7. Medical History
- The medical history is important to note as part of standard medical care. Any previous
or present diseases such as diabetes, cancer or auto immune and inflammatory disorders
may be relevant to the patient’s instability presentation and treatment plan. - The patient’s current or previous history of any mental health issues, and whether they are
receiving counselling +/- adequate medication) is also relevant to the patient’s presentation. - The clinician should question the patient on current or past medications and what condition
they relate to. - The clinician should question the patient on a history of trauma to any part of the body
which may lend insight to the initial mechanism of injury for a current shoulder problem.
For example, a patient may not think its relevant that they had a major fall off their skateboard
onto an outstretched arm and fractured their wrist when they were 16 years old. However,
since then they haven’t felt comfortable pushing considerable weight through the shoulder
and now 20 years on, they are experiencing shoulder pain when performing higher loads
of bench press in the gym and a recent MRI confirms a chronic posterior labral tear. - Not only is the family history of GHJ instability, shoulder and/or generalised joint hypermobility
important to discuss, but also if there are any symtpoms that may be associated with
pathological alterations in the systemic collagen structure of the body, such as Hypermobility
type Ehler’s Danlos Syndrome (EDHS). - Ehler’s Danlos Syndrome (EDS) a (likely) hereditary connective tissue disorder that affects
musculoskeletal joints as well as other systemic systems. There are different sub-groups
of EDS(Gensemer et al., 2021) but one of the most common types to be associated with GHJ
instability is Hypermobility type EDS (hEDS)(Rupp et al., 2023) or EDS type III (Gensemer
et al., 2021). Over 95 % of patient with hEDS/EDS III experience joint subluxations, with the
shoulder being the most common(Tinkle et al., 2017) Due to alterations in collagen structure,
patients with EDS commonly experience other systematic disorders such as gastric intestinal
dysmotility, irritable bowel syndrome, autonomic nervous system dysfunction (such as postural
orthostatic tachycardia syndrome (POTS)) cardiac value changes and skin alterations
(Gensemer et al., 2021; Miller et al., 2020; Rupp et al., 2023). - Clinicians should query the patient on the presence of any night pain. While shoulder-
specific night pain is often associated with the inflammatory phase of a shoulder condition
(e.g.: acute injury, reactive tenopathology, reactive capsulitis), any unrelenting night pain or
night pain not altered by a change in position, unexplained weight loss and/or night sweats,
may indicate a more sinister condition. In such cases, a referral to the patient’s general
practitioner (GP) and/or current medical specialist is warranted for further investigations,
usually with MRI plus or minus CT scan.