Hospital Del Mar Criteria: Difference between revisions
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== Introduction == | == Introduction == | ||
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. <ref> | 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. <ref>Bird H. [https://pubmed.ncbi.nlm.nih.gov/17152113/ Joint hypermobility]. Musculoskeletal Care. 2007; 5 (1): 4-19.</ref> 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). <ref>Glans MR, Thelin N, Humble MB, Elwin M, Bejerot S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861852/ 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. </ref> | ||
To date, diagnosis of hypermobility is generally based on clinical judgement because there is no universal gold standard of diagnostic criteria for the condition. The Hospital Del Mar criteria assesses ten joints and and trunk for hypermobility in passive movement. | To date, diagnosis of hypermobility is generally based on clinical judgement because there is no universal gold standard of diagnostic criteria for the condition. The Hospital Del Mar criteria assesses ten joints and and trunk for hypermobility in passive movement. | ||
== Objective == | == Objective == | ||
To assess general passive joint hypermobility. | |||
== Intended Population | == Intended Population == | ||
The Hospital Del Mar criteria have been mainly used in paediatric populations. In addition, it has been suggested that screening studies and clinical rheumatological settings may be suitable for this type of testing. <ref name=":0">Bulbena A, Duro JC, Porta M, Faus S, Vallescar R, Martin-Santos R. [https://pubmed.ncbi.nlm.nih.gov/1556672/ Clinical assessment of hypermobility of joints: assembling criteria]. J Rheumatol 1992; 19: 115-22.</ref> | |||
== Method of Use == | == Method of Use == | ||
The Hospital Del Mar test assesses the degree of hypermobility in passive movement in ten joints: <ref name=":1">Öhman A, Westblom C, Henriksson M. [https://www.clinexprheumatol.org/article.asp?a=7086 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.</ref> | |||
= | # little finger, | ||
# thumb, | |||
# elbow, | |||
# shoulder rotation, | |||
# hip, | |||
# knee extension and flexion, | |||
# patella, | |||
# ankle | |||
# metatarsal-phalangeal joint | |||
# and 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. <ref name=":2">Bevilacqua D, Maillard S, Ferrari J. [https://irispublishers.com/arar/pdf/ARAR.MS.ID.000502.pdf 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.</ref> | |||
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== Evidence == | == Evidence == | ||
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. <ref name=":0" /> Validity and reliability is suggested to be high. <ref name=":0" /> <ref name=":2" /> 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. <ref name=":1" />The same may apply for trunk assessment, since some authors consider heel to buttock movement as the same motion as knee hyperflexion. <ref name=":1" /> 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). <ref name=":1" /> | |||
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. <ref name=":2" /> To date, no high quality studies exist regarding effects of existing treatments. Hypermobility may be associated with osteoarthritis, but so far this is unproven. <ref>Remvig L, Jensen DV, Ward RC. [https://pubmed.ncbi.nlm.nih.gov/17407233/ 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.</ref> | |||
== Links == | == Links == | ||
Revision as of 11:41, 21 April 2024
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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. The Hospital Del Mar criteria assesses ten joints and and trunk for hypermobility in passive movement.
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. In addition, it has been suggested that screening studies and clinical rheumatological settings may be 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 ten joints: [4]
- little finger,
- thumb,
- elbow,
- shoulder rotation,
- hip,
- knee extension and flexion,
- patella,
- ankle
- metatarsal-phalangeal joint
- and 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 | |||
|---|---|---|---|
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 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.
