Ehlers-Danlos Syndrome · Joint Hypermobility · Ligament Laxity · Glastonbury, CT
In Ehlers-Danlos syndrome and other hypermobility disorders, ligaments can be too lax to keep joints stable, and the resulting instability can drive pain, joints that slip or give way, and irritation of nearby nerves. Dr. Paul Tortland, DO, FAOASM, CAQSM, RMSK evaluates unstable joints with digital motion X-ray (DMX) and diagnostic musculoskeletal ultrasound, treats lax ligaments with prolotherapy and PRP, and treats entrapped nerves with hydrodissection when appropriate.
Quick answer
Joint hypermobility means joints move beyond the normal range. In Ehlers-Danlos syndrome (EDS), an underlying difference in connective tissue can leave ligaments lax and joints unstable, often in several places at once, including the neck, jaw, shoulders, hips, knees, ankles and wrists. Instability can cause pain, a sense of joints slipping or giving way, and irritation of nearby nerves. Dr. Tortland focuses on the musculoskeletal side of EDS: finding which joints are unstable, confirming it with motion imaging and ultrasound, and treating the lax ligaments. This care is meant to work alongside, not replace, your primary care or genetics team.
Associated conditions
Cervical instability, TMJ dysfunction, nerve entrapment, shoulder, hip, knee and ankle instability
Diagnosis method
History and exam, digital motion X-ray (DMX) and diagnostic musculoskeletal ultrasound
Interventional options
Prolotherapy, PRP, nerve hydrodissection when appropriate
First visit
At least an hour, $500, ultrasound included
Physician
Paul Tortland, DO, FAOASM, CAQSM, RMSK
Who treats you
Dr. Tortland personally, every visit
Main treatments
Prolotherapy and custom-concentrated PRP, both well suited to lax, unstable ligaments
Insurance
Regenerative procedures not covered; HSA / FSA eligible
When to see a doctor
Consider an evaluation if you have joints that slip, subluxate or give way, recurrent sprains, joint pain that seems out of proportion to your imaging, neck, jaw or hip pain with a feeling of instability, or tingling and numbness from nerves near an unstable joint, especially if you have been diagnosed with Ehlers-Danlos syndrome or a hypermobility spectrum disorder, or have a family history of either.
Seek emergency care right away, not an office visit, for a dislocation that will not go back in or comes with numbness or a pale, cold limb; sudden severe headache unlike any before; new weakness or numbness in an arm or leg; loss of coordination; difficulty swallowing or speaking; or sudden severe chest, abdominal or other pain if you have known or suspected vascular EDS.
The challenge with hypermobility and EDS is that symptoms are scattered across many joints and are often attributed to unrelated causes, so people are frequently told their imaging is normal. A static MRI or X-ray captures a joint at rest, but laxity shows itself in motion. Digital motion X-ray and ultrasound examine the joint as it moves, which is where instability becomes visible.
Related conditions
Ligament laxity is frequently connected to, or mistaken for, the conditions below.
Diagnose · Confirm · Treat
01
An unrushed first visit maps which joints slip, give way or hurt, your history of sprains, subluxations or dislocations, and any diagnosis of EDS or hypermobility, and examines each joint's range of motion and stability.
02
DMX images a joint as it moves through its range to reveal abnormal motion that a static MRI or X-ray, taken at rest, cannot show.
03
Dr. Tortland, who is registered in musculoskeletal ultrasound (RMSK), uses live ultrasound to examine ligaments, tendons and nerves in real time and to see how a joint behaves with movement.
04
When a lax joint is irritating or entrapping a nearby nerve, ultrasound-guided hydrodissection frees the nerve from surrounding tissue.
05
A dextrose solution is injected into lax ligaments to stimulate a localized healing and tightening response. Prolotherapy is well suited to ligament instability.
06
For ligaments that need a stronger biologic signal, PRP is custom-prepared on site to 12 to 15 times baseline platelet concentration and placed into the lax ligament under ultrasound guidance. Like prolotherapy, PRP is well suited to ligament instability.
07
Follow-up at six to ten weeks compares your symptoms against baseline. Because hypermobility often involves more than one joint, treatment is planned joint by joint, and most patients need a short series of injections spaced several weeks apart as the ligament tightens.
Candidacy
Comparison
Frequently asked
Sources
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Henderson FC Sr, Austin C, Benzel E, et al. Neurological and spinal manifestations of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):195-211.
03
Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26.
05
Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159.
Candidacy is determined by exam, motion imaging and ultrasound, not over the phone. Bring your imaging and any records of an EDS or hypermobility diagnosis, and start with a clear evaluation in one visit.