Hospital Del Mar Criteria
Original Editor - Uchechukwu Chukwuemeka
Top Contributors - Angeliki Chorti and Uchechukwu Chukwuemeka
Introduction[edit | edit source]
Joint hypermobility (JH) or else, joint laxity, refers to the larger than normal range of motion (ROM) during passive or active joint movements of an individual's synovial joints. [1] Generalised joint hypermobility (GJM) involves several joints, occurs as an asymptomatic condition attached to various musculoskeletal and extra-musculoskeletal manifestations, relatively frequently in the general population; however, GJH is also present in various hereditary connective tissue disorders, such as the Ehlers Danlos syndrome (EDS). [2]
To date, diagnosis of hypermobility is generally based on clinical judgement because there is no universal gold standard of diagnostic criteria for the condition.
Objective[edit | edit source]
To assess general passive joint hypermobility.
Intended Population[edit | edit source]
The Hospital Del Mar criteria have been mainly used in paediatric populations. Sreening and clinical rheumatological settings may be more suitable for this type of testing. [3]
Method of Use[edit | edit source]
The Hospital Del Mar test assesses the degree of hypermobility in passive movement in the following joints: [4]
- little finger,
- thumb,
- elbow,
- shoulder rotation,
- hip,
- knee extension and flexion,
- patella,
- ankle
- metatarsal-phalangeal joint
- and, in some versions, trunk mobility i.e. forward flexion to the floor (stretched legs)
The test is performed bilaterally but only one point is given regardless of bi- or unilateral hypermobility results. The maximum score is ten(10) points. [5]
| Hospital Del Mar criteria for the assessment of joint hypermobility [3] | ||
|---|---|---|
| Upper Extremities | 1. Thumb: Passive apposition of the thumb to the flexor of the forearm at ˂21 mm
2. Metacarpophalangeal: With the palm of the hand resting on the table, the passive dorsiflexion of the fifth finger is ≥90° 3. Elbow hyperextension: The passive extension of the elbow is ≥ 10° 4. External shoulder rotation: With the upper arm touching the body and with the elbow at 90°, the forearm is taken in external rotation ≥ 85° of the sagital plane (shoulder-to-shoulder line). |
|
| Lower Extremities | Supine Position:
5. Hip abduction: The passive hip abduction can be taken to an angle of ≥ 85° 6. Patellar hypermobility: With one hand holding the proximal end of the tibia, the patella can be moved well to the sides with the other hand 7. Ankle and feet hypermobility: An excess range of passive dorsiflexion of the ankle and eversion of the foot can be produced 8. Metatarsophalangeal: Dorsal flexion of the toe of the foot over the diaphysis of the first metatarsal is ≥ 90° Prone Position: 9. Knee hyperflexion: Knee flexion allows the heel to make contact with the buttock | |
| Ecchymoses | 10. Ecchymoses: Appearance of ecchymoses after hardly noticed, minimal traumatism | |
Evidence[edit | edit source]
The Hospital del Mar criteria has been used with the Beighton test to supplement for the shoulder, hip, knee flexion, patella, ankle and metatarsalphalangeal hypermobility joint assessment. [3] Validity and reliability is suggested to be high. [3] [5] However, the use of some of the Hospital del Mar criteria result in high values in knee hyperflexion (78–100%) and external shoulder rotation (67–95%), and this may suggest that the limit values for these motions might be within “normal” in children (5-8 years old). As a result, these criteria may be inappropriate for hypermobility in children. [4]The same may apply for trunk assessment, since some authors consider heel to buttock movement as the same motion as knee hyperflexion. [4] It is also argued that the cut-offs and scoring system for the Hospital del Mar criteria ought to change (e.g. give one point for each joint instead of giving one point regardless of bi- or unilateral hypermobility results). [4]
Although some support that arthralgia may present later in hypermobility-related problems, there is no clear evidence that diagnostic criteria are associated with hypermobility-related problems. Reference values for hyper mobility in infants and preschool children need further investigation when determing specific cut-offs for younger ages and ethnic group. [5] To date, no high quality studies exist regarding effects of existing treatments. Hypermobility may be associated with osteoarthritis, but so far this is unproven. [6]
Links[edit | edit source]
Hypermobility Masterclass by JV Simmonds
References[edit | edit source]
- ↑ Bird H. Joint hypermobility. Musculoskeletal Care. 2007; 5 (1): 4-19.
- ↑ Glans MR, Thelin N, Humble MB, Elwin M, Bejerot S. The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison. Front Psychiatry. 2022 Feb 8;12:803334.
- ↑ 3.0 3.1 3.2 3.3 Bulbena A, Duro JC, Porta M, Faus S, Vallescar R, Martin-Santos R. Clinical assessment of hypermobility of joints: assembling criteria. J Rheumatol 1992; 19: 115-22.
- ↑ 4.0 4.1 4.2 4.3 Öhman A, Westblom C, Henriksson M. Hypermobility among school children aged five to eight years: the Hospital del Mar criteria gives higher prevalence for hypermobility than the Beighton score. Clinical and Experimental Rheumatology 2014; 32: 285-90.
- ↑ 5.0 5.1 5.2 Bevilacqua D, Maillard S, Ferrari J. Measuring Joint Hypermobility Using the Hospital Del Mar Criteria - A Reliability Analysis Using Secondary Data Analysis. Archives of Rheumatology & Arthritis Research 2019; 1(1):1-6.
- ↑ Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007 Apr;34(4):804-9.
