The effect of five isometric exercises on glenohumeral translations in healthy subjects and patients with the hypermobility type of the ehlers-danlos syndrome (heds) or hypermobility spectrum disorder (hsd) with multidirectional shoulder instability: an observational study

Valentien Spanhove; Inge De Wandele; Birgitte Hougs Kjær; Fransiska Malfait; Fran Vanderstukken; Ann Cools

doi:10.1016/j.physio.2019.06.010

The effect of five isometric exercises on glenohumeral translations in healthy subjects and patients with the hypermobility type of the ehlers-danlos syndrome (heds) or hypermobility spectrum disorder (hsd) with multidirectional shoulder instability: an observational study

Physiotherapy. 2020 Jun:107:11-18. doi: 10.1016/j.physio.2019.06.010. Epub 2019 Jun 28.

Authors

Valentien Spanhove¹, Inge De Wandele², Birgitte Hougs Kjær³, Fransiska Malfait⁴, Fran Vanderstukken⁵, Ann Cools⁵

Affiliations

¹ Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address: valentien.spanhove@ugent.be.
² Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
³ Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospitals, 2400 Copenhagen, Denmark.
⁴ Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
⁵ Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.

PMID: 32026810
DOI: 10.1016/j.physio.2019.06.010

Abstract

Objectives: To examine whether patients, diagnosed with the hypermobility type of the Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), with multidirectional shoulder instability (MDI) have increased humeral head translations compared to healthy controls and to describe the direction of the humeral translations during five exercises.

Design: Observational study.

Setting: Ghent University Hospital.

Participants: Twenty-seven female patients (aged mean (SD) 35 (13) years) with hEDS/HSD and MDI and 20 female healthy controls (aged 34 (11) years) participated in this study.

Interventions: 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 2kg dumbbell.

Main outcome measures: Ultrasound measures of the AHD and HGD.

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.

Conclusions: Isometric external rotation and holding a 2kg 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.

Keywords: Acromiohumeral distance; Ehlers-Danlos syndrome; Hypermobility; Joint instability; Shoulder; Ultrasonography.

Publication types

Comparative Study
Observational Study

MeSH terms

Adult
Ehlers-Danlos Syndrome / diagnostic imaging
Ehlers-Danlos Syndrome / rehabilitation*
Exercise*
Female
Healthy Volunteers
Humans
Joint Instability / diagnostic imaging
Joint Instability / rehabilitation*
Middle Aged
Shoulder Joint / diagnostic imaging
Shoulder Joint / physiopathology*
Ultrasonography