How many of you out there have hypermobile joints?
Mobility tends to be thought of as a good thing, however when you have more then the normal amount of mobility in your body, this can lead to problems. Hypermobility only becomes a syndrome when it starts to produce symptoms- it is then know as Joint Hypermobility Syndrome or JHS.
JHS is a inheritable disorder of the connective tissue that can predispose to joint pain, soft tissue injury and joint instability. I cannot tell how often I see Joint Hypermobility patients being mis-diagnosed. In fact in a recent survey of the Hypermobility Syndrome Association 52% of 251 patients waited over 10 years from the onset of their symptoms to get the right diagnosis (Ross and Grahame 2011). Misdiagnosis can lead to inappropriate or potential harmful treatment and potentially a reversible downward spiral of immobility, deconditioning and despair.
How is hypermobility diagnosed?
Joint hypermobility is diagnosed with 2 scales, the Beighton and the Brighton. The Beighton scale is a test which is scored out of 9. One point is gained for each side of the body for the first 4 manoeuvres. The maximum score is 9 if all movements are positive. Try these tests and record your score
1) Passive dorsiflexion of the little finger to more than 90 degrees
2) Can your thumb reach your forearm
3) Do your elbows hyperextend more than 10 degrees
4) Do your knees hyperextend more than 10 degrees
5) Can you place your hands flat on the floor without bending your knees
The Beighton Scale:
Now that you have your Beighton score you can check if you have Joint Hypermobility Syndrome by using the Brighton scale. The Brighton scale uses major and minor criteria to diagnosis JHS (see below for criteria). If you have 2 major criteria, one major and 2 minor criteria or 4 minor criteria it is likely you have JHS.
• Beighton score of ≥4 (either currently or previously)
• Arthralgia for longer than three months in four or more joints
• Beighton score of 1, 2, or 3 (0, 1, 2, or 3 if aged >50 years)
• Arthralgia in one to three joints or back pain or spondylosis, spondylolysis and/or spondylolisthesis
• Dislocation in more than one joint or in one joint on more than one occasion
• Three or more soft tissue lesions (eg, epicondylitis, tenosynovitis, bursitis)
• Marfanoid habitus (tall, slim, ratio of span to height greater than 1.03 and/or ratio of upper segment to lower segment less than 0.89, arachnodactyly)
• Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring
• Eye signs: drooping eyelids, myopia, or antimongoloid slant
• Varicose veins, hernia, or uterine or rectal prolapse
How is joint hypermobility managed?
Physiotherapy plays a major role in improving symptoms of patients with joint hypermobility. Physiotherapist should work on restoring any lost mobility to naturally hypermobile joints using soft tissue and mobility techniques. Core strengthening and joint stability exercises are essential to improve strength and proprioception. General fitness is also very important to prevent deconditioning.
Patients should also be very aware of the postures they are getting into and try to avoid end of range postures that put alot of pressure on joints. Sitting in the W position is one such posture that hypermobile patients find comfortable but that is not good for joints!
Ross J and Grahame R (2011) Joint Hypermobility Syndrome. BMJ Vol 342
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