Case Study: Testing for Hypermobile Shoulder Dysfunction

In patients with upper quarter pain and EDS/hypermobility spectrum disorders, standard imaging and testing are often insufficient to develop a comprehensive treatment strategy. 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

Our patient presented with bilateral upper trapezius pain. They scored high on the hypermobility spectrum and they had a history of left shoulder subluxation – a condition where the humerus partially slips out of the glenoid socket, causing pain, instability, and a feeling of shoulder laxity. 

Our Diagnostic Process

Clinical Exam

In addition to testing for general hypermobility syndrome, we conducted additional tests specific to the shoulder joint:

• 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. We found greater instability in the left vs right shoulder joint.
• Clunk test – a physical examination maneuver used to assess for labral tears, where the shoulder is passively rotated and loaded. A positive clunk test, characterized by a noticeable click or grinding sensation.

While these tests help to confirm shoulder instability and possible labral tears, neither is conclusive, and they may produce false positives. 

Ultrasound Exam

Our exam with high-resolution ultrasound found the rotator cuff to be structurally normal. A scan of the glenohumeral joint revealed anterior humeral head translation, with flipping of the anterior labrum over the glenoid rim during external rotation. There was no visible evidence of labral tearing, suggesting labral hypermobility. A scan of the scapula detected global hypermobility of aponeurotic fascial attachments. 

ShowMotion 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: 

• Slight alterations in scapulohumeral rhythm during left shoulder abduction
• Minor deficits with preserved upward rotation and tilt 
• Global kinematic score for left shoulder of 93–98, indicating near-normal to mildly impaired coordination 
• Subclinical glenohumeral microinstability without frank labral tear 
• Mild scapular dyskinesis due to fascial hypermobility 
• Sufficient kinematic control to tolerate early regenerative intervention 

Our Recommended Intervention

Based on our clinical and ultrasound exams and ShowMotion results, we recommended ligament restoration using Prolotherapy and orthobiologic injections, followed by moderate-quality physical therapy.

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.