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REVIEW PAPER
Ehlers-Danlos syndrome and shoulder instability: current surgical strategies and future directions
1
Department of Clinical Immunology, Medical University of Warsaw, Poland
2
Clinical Immunology Student Scientific Association, Medical University of Warsaw, Poland
3
Faculty of Medicine, Medical University of Warsaw, Poland
4
Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw, Poland
Submission date: 2025-05-06
Final revision date: 2026-04-14
Acceptance date: 2026-05-25
Online publication date: 2026-10-21
Corresponding author
Aleksandra Poszytek
Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
KEYWORDS
orthopaedic surgeryEhlers-Danlos syndromeshoulder instabilitymusculoskeletal treatmentjoint hypermobility
TOPICS
ABSTRACT
Ehlers-Danlos syndromes (EDS) are complex connective tissue disorders, with hypermobile EDS (hEDS) being the most common subtype, characterised by joint hypermobility. Diagnosis relies primarily on clinical assessment and family history, as definitive genetic testing is not yet available. Patients with hEDS frequently experience shoulder instability, often involving bidirectional patterns, posing substantial management challenges.
Conservative management remains the cornerstone of treatment for hEDS-related shoulder instability. Evidence supports structured, progressive physiotherapy programmes that emphasise strengthening of dynamic stabilisers, including higher-load exercise where tolerated, alongside neuromuscular and proprioceptive training. Progressive home-based programmes with monitoring and selective adjunctive interventions, such as compression garments and taping for short-term improvements in pain or range of motion, have demonstrated feasibility and potential benefit, enhancing accessibility and long-term adherence.
Surgical interventions, including arthroscopic techniques such as posterior glenohumeral capsular reconstruction with allografts, and open procedures such as inferior capsular shift or shoulder arthroplasty, have shown promise in carefully selected patients. Long-term outcomes remain limited, and surgical decision-making should be individualised, performed in specialised centres, and integrated with structured postoperative rehabilitation.
This narrative review summarises and compares available surgical options and evaluates current evidence supporting conservative management for shoulder instability in hEDS.
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Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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