Prolotherapy For The Treatment Of Multidirectional Shoulder Instability In Ehlers-Danlos

PURPOSE: To evaluate the utility of prolotherapy for the treatment of multidirectional shoulder instability in patients with Ehlers Danlos (EDS). METHODS: A retrospective cohort study was performed on patients aged 19-49 years diagnosed with EDS who received shoulder prolotherapy treatment. Agents used were Dextrose 25%, Polidocanol and Tetradecyl Sulfate. The posterior capsule as well as the inferior, middle and superior glenohumeral ligaments were injected. The technique was developed based on principles described in one EDS study (Burling F, BMJ Open 2019). Number of treatments each patient required was documented. Patients who received prolotherapy from 2018 to 2023 were contacted by phone. Outcomes were patient reported and based on the visual analog score (VAS), number of dislocation/subluxation events pre- and post-treatment, athletic ability, and patient satisfaction. VAS was considered satisfactory if <5. RESULTS: Table 1 presents descriptive statistics, table 2 patient reported outcomes. 15 patients with 17 shoulders were included in the analyses. The median VAS was 2 (IQR, 0-4; p = 0.01). 79% of patients reported a higher level of athletic ability. Number of dislocations/subluxations decreased (92% vs 38%; p = 0.008). Patient satisfaction was described as better to much better in 79% of participants. There was no correlation between number of injections and VAS. CONCLUSION: Treatment of multidirectional shoulder instability with prolotherapy should be considered for EDS patients to help reduce episodes of dislocations/subluxations, increase level of athletic activity, and overall satisfaction.