| Hypermobility | |
|---|---|
| Classification and external resources | |
Hypermobile fingers and thumb |
|
| ICD-10 | M35.7 |
| ICD-9 | 728.5 |
| OMIM | 147900 |
| DiseasesDB | 31101 |
| MeSH | D007593 |
Hypermobility (also incorrectly called "double jointedness" or hypermobility syndrome, benign joint hypermobility syndrome, or hyperlaxity) describes joints that stretch farther than is normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or other contortionist performances. It can affect a single joint or multiple joints throughout the body.
Contents |
Hypermobility generally results from one or more of the following:
These abnormalities cause abnormal distribution of wear and tear on joints, meaning that the joints wear out and can lead to osteoarthritis.
The condition tends to run in families, suggesting that there may be a genetic basis for at least some forms of hypermobility. The term double jointed is often used to describe hypermobility; however, the name is a misnomer and should not to be taken literally, as an individual with hypermobility in a joint does not actually have two separate joints where others would have just one.
Some people have hypermobility with no other symptoms or medical conditions. However, people with hypermobility syndrome may experience many difficulties. For example, their joints may be easily injured, be more prone to complete dislocation due to the weakly stabilized joint and they may develop problems from muscle fatigue (as muscles must work harder to compensate for the excessive weakness in the ligaments that support the joints). Hypermobility syndrome can also lead to chronic pain. Woodwind musicians with hypermobile fingers may have difficulties with hand postition, because their fingers tend to collapse into the finger locking position when they should be curved.
Hypermobility may also be symptomatic of a serious medical condition, such as Ehlers-Danlos syndrome, Marfan syndrome, rheumatoid arthritis, osteogenesis imperfecta, lupus, polio, Down syndrome, morquio syndrome, cleidocranial dysostosis or myotonia congenita.
In addition, hypermobility has been associated with chronic fatigue syndrome and fibromyalgia. During pregnancy certain hormones alter the physiology of ligaments making them able to stretch to accommodate the birthing process. For some women with hypermobility pregnancy-related pelvic girdle pain can be debilitating due to these two converging factors, and prohibits her from standing up or walking. Use of a bedpan and wheelchair may be necessary, or even permanent in some cases due to hip stretching.
Symptoms of hypermobility include a dull but intense pain around the knee and ankle joints and the soles of the feet. The condition affecting these parts can be alleviated by using insoles in the footwear that have been specially made for the individual after assessment by an orthopaedic surgeon and orthotist.
In 1998, a study was done concerning the link between panic disorder with joint hypermobility. The prevalence of joint hypermobility syndrome among patients with panic disorder was 67.7% compared to the control psychiatric group (10.1%). Women and subjects who were younger were found to be over 20 times more likely to have the hypermobile joints than their counterparts in the control group. In the study, there was also a higher prevalence for mitral valve prolapse (8%). The study does not determine whether hypermobility is associated in any way with psychiatric dysfunction or dysautonomia; many factors could explain the relation, and hypermobility's unwelcome gift of chronic pain may very well cause many people anxiety or depression. [1]
Hypermobility syndrome is generally considered to comprise hypermobility together with other symptoms, such as myalgia and arthralgia. It is relatively common among children and affects more females than males.
Current thinking suggests that there are four factors: These four factors affect different people to varying degrees.
People with hypermobility syndrome may develop other conditions caused by their unstable joints. These conditions include:
Joint hypermobility syndrome needs to be distinguished from other disorders that share many common features, such as Marfan syndrome, Ehlers-Danlos Syndrome, and osteogenesis imperfecta. In the last couple of years collaborations of experts in connective tissue disorders formally agreed that there was little distinction between Hypermobility Syndrome and Ehlers Danlos Syndrome and that they are in fact the same disorder. Information on this can be found in an article titled "The lack of clinical distinction between the hypermobility type of Ehlers–Danlos syndrome and the joint hypermobility syndrome (a.k.a. hypermobility syndrome)"[4]
Generalized hypermobility is a common feature in all these hereditary connective tissue disorders and many features overlap, but often distinguishing features are present that enable differentiating these disorders.[5]
As of July 2000, hypermobility is diagnosed using the Brighton criteria[6]. The Brighton criteria will not replace the Beighton score but instead will use the previous criteria in conjunction with other symptoms. HMS will be diagnosed in the presence of either two major criteria, one major and two minor criteria, or four minor criteria. The criteria are as follows:
The Beighton score is an edited version of the Carter & Wilkinson scoring system which has been used for many years as an indicator of widespread hyper-mobility. However medical professionals varied in their interpretations of the results; some accepting as low as 1/9 and some 4/9 as a diagnosis of HMS. Therefore it was incorporated, with clearer guidelines, into the Brighton Criteria. The Beighton score is measured by adding 1 point for each of the following:
It is important that the individual with hypermobility remain extremely fit - even more so than the average individual - to prevent recurrent injuries. Regular exercise and physical therapy or hydrotherapy can reduce symptoms of hypermobility, because strong muscles help to stabilise joints. These treatments can also help by stretching tight, overused muscles and ensuring the person uses joints within the ideal ranges of motion, avoiding hyperextension or hyperflexion. Low-impact exercise such as Pilates or T'ai chi is usually recommended for hypermobile people as it is less likely to cause injury than high-impact exercise or contact sports.
Moist hot packs can relieve the pain of aching joints and muscles. For some patients, ice packs also help to relieve pain.
Medications frequently used to reduce pain and inflammation caused by hypermobility include analgesics, anti-inflammatory drugs (though these have been linked with an increase in pain and joint instability for some sufferers), and tricyclic antidepressants. Some people with hypermobility may benefit from other medications such as steroid injections or gabapentin, a drug originally used for treating epilepsy. Europe is far ahead of the United States in terms of HMS recognition and its knowledge of how to treat it{{www.hypermobility.org}}. Tramadol, a non-narcotic yet opioid pain reliever that is nearly as effective as narcotics, has been used in England to treat HMS joint pain, and it is available either by prescription from a doctor in the United States or from Mexico. Benzodiazapines are also used in HMS sufferers who experience painful muscles spasms around loose joints.
For some people with hypermobility, lifestyle changes decrease the severity of symptoms. For example:
Grahame R. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000;27:1777 –1779
|
||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||