Hypermobility Syndrome

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Search Strategy

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

Hypermobility syndrome (HMS) is defined as the presence of musculoskeletal symptoms in subjects with Hypermobility in the absence of demonstrable systemic rheumatic disease. [1]
Excessive laxity in multiple joints is necessary to have HMS.

Most common symptoms:

• pain in multiple joints
•  back pain
•  overuse syndromes with normal levels of activity
• always being tired

Less common symptoms:

• joint stiffness
• myalgia
• muscle cramps

[1][2][3]
Although women are more likely than men to have HMS and Asians and Africans are more likely to have HMS than white people, joint laxity is a consequence of a connective tissue disorder with a chance on heredity of 50%.

Epidemiology /Etiology

Generalized hypermobility is both sex- and age-related. Racial differences are also identifiable. The existence of BJHS can be accepted using present criteria. (2) (6)

Characteristics/Clinical Presentation

_ 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

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Diagnostic Procedures

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The Beighton score measures the degree of hypermobility, the Brighton criteria is to determine the syndrome.

- Beighton score:

File:Beighton score.jpg

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

- Brighton criteria:

• Major criteria:

           • Beighton score of ≥4
           • Arthralgia for longer than 3 months in 4 or more joints

• Minor criteria:

           • Beighton score of 1, 2 or 3
           • Arthralgia (>3 months) in 1 to 3 joints or back pain (>3 months) or spondylosis/spondylolysis/spondylolisthesis
           • Dislocation or subluxation in more than 1 joint, or in 1 joint one more than 1 occasion
           • 3 or more soft tissue lesions (epicondylitis, tenosynovitis, bursitis)
           • Marfanoid habitus (span: height ration >1.03 or upper segment lower segment ratio < 0.89)
           • Abnormal skin: striae, hyperextensibility, papyraceous scars, thin skin
           • Eye signs: drooping eye lids, myopia, or antimongoloid slant
           • Varicose veins, hernia, uterine/rectal prolapse

• 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

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Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

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The Hypermobility Syndrome can not 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.

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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