–144 (2023). https://doi.org/10.1007/s12178-023-09822-6

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