Danielle R. Steilen-Matias, MMS, PA-C

The patient is a 34-year-old woman with hypermobility, specifically she is being treated for shoulder instability due to shoulder ligament weakness.

This patient had already completed physical therapy and other conservative treatments without achieving her desired stability. If her instability had been due solely to muscle weakness, physical therapy might have resolved her symptoms. However, when joint instability is caused by ligament laxity rather than muscle weakness, the ligaments themselves need to be addressed first. Strengthening these ligaments enables better muscle activation and makes it possible to build muscle and continue strength training to protect the joints.

Ligaments connect bone to bone, providing joint stability by preventing bones from wandering from each other. People who are hypermobile are more susceptible to soft tissue injuries. In this patient, both shoulders displayed increased range of motion, and one shoulder was notably unstable.

Treatment Approach

Given the severity of her ligament laxity, I recommended prolotherapy. This involves injecting a solution into the ligaments around the joint to stimulate strengthening and increase stability. Dynamic imaging, such as motion X-ray, is essential in determining the presence and extent of instability, not only in the glenohumeral (ball-and-socket) joint but also in the acromioclavicular (AC) joint and other shoulder structures. Assessing the specific location and severity of instability helps in creating an effective treatment plan.