Shoulder instability in Ehlers-Danlos syndrome. An indication for surgical treatment?

In a 19-year-old female patient with Ehlers-Danlos Syndrome and bilateral multidirectional voluntary dislocations, multiple surgical attempts to achieve stability were ineffective. Joint laxity and hyperelastic tissue are underlying factors contributing to failure of stabilization. More importantly, voluntary dislocations often achieve secondary gain and need preoperative psychological evaluation.