Hypermobility Syndrome: Difference between revisions
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== Definition/Description<br> == | == Definition/Description<br> == | ||
The hypermobility syndrome(HMS) was first described in 1967 by Kirk et al as the occurrence of musculoskeletal symptoms in hypermobile in healthy persons.<ref name="1" /> Meanwhile, other names are given to HMS, such as joint hypermobility syndrome and benign hypermobility joint syndrome. HMS is a dominant inherited connective tissue disorder described as “generalized articular hypermobility, with or without subluxation or dislocation.<ref name="2" /> | The hypermobility syndrome(HMS) was first described in 1967 by Kirk et al as the occurrence of musculoskeletal symptoms in hypermobile in healthy persons.<ref name="1">Kirk JA. Et al. The hypermobility syndrome: musculoskeletal complaints look for more recent sources associated with generalized joint hypermobility. Ann Rheum Dis. 1967; 26: 419–25. (Level of Evidence: 4)</ref> Meanwhile, other names are given to HMS, such as joint hypermobility syndrome and benign hypermobility joint syndrome. HMS is a dominant inherited connective tissue disorder described as “generalized articular hypermobility, with or without subluxation or dislocation.<ref name="2">Russek LN. Hypermobility Syndrome. Physical therapy . 1999 (Level of Evidence: 2C)</ref> | ||
<br>The primary symptom is excessive laxity of multiple joints. <ref name="3" /> | <br>The primary symptom is excessive laxity of multiple joints. <ref name="3" /> | ||
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Search Strategy[edit | edit source]
Search on Pubmed and Pedro with keywords: “hypermobility”, “hypermobility syndrome” , “hypermobility ”and “therapy”. Search in libraries books about sport injuries, sports medicine, sport anatomy.
Definition/Description
[edit | edit source]
The hypermobility syndrome(HMS) was first described in 1967 by Kirk et al as the occurrence of musculoskeletal symptoms in hypermobile in healthy persons.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Meanwhile, other names are given to HMS, such as joint hypermobility syndrome and benign hypermobility joint syndrome. HMS is a dominant inherited connective tissue disorder described as “generalized articular hypermobility, with or without subluxation or dislocation.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The primary symptom is excessive laxity of multiple joints. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Hypermobility syndrome is different from localized joint hypermobility and other disorders that have generalized joint hypermobility, such as Ehlers-Danlos Syndrome, Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Marfan Syndrome.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title HMS may occur also in chromosomal and genetic disorders such as Down syndrome and in metabolic disorders such as homocystinuria and hyperlysinemia.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Laboratory tests are used to exclude these other systemic disorders when HMS is suspected.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinically Relevant Anatomy[edit | edit source]
The pathophysiology in Hypermobility Syndrome is not yet fully understood, it appears to be a systemic collagen abnormality. The abnormality in collagen ratios is related with joint hypermobility and laxity of other tissues. The ratio of collagen (type I,II and III) is decreased in skin.
The diagnostic criteria for HMS includes joint abnormalities but it also affects cardiac tissue, smooth muscle in the female genital system and the gastrointestinal system. HMS also affects the joint position sense.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Epidemiology /Etiology[edit | edit source]
Joint hypermobility happen most often in children and reduce with age.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Joint mobility is highest at birth, there is a decrease in children around nine to twelve years old.
In adolescent girls there is a peak at the age of fifteen years, after this age the joint mobility decreases, as well in boys as in girls. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleHormonal changes that occur in puberty by adolescent girls, will influence the joint mobility.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
In general, hypermobility is more common in children than adults, is more common in girls than in boys Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, more common in Asian, African and middle eastern people. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Characteristics/Clinical Presentation[edit | edit source]
_ Acute or Traumatic'
▫ Sprains
— recurrent ankle sprains
▫Meniscus tears
▫ Acute or recurrent dislocations or subluxations of the:
— shoulder
— patella
— metacarpophalangeal joint
— temporomandibular joint
▫ Traumatic arthritis
▫Bruising
▫ Fractures
_ Chronic or Nontraumatic
▫ S'oft tissue rheumatism
— tendinitis
— epicondylitis
— rotator cuff syndrome
— synovitis
— juvenile episodic synovitis
— bursitis
▫ Chondromalacia
▫ Back pain
▫ Scoliosis
▫ Fibromyalgia
▫ Temporomandibular joint dysfunction
▫ Nerve compression disorders
— carpal tunnel syndrome
— Tarsal_Tunnel_Syndrome
— acroparesthesia
— thoracic outlet syndrome
▫ Raynaud syndrome
▫ Flat feet and sequelae
▫Unspecified arthralgia or effusion of affected joint(s)
(foot, ankle, knee, hip, back, neck, shoulder, elbow,
wrist, finger)
▫ Osteoarthritis
▫ Delayed motor development
▫ Congenital hip dislocation
Differential Diagnosis[edit | edit source]
The signs and symptoms of hypermobility syndrome are variable. Most commonly, the initial complaint in a hypermobile patient is joint pain, which may affect one or multiple joints and may be generalized or symmetric. Primary care physicians can use the five simple questions to aid in recognizing hypermobility.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Questions to Ask
- Can you now (or could you ever) place your hands flat on the floor without bending your knees?
- Can you now (or could you ever) bend your thumb to touch your forearm?
- As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?
- As a child or teenager, did your shoulder or kneecap dislocate on more than one occasion?
- Do you consider yourself double-jointed?
Diagnostic Procedures[edit | edit source]
The Beighton score measures the degree of hypermobility, the Brighton criteria is to determine the syndrome.
- Beighton score:
1. Hands flat on the floor with knees extended (1 point if positive)
2. Hyperextension of the elbow (1 point for each positive side)
3. Hyperextension of the knee (1 point for each positive side)
4. Thumb touching the forearm (1 point for each positive side)
5. Hyperextension of the 5th MCP (1 point for each positive side)
Maximum possible score: 9
Hypermobility present if total score ≥ 4
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Brighton criteria:
Major Criteria:
- Beighton Score of ≥ 4/9
- Arthralgia for > 3 months in > 4 joints
Minor Criteria:
- Beighton score of 1–3
- Arthralgia in 1–3 joints
- History of joint dislocation
- Soft tissue lesions >3
- Marfan-like habitus
- Skin striae, hyperextensibility or scarring
- Eye signs, lid laxity
- History of varicose veins, hernia, visceral prolapse
For a diagnosis to be made either both of the the major criteria must be present or 1 major and 2 minor or 4 minor.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Requirement for diagnosis of hypermobility syndrome:
- 2 major criteria
- 1 major criteria + 2 minor criteria
- 4 minor criteria
- 2 minor criteria and unequivocally affected first-degree relative in family history
Another tests that the physiotherapist can do is: 'The Beighton score' Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- A passive dorsiflexion of the fingers above 90degrees (1 point for each hand).
- Bringing the thumb passive against the ventral side of the forearm (1 point for each thumb).
- Hyperextension of the elbow above 10 degrees ( 1 point for each elbow)
- Hyperextension of the knee above 10 degrees (1 point for each knee)
- Flexion of the trunk, whit knees straight and the palms flat on the ground ( 1 point)
According to the Beighton and Horan criteria, generalized joint laxity is present when four or more of five tests are positive, including contralateral knee hyperextension.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In fact there is no universal agreement on a threshold for BJHMS, some researchers use a Beighton scale score of 5/9, other researchers use a score of 6/9 and still others use a modified score of 3/9.
Outcome Measures[edit | edit source]
- Range of motion Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - joint integrity and mobilityCite error: Invalid
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<ref>tag; name cannot be a simple integer. Use a descriptive title - visual analog scale was used to assess musculoskeletal pain.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - quality of life was evaluated by a Short Form 36 questionnaire (SF-36).Cite error: Invalid
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add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
- ROM: Norkin and WhiteCite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - End feelCite error: Invalid
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add text here related to physical examination and assessment
Medical Management
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add text here
Physical Therapy Management
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The Hypermobility Syndrome can’t be healed and there is not much known about an effective treatment yet.
Important is that HMS-patients have a good body conscience, to lower the risk of injuries, a good muscle balance, to support the joints, and they have to avoid excessive laxity movements.
They have to know their own body and their own limits.
Relieving joint pain and preventing its recurrence are primary aims of treatment and exercise to improve joint stability and control is a major component of physical rehabilitation. Research has identified that posture, proprioception, strength and motor control are important components in achieving this aim along with education, physical activity and fitness. (4)
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
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add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
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References[edit | edit source]
