Maryrose Zavaro, MMSc
Medical Student OMS IV
LECOM
El Cajon, California, United States
Richard Martirosian, MD
Resident Physician PGY2
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
Brian Vu, MD
Resident Physician
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
Hunter Goldsmith, MD
PGY2
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
Emmanuel Villalpando, MD
Resident Physician PGY-2
Casa Colina
Winnetka, California, United States
Allen Huang, MD
Physical Medicine & Rehabilitation
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
A 25-year-old female with Ehlers-Danlos Syndrome presented to acute rehabilitation with chronic right shoulder pain and multiple subluxation episodes impacting daily activities and sleep. Physical examination revealed limited shoulder flexion and abduction, scapular winging, and reduced mobility. MRI findings showed no structural abnormalities. Physical therapy sessions were limited by right shoulder discomfort. She did not respond to duloxetine, pregabalin, nor trigger point injections. Significant pain relief and improved stability was achieved after multiple sessions of 21.6% to 25% dextrose solution injections into the glenohumeral joint, subacromial bursa, infraspinatus, supraspinatus, and subscapularis. Thereafter, her therapy participation improved with less limitations.
Discussions:
Traditional treatments like physical therapy, pain medications, and surgery often yield mixed results in many patients experiencing ongoing pain and joint instability. Prolotherapy involves injecting irritant solutions such as dextrose into symptomatic joints, tendons, or ligaments. It is believed to stimulate local inflammation, promote fibroblast proliferation, and strengthen connective tissue. In patients with Ehlers-Danlos Syndrome, prolotherapy may be efficacious as there were notable shoulder improvements in our patient. Prolotherapy likely allowed strengthening of her right rotator cuff stabilizers, thus limiting laxity and consequent symptoms. Prolotherapy may be considered for patients that are refractory to conservative measures. However, further research is needed to establish standardized protocols, efficacy, and long-term outcomes. A deeper understanding of its mechanisms could also facilitate the development of more targeted therapies for managing Ehlers-Danlos Syndrome-related joint instability. Prolotherapy may offer improved shoulder joint stability and pain relief in Ehlers-Danlos Syndrome patients who do not respond to conventional treatments.
Conclusions:
