True congenital shoulder dislocation is a rare condition present at birth where the shoulder joint is out of place. It is usually recognized in newborns or early infancy because of early signs of True congenital shoulder dislocation such as limited arm movement, uneven shoulder position, or a stiff shoulder on one side. True congenital shoulder dislocation does not usually affect life expectancy, but it can cause lasting problems with shoulder function if it is not treated. Not everyone will have the same experience. Treatment for True congenital shoulder dislocation often involves early gentle reduction of the joint and support with splinting or casting, and some children may need surgery and physical therapy.
How many people live with True congenital shoulder dislocation?
True congenital shoulder dislocation, where the shoulder joint is already out of place at birth, is so rare that no reliable worldwide estimate of how many people are living with it is consistently reported by a single trusted source. The same is true in the United States: there is no widely accepted national estimate, and the condition is generally described in medical writing as exceptionally rare rather than counted in a registry.
Overview
True congenital shoulder dislocationSymptoms
True congenital shoulder dislocation is usually noticed at birth or in early infancy. Typical signs include a shoulder that sits out of place, reduced arm movement on one side, and sometimes unequal shoulder shape or length.
Outlook and prognosis
With true congenital shoulder dislocation, outlook often depends on how early it is recognized and treated. Many children do well after treatment, with better shoulder movement and use for daily tasks. Some may still have lasting stiffness, weakness, or uneven growth.
Causes and risk factors
True congenital shoulder dislocation starts before birth, when the shoulder joint does not form or position normally. Risk is higher with limited space in the womb, unusual fetal positioning, or nearby muscle and bone differences. Most cases are not clearly inherited.
Genetic influences
Genetics may matter in True congenital shoulder dislocation, especially when it occurs as part of an inherited syndrome affecting joints or connective tissue. But many cases are isolated, with no single clear genetic cause found.
Diagnosis
Diagnosis of true congenital shoulder dislocation usually starts with clinical features present at birth, such as uneven shoulder position or limited arm movement. Doctors confirm it with a physical exam and imaging findings, often using ultrasound or X-rays.
Treatment and drugs
True congenital shoulder dislocation is usually treated early with gentle repositioning and a cast or brace to hold the shoulder in place. If that does not work, surgery may help. Pain medicine can ease discomfort.
Symptoms
Simple things like getting an arm into a shirt sleeve or reaching for a toy can be harder when true congenital shoulder dislocation affects one shoulder from birth. The main signs are an uneven-looking shoulder, limited movement, and a child using that arm less than expected. Features can vary from person to person and can change over time. Some babies seem comfortable, while others show discomfort when the shoulder is moved or dressed.
One shoulder may look flatter, less rounded, or sit differently from the other side. Parents often notice the uneven shape during bathing, dressing, or when the child is lying still.
It can be hard to lift the affected arm up or out to the side. In true congenital shoulder dislocation, reaching overhead or using that arm for play may be more difficult.
The arm may rest closer to the body or turn inward more than expected. These can be among the early features of true congenital shoulder dislocation seen soon after birth.
Babies and children may use the affected arm less during reaching, pushing up, or play. Over time, that side can seem weaker or less coordinated than the other arm.
How people usually first notice True congenital shoulder dislocation?
True congenital shoulder dislocation is usually first noticed at birth or in the first weeks of life, when a baby’s shoulder looks uneven, the arm rests in an unusual position, or the arm does not move as freely as expected during dressing, feeding, or routine newborn checks. In many living with this condition, doctors or parents first spot a limited range of motion, a visible difference in shoulder shape, or a gentle “stiff” feel when the arm is lifted, although the exact first signs of true congenital shoulder dislocation can vary. How true congenital shoulder dislocation is first noticed often comes down to careful observation early in life, followed by a physical exam and imaging to confirm that the shoulder joint did not form in its usual position.
Types of True congenital shoulder dislocation
No distinct types of True congenital shoulder dislocation are widely recognized.
Can I slow down the onset of symptoms?
No. True congenital shoulder dislocation is already present at birth, so there is no proven lifestyle change, exercise, diet, or medicine that can delay it from starting. What can help is early care from a child bone-and-joint specialist, because gentle treatment, therapy, and sometimes surgery may improve shoulder movement and reduce later stiffness or weakness, even though they do not prevent the condition itself.
What genetics can tell you about symptoms
For true congenital shoulder dislocation, genetics usually cannot predict the exact day-to-day symptoms in an isolated case, but they can matter when the shoulder problem is part of a broader inherited condition that affects joints, muscles, or connective tissue. In those situations, genetic changes may influence whether someone has only a shoulder dislocation or also has other joint problems, limited movement, or differences present at birth, and they can affect how severe these features are. Even so, genetics rarely gives a precise forecast for one person, because symptoms can vary widely even among family members with the same underlying condition.
Causes and risk factors
True congenital shoulder dislocation begins before birth, when the shoulder joint does not develop in the usual way. Most cases are not tied to one known gene change, but inherited conditions that affect joints, muscles, or nerves can raise the risk. Other risk factors for true congenital shoulder dislocation include joint looseness, nearby muscle imbalance, and limited space or unusual positioning in the womb. Think of risk factors as pieces of a puzzle, not the whole picture. There are no clear lifestyle causes, and this condition is usually not linked to anything a parent did or did not do during pregnancy.
What are the most common causes or risk factors?
The most common cause of true congenital shoulder dislocation is a problem with how the shoulder joint forms before birth, so the ball and socket do not line up the way they should from the start. Risk may be higher in babies who have other conditions that affect joint shape, muscle balance, or how much they move before birth, and in some cases it happens as part of a broader genetic condition that makes joints less stable. It is very rare, and it is usually not caused by anything a parent did during pregnancy or by the act of delivery itself.
Environmental and biological risk factors
Risk factors for true congenital shoulder dislocation mostly involve how the shoulder forms and how it is positioned before birth. Doctors often group risks into internal (biological) and external (environmental). Because true congenital shoulder dislocation is very rare, these factors can raise the chance but do not mean it will happen.
If the shoulder socket or the top of the upper arm forms differently before birth, the joint may be less stable. This can make true congenital shoulder dislocation more likely.
Some babies have looser supporting tissues around the shoulder joint before birth. When the capsule and nearby soft tissues are less firm, the shoulder can slip out of place more easily.
The shoulder stays centered when nearby muscles pull in balance. If muscle development or nerve control is uneven before birth, the joint may not be held as securely.
Babies who move less in the womb may not shape the shoulder joint in the usual way. Less movement can also leave the shoulder in an awkward position for longer periods.
Genetic risk factors
True congenital shoulder dislocation is very rare, and a single genetic cause is not found in every child. In some families, it appears alongside inherited conditions that affect how joints, muscles, or connective tissue develop before birth. Some risk factors are inherited through our genes. Many cases are still isolated, with no clear family pattern or confirmed gene change.
Family history: A close family history of shoulder dislocation, multiple joint dislocations, or unusual joint looseness can suggest an inherited tendency. This does not guarantee true congenital shoulder dislocation, but it makes a genetic explanation more likely.
Genetic syndromes: Some children with true congenital shoulder dislocation have a broader inherited syndrome that affects how bones and joints develop before birth. Examples include Larsen syndrome and some genetic forms of arthrogryposis.
Connective tissue: Inherited connective tissue conditions can make ligaments and joint capsules too loose to hold the shoulder securely in place. When this happens early in development, the joint can be unstable at birth.
Joint laxity: Some families tend to have very flexible joints because of inherited tissue differences. That extra looseness can raise the chance of shoulder instability, although many people with flexible joints never develop a dislocation.
New gene change: Sometimes the genetic causes of true congenital shoulder dislocation come from a new change in a gene that starts in the child rather than being passed down from a parent. This can happen even when there is no known family history.
Lifestyle risk factors
True congenital shoulder dislocation is present from birth, so lifestyle habits do not cause it. However, how lifestyle affects true congenital shoulder dislocation can matter for pain, joint stability, movement, and long-term wear of the shoulder. The main lifestyle risk factors for true congenital shoulder dislocation relate to shoulder loading, muscle conditioning, activity choices, and day-to-day joint protection.
Frequent overhead lifting, throwing, or forceful reaching can increase strain on an already abnormal shoulder joint. This may worsen pain, fatigue, or feelings of instability during daily activities.
Contact sports or activities with falls and sudden traction on the arm can raise the chance of subluxation, soft-tissue injury, or symptom flare-ups. In people with true congenital shoulder dislocation, choosing lower-impact options may reduce repeated joint stress.
Weak shoulder blade, rotator cuff, and upper back muscles can reduce dynamic support around the joint. Poor muscle control may make abnormal movement patterns and functional limitation more noticeable.
Too little guided movement can lead to stiffness, reduced range of motion, and worsening weakness around the shoulder. Gentle, condition-specific exercise may help preserve function without overloading the joint.
Risk prevention
True congenital shoulder dislocation is present before or at birth, so there is usually no proven way to prevent the condition itself. Prevention is mainly about lowering the risk of stiffness, weakness, pain, and delayed arm use through early orthopedic care and steady follow-up. Prevention is flexible—it adapts to your life and health background.
Early assessment by a pediatric orthopedic specialist can help confirm true congenital shoulder dislocation and guide treatment before the joint becomes harder to move. This can improve shoulder alignment, comfort, and later arm function.
Following the recommended treatment plan, which may include gentle positioning, therapy, or surgery in some children, can reduce the risk of long-term limitation. Early treatment often matters most while the shoulder is still developing.
Guided exercises can help maintain range of motion and support strength around the shoulder. For many families, this is one of the main ways to help prevent shoulder stiffness in true congenital shoulder dislocation.
Parents and caregivers can help by handling, dressing, and carrying the child in ways that avoid extra strain on the shoulder. Caregivers can help by reminding about check-ups and healthy routines.
Can you prevent True congenital shoulder dislocation?
In most cases, true congenital shoulder dislocation, where the shoulder joint is already out of place at birth, cannot be prevented because it happens very early during a baby’s development in the womb and is not caused by anything a parent did or did not do. Good pregnancy care supports overall health, but there is no proven way to reliably prevent this condition.
Transmission
True congenital shoulder dislocation is not infectious, so it cannot be caught from another person through touch, air, food, or sex. It is a condition present at birth, meaning the shoulder joint formed abnormally before delivery.
For many families asking about how True congenital shoulder dislocation is inherited, the answer is that there is no usual person-to-person transmission pattern. Most cases are thought to happen during early development in the womb rather than being directly passed down, although inherited factors can sometimes matter when True congenital shoulder dislocation occurs as part of a broader genetic syndrome or runs in a family.
When to test your genes
For true congenital shoulder dislocation, routine genetic testing is usually not needed because it is most often diagnosed from the joint finding itself, not from a known single gene. Testing may be worth discussing if there is a family history, other birth differences, or signs of a broader syndrome, because that can guide follow-up and counseling.
Diagnosis
True congenital shoulder dislocation is usually recognized very early, often in a newborn or young infant whose shoulder does not move normally or looks uneven. Doctors usually begin with a careful exam and then confirm what they find with imaging. The diagnosis of true congenital shoulder dislocation focuses on showing that the joint was dislocated before birth, rather than injured during delivery.
The doctor checks how the shoulder looks and moves, including whether one arm rests in an unusual position or has a limited range of motion. They also look for differences in muscle tone, arm length, and how the shoulder joint feels during gentle movement.
A detailed family and health history can help place the findings in context. Doctors ask about pregnancy, delivery, and when the shoulder problem was first noticed to help separate a congenital dislocation from a birth injury that happened during labor.
X-rays are often used to see the position of the upper arm bone in relation to the shoulder socket. They can support the diagnosis of true congenital shoulder dislocation and help rule out fractures or other bone problems.
In very young babies, ultrasound can be useful because parts of the shoulder are still partly cartilage and may not show fully on X-rays. It helps the doctor look at the joint in real time without radiation.
How is True congenital shoulder dislocation diagnosed?
True congenital shoulder dislocation is usually diagnosed with a physical exam and imaging tests, most often an X-ray or ultrasound, to show that the top of the upper arm bone is not sitting in the shoulder joint the way it should from birth. Doctors also look at how the arm moves, whether one shoulder sits differently, and whether there are signs of a birth injury or a nerve problem that could look similar. Genetic testing is not usually needed, but it may be considered if a baby also has other unusual physical differences that suggest a broader condition.
Stages of True congenital shoulder dislocation
True congenital shoulder dislocation does not have defined progression stages. This is because it is present at birth rather than a condition that typically moves through clear phases over time. Instead, doctors usually diagnose true congenital shoulder dislocation by examining how the shoulder sits and moves, often noticing limited movement, uneven arm use, or an arm position that seems unusual in a newborn or infant; these can overlap with early symptoms of true congenital shoulder dislocation. Imaging tests such as ultrasound or X-rays may be used to confirm the joint position and to guide follow-up over time.
Outlook and prognosis
With early recognition and appropriate treatment, the outlook for true congenital shoulder dislocation is often favorable, especially when the joint can be reduced and shoulder motion is preserved during growth. Prognosis depends on how severe the displacement is, whether there are associated bone or nerve abnormalities, and how quickly orthopedic care begins. Some children achieve good long-term function, but others may have persistent limits in range of motion, weakness, asymmetry, recurrent instability, or later degenerative joint changes. Delayed diagnosis generally worsens the expected outcome because the joint and surrounding soft tissues become harder to correct over time. Mortality is not typically associated with true congenital shoulder dislocation itself, and life expectancy is usually normal unless prognosis is influenced by a broader underlying syndrome or major associated anomalies.
Long-term effects
For many living with true congenital shoulder dislocation, the long-term picture depends on how stable the shoulder is over time and whether nearby bones, muscles, and joints developed differently from early life. Some may have only mild limits in daily tasks, while others find that reaching overhead, lifting, dressing, or sports stay harder into adulthood. Long-term effects vary widely, and differences can become more noticeable during growth, with repeated strain, or later with age-related joint wear.
The shoulder may not move through a full range, especially for lifting the arm, reaching overhead, or rotating it outward. In everyday life, this can mean trouble with tasks like putting on a shirt, washing hair, or reaching a high shelf.
Many people with true congenital shoulder dislocation have lasting weakness around the shoulder and upper arm. Over time, daily routines may require extra effort, and the arm can tire more quickly during carrying, sports, or repeated reaching.
Some people develop ongoing shoulder discomfort, especially with activity, repetitive use, or later joint wear. Early symptoms of true congenital shoulder dislocation can be subtle, but long-term strain may also spread to the neck, shoulder blade, or upper back as the body compensates.
If the condition affects how the shoulder joint formed, the upper arm bone, shoulder blade, or muscles around the joint may develop differently over time. In children, this can lead to asymmetry, and in adults it may leave a lasting difference in shoulder shape or position.
How is it to live with True congenital shoulder dislocation?
Living with true congenital shoulder dislocation can mean limited shoulder movement from birth, and for many this affects everyday tasks like reaching overhead, getting dressed, washing hair, sports, or lifting and carrying objects. Some people have little pain, while others develop discomfort, weakness, or tire more easily in that arm, especially if the joint stays unstable or if muscle balance around the shoulder is poor. Daily life often involves physical therapy, adapting how tasks are done, and sometimes surgery followed by rehabilitation, which can place extra demands on parents, caregivers, and family routines, but with the right support many people find practical ways to stay active and independent.
Treatment and drugs
True congenital shoulder dislocation is usually treated by a pediatric orthopedic specialist, with the goal of improving shoulder position, movement, and comfort as a child grows. Treatment often depends on how severe the dislocation is and whether nearby muscles, bones, or nerves are also affected; in some babies, careful monitoring and physical therapy may help, while others need a procedure to place the shoulder more normally. If surgery is needed, it is often followed by a period of gentle immobilization and then guided exercises to improve range of motion and strength. Medicines do not fix True congenital shoulder dislocation itself, but pain relief may be used around procedures or during recovery. Not every treatment works the same way for every person, and regular follow-up helps the care team adjust the plan as the child develops.
Can you cure True congenital shoulder dislocation?
There is no simple cure for true congenital shoulder dislocation, but it can often be treated, especially when it is found early. Treatment may include putting the shoulder back into place, surgery if needed, and physical therapy to improve movement, strength, and comfort. Even with treatment, some children may still have some stiffness, weakness, or limits in how well the shoulder works.
Non-drug treatment
Daily tasks like dressing, reaching overhead, or lifting a child can be harder for people living with true congenital shoulder dislocation, especially if the shoulder feels stiff or weak. Supportive therapies can improve comfort, movement, and day-to-day function, and they are often started early with guidance from a pediatric orthopedic team or a physical therapist. The best plan depends on age, how stable the shoulder is, and whether there are signs that the joint is staying out of place.
Gentle physical therapy is a main part of non-drug care for true congenital shoulder dislocation. It focuses on improving range of motion, building safe strength, and helping the shoulder move in a more controlled way.
A therapist may teach simple home exercises so movement practice continues between visits. This can be an important part of physical therapy for true congenital shoulder dislocation, especially in infants and children as they grow.
Careful positioning during play, carrying, sleep, and daily routines can help avoid extra strain on the shoulder. For many, treatment begins not at the pharmacy, but with small changes in how the arm is supported through the day.
Occupational therapy can help with dressing, feeding, school tasks, and other daily activities if shoulder motion is limited. Some may find that small adaptations make it easier to stay active without overloading the joint.
Your genes may have an impact on how drugs work for you
For true congenital shoulder dislocation, genetic differences usually do not change the main treatment plan itself, which is based more on the shape and stability of the shoulder and whether surgery is needed. Still, many living with this condition may need pain medicine or anesthesia for imaging, procedures, or surgery, and inherited differences can affect how strongly some medicines work or how likely side effects are, so one child may get good pain relief while another may be sleepier or need a different dose. This kind of gene-based drug planning is not a routine part of care for this condition, but doctors may think about it if there is an unusual medicine reaction or a strong family history of problems with certain drugs.
Pharmacological treatments
For true congenital shoulder dislocation, medicines do not put the shoulder back in place or correct the joint itself. Medication can feel like a big step, but for this condition it is usually used to ease pain around exams, casting, or surgery rather than to treat the underlying problem. In practice, the main treatment is orthopedic care, and the drugs used are usually the same ones doctors use for short-term pain control in children and adults.
Acetaminophen is often the first choice for mild to moderate pain from true congenital shoulder dislocation, especially after a procedure or during recovery. It can help with soreness but does not reduce joint instability or change the shape of the shoulder.
Ibuprofen or naproxen may be used when pain comes with swelling or irritation around the joint. These medicines can help after reduction or surgery, but they are not a long-term fix for the early symptoms of true congenital shoulder dislocation.
Short-term opioids such as morphine or oxycodone may be used after surgery if pain is more severe. Because they can cause sleepiness, nausea, constipation, and breathing problems, doctors usually keep the dose low and the treatment brief.
During procedures, doctors may use anesthetic drugs such as sevoflurane, propofol, or local numbing medicines like lidocaine so the shoulder can be examined or treated safely. These drugs are part of procedural care and are not ongoing treatment for true congenital shoulder dislocation.
Genetic influences
Many families ask whether true congenital shoulder dislocation is inherited when a baby is born with a shoulder that does not sit normally in the joint. In true congenital shoulder dislocation, genetics may matter in some cases, but no single gene is known to explain most isolated cases. It’s natural to ask whether family history plays a role. Sometimes this shoulder problem appears as part of a broader genetic condition that affects joint looseness, connective tissue, or how the bones and joints formed before birth. If a baby also has other differences at birth, unusual flexibility, or relatives with similar findings, doctors may suggest a genetics evaluation to look for an underlying cause. When true congenital shoulder dislocation happens on its own, without other signs of a broader condition, the cause is often unclear and may not follow a strong inherited pattern.
Is True congenital shoulder dislocation genetic?
Genetics may matter in True congenital shoulder dislocation, especially when it occurs as part of an inherited syndrome affecting joints or connective tissue. But many cases are isolated, with no single clear genetic cause found.
Having a genetic risk is not necessarily a diagnosis
Genetic variants are a usual part of human biology and are common in the wider population. Most do not have a direct effect on health and simply make up part of natural human variation. For many genes, having a variant associated with a condition points to a possible link rather than a definite diagnosis, especially when several genes and environmental factors are involved. In some situations, though, a single well-understood variant in a particular gene can be enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
For many families, treatment for true congenital shoulder dislocation is shaped more by the way the shoulder formed and how early it is found than by genes alone. In many living with true congenital shoulder dislocation, care focuses on gentle stretching, physical therapy, and sometimes surgery to improve joint position and arm movement, because there is no medicine that can put the shoulder back in place. When true congenital shoulder dislocation happens as part of a broader inherited condition that affects joints, muscles, or nerves, genetic testing may help explain the cause and guide the overall care plan. Genetics is only one factor, and doctors usually choose pain medicines, anesthesia, and rehabilitation based on age, other health issues, and the type of procedure rather than on a specific gene result. This means pharmacogenetic testing is not usually a central part of treating true congenital shoulder dislocation, although a genetic diagnosis can still matter for long-term follow-up and family counseling. If a child has true congenital shoulder dislocation along with other birth differences or repeated joint problems, asking about possible genetic causes of true congenital shoulder dislocation can help bring the right specialists together.
Interactions with other conditions
Many living with true congenital shoulder dislocation also have other conditions that affect the way the joints, muscles, or bones formed before birth. It may occur along with problems such as stiff joints in several parts of the body, loose connective tissue, or certain nerve and muscle conditions, and these can make shoulder movement more limited than it would be on its own. Doctors call it a comorbidity when two conditions occur together. Day to day, this can mean that what seem like early symptoms of true congenital shoulder dislocation, such as trouble lifting an arm, reaching overhead, or getting dressed, are partly shaped by the other condition too. If there is also a brachial plexus injury, muscle weakness around the shoulder can add to joint instability and make treatment planning more complex. Because this condition is rare and often linked with other birth differences, care is usually most helpful when the whole child is assessed rather than looking at the shoulder alone.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to True congenital shoulder dislocation?
Other problems can look similar, especially in a newborn who is not moving one arm normally. Common examples include a birth-related nerve injury in the shoulder or arm, a broken collarbone or upper arm bone, and other shoulder differences present from birth, such as a shallow socket or a joint that slips partly out of place. Less often, an infection in the joint or nearby bone can also cause pain and limited arm movement.
History
For a long time, true congenital shoulder dislocation was difficult to separate from other shoulder problems seen in newborns. Babies can be born with a shoulder that looks stiff, sits unevenly, or does not move normally, and in earlier eras doctors often grouped these findings together. That meant true congenital shoulder dislocation was sometimes mistaken for an injury that happened during delivery rather than a joint problem that was already present before birth.
Once considered rare, now recognized as a distinct condition, true congenital shoulder dislocation gradually became better described as doctors compared careful physical exams with imaging and follow-up over time. Older reports often relied only on what could be seen or felt, so it was not always easy to tell whether the shoulder was dislocated from birth, loosened by trauma, or affected by a nerve injury. As medical imaging improved, especially with better X-rays and later ultrasound and MRI, specialists became more confident about telling these conditions apart.
This mattered in everyday life. A newborn who did not move one arm well, or whose shoulder seemed oddly positioned during dressing or bathing, might once have been assumed to have a temporary birth injury. Over time, clearer descriptions helped doctors recognize when the shoulder joint itself had developed abnormally before birth.
The history of true congenital shoulder dislocation is also tied to a broader change in how rare conditions are understood. Early case reports were usually small, sometimes only one infant at a time, so the medical picture developed slowly. Not every early description was complete, yet together they built the foundation of today’s knowledge, showing that some babies are born with a shoulder dislocation that is present from the start and not caused by delivery alone.
In more recent decades, clinicians have paid closer attention to the differences between true congenital shoulder dislocation and other causes of limited arm movement in newborns. This has improved diagnosis, helped families get more accurate explanations, and guided treatment earlier in life. Knowing this history helps explain why early symptoms of true congenital shoulder dislocation can still be confused with other newborn shoulder conditions, even though doctors now understand the condition far better than in the past.