Thermal capsulorraphy of bilateral glenohumeral joints in a pediatric patient with Ehlers-Danlos syndrome.
Ehlers-Danlos syndrome (EDS) is a heterogeneous collection of inherited connective tissue disorders characterized by hypermobility of the joints and hyperextensibility and fragility of the skin. For many patients, the hypermobile joints become problematic. To date, the mainstay of surgical treatment for EDS-related joint laxity has been open surgical capsulorraphy, which, although usually effective, confers significant morbidity to the patient. We present the case of a 9-year-old girl diagnosed with a variant of EDS and severely disabled from multidirectional instability of her shoulders and recurrent dislocations of her hips. After 1 year of nonoperative treatment (physical therapy, bracing, and activity restriction) failed, we performed a sequential arthroscopic thermal capsulorraphy of both shoulders. At a 2-year follow-up, the patient has no instability in the left shoulder and only occasional subluxations of the contralateral shoulder. We believe that thermal capsulorraphy is a viable addition to the shoulder surgeon's armamentarium in treating multidirectional instability in children with EDS.
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. aldri004@mc.duke.edu
Julian M
JM
Aldridge
John J
JJ
Perry
Daryl C
DC
Osbahr
Kevin P
KP
Speer
D002370:Casts, Surgical; D002648:Child; D003131:Combined Modality Therapy; D004535:Ehlers-Danlos Syndrome / Q000628:therapy*; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000628:therapy*; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012008:Recurrence; D012783:Shoulder Dislocation / Q000209:etiology / Q000517:prevention & control*; D012785:Shoulder Joint / Q000473:pathology*