Case Study: Multimodal Analysis of Hypermobile Shoulder Dysfunction

Patients with EDS/hypermobility spectrum disorders are particularly susceptible to shoulder dysfunction due to the shoulder’s unique ball-and-socket architecture. Standard tests and imaging rarely provide sufficient information to recommend specific interventions. This case study demonstrates how multimodal functional testing that includes dynamic ultrasound imaging and ShowMotion kinematic analysis provides superior results that help form the basis for personalized treatment. 

Our Patient

The patient presented with chronic pain in the neck, upper back, and scapular region. There was no history of prior trauma, but the patient had a high hypermobility score. 

Our Diagnostic Process

Clinical Exam

After testing for general joint hypermobility, we used additional assessments for shoulder-specific functionality: 

• Sulcus sign – a clinical assessment for inferior glenohumeral instability. A positive sulcus sign indicates a gap between the humeral head (the ball of the shoulder joint) and the acromion process. Test results for the patient were positive for both shoulders, but the humeral heads remained seated in the glenoid, suggesting microinstability.
• Anterior drawer test – an assessment to determine excessive forward movement of the humerus in the glenoid, suggesting potential shoulder instability. Our test results were mildly positive. 

Ultrasound Exam

We scanned the glenohumeral joint and found gapping of the anterior joint space, but no translation or indication of labral tearing. We found fraying and instability of the latissimus dorsi and serratus anterior fascial insertions, with possible fascial decoupling.

ShowMorion Analysis

ShowMotion is an objective tool for joint movement analysis that uses motion tracking sensors, placed on the patient’s skin to collect data about movement quality.

Our ShowMotion analysis revealed: 

• Significant bilateral neuromuscular disorganization and abnormal movement
• Disrupted scapulohumeral rhythm, especially on the right side, with global loss of force coupling 
• Partially preserved, but poor protraction/retraction control, indicating dynamic scapulothoracic instability and glenohumeral decentering. 
• Multidirectional instability without labral pathology.
• Proprioceptive collapse and fascial instability at multiple muscle insertion points. 

Our Recommended Intervention

This case called for a rehab-first strategy to restore the competency of the patient’s neuromotor control system before introducing any structural biologic support. Prolotherapy and orthobiologics may be introduced after coordinated neuromuscular pathways have been restored. 

Conclusion

In patients with hypermobility spectrum disorders presenting with upper quadrant pain, standard orthopedic and imaging protocols are insufficient to inform a comprehensive treatment approach. 

Our case emphasized:

• The importance of dynamic testing over static findings 
• The need to differentiate neuromotor collapse from isolated mechanical instability. 
• The importance of staged personalized planning.

Augmenting standardized tests with dynamic ultrasonography and data-rich objective feedback from ShowMotion gave us an objective basis for intervention planning, dramatically improving the patient’s odds of satisfactory treatment.