Hypermobility

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Hypermobility
Classification and external resources
Hypermobile fingers and thumb.jpg
Hypermobile fingers and thumb
ICD-10M35.7
ICD-9728.5
OMIM147900
DiseasesDB31101
MedlinePlus003295
MeSHD007593
 
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Hypermobility
Classification and external resources
Hypermobile fingers and thumb.jpg
Hypermobile fingers and thumb
ICD-10M35.7
ICD-9728.5
OMIM147900
DiseasesDB31101
MedlinePlus003295
MeSHD007593

Hypermobility describes joints that stretch farther than 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 perform other contortionist "tricks". It can affect a single joint or multiple joints throughout the body.

Causes[edit]

Hypermobility generally results from one or more of the following:

These abnormalities cause abnormal stress on a joint or many joints, meaning that the joints can wear out, leading 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 be taken literally, as an individual with hypermobility in a joint does not actually have two separate joints where others would have just one.

Most people have hypermobility with no other symptoms. In fact, approximately 5% of the healthy population have hypermobile joints. However, people with "joint 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 or even disability in severe cases. Instrumentalists with hypermobile fingers may have difficulties when fingers collapse into the finger locking position.

Hypermobility may also be symptomatic of a serious medical condition, such as Stickler Syndrome, Ehlers-Danlos syndrome,[1] Marfan syndrome,[1] rheumatoid arthritis, osteogenesis imperfecta,[1] lupus, polio, Down syndrome,[1] morquio syndrome, cleidocranial dysostosis or myotonia congenita.

In addition, hypermobility has been associated with chronic fatigue syndrome and fibromyalgia. Just as people with hypermobility have a higher risk for Osteoarthritis, they may also have a higher risk for Fibromyalgia. Some speculate that those with Fibromyalgia might have some form of Connective Tissue Disorder, such as the ones that cause hypermobility. Hypermobility causes physical trauma (In the form of Joint Dislocations, Joint Subluxations, Joint Instability, Sprains, etc), in turn causes emotional trauma; physical trauma, emotional trauma, and a few other factors either trigger and/or are possible causes for Fibromyalgia.[2]

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 them from standing up or walking. Use of a bedpan and wheelchair may be necessary, or even permanent in some cases due to hip stretching. Also many people complain about joints or muscles hurting because of this.

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.

Anxiety and joint hypermobility[edit]

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. In a 2003 study, 78% of people with hypermobility also had orthostatic intolerance, which can lead to chronically high adrenalin and chronic anxiety. [3] Hypermobility's unwelcome gift of chronic pain may very well cause many people anxiety or depression. These people feel alone in that nobody understands their disorder and they find it difficult to explain to skeptics because their body looks perfectly normal. Often accused of not getting enough rest these patients become agitated that their previous life activities become increasingly difficult as their condition worsens. Lashing out, anxiety, depression, and sadness are all common [4]

Hypermobility syndrome[edit]

Hypermobile metacarpo-phalangeal joints

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.

Causes[edit]

Current thinking suggests that there are four factors: These four factors affect different people to varying degrees.

Hypermobility can also be caused by Connective Tissue Disorders, such as Ehlers-Danlos Syndrome and Marfan syndrome. Joint Hypermobility is a common symptom for both of these. Ehlers Danlos Syndrome has numerous types; however, most types have hypermobility in some degree. When hypermobility is the main symptom, to where it overshadows the rest, then it most likely is Ehlers Danlos Syndrome - The Hypermobility Type (EDS-HT). People with EDS-HT suffer frequent joint dislocations and subluxations (partial/incomplete dislocations), with or without trauma, and sometimes spontaneously. Commonly, the hypermobility is assumed by medical professionals to be nonpainful, mild, and dismissed in general. Consequently, they receive little to no treatment and left to suffer debilitating pain by many health professionals. They are labeled hypochondriacs, lazy, and/or as if the pain were a figment of their imagination.[7]

Symptoms[edit]

People with hypermobility syndrome may develop other conditions caused by their unstable joints. These conditions include:

Diagnosis[edit]

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 severe forms of Hypermobility Syndrome and mild forms Ehlers-Danlos Syndrome Hypermobility Type, 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)"[8]

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.[9] The inheritance pattern of Ehlers-Danlos syndrome varies by type. The arthrochalasia, classic, hypermobility, and vascular forms of the disorder usually have an autosomal dominant pattern of inheritance. Autosomal dominant inheritance means that one copy of the altered gene in each cell is sufficient to cause the disorder. In some cases, an affected person inherits the mutation from one affected parent. Other cases result from new (sporadic) gene mutations. These cases occur in people with no history of the disorder in their family. The dermatosparaxis and kyphoscoliosis types of Ehlers-Danlos syndrome, and some cases of the classic and hypermobility forms, are inherited in an autosomal recessive pattern. In autosomal recessive inheritance, two copies of the gene in each cell are altered. Most often, the parents of an individual with an autosomal recessive disorder are carriers of one copy of the altered gene but do not show signs and symptoms of the disorder[10].

Beighton's criteria[edit]

As of July 2000, hypermobility is diagnosed using the Beighton criteria.[10] The Beighton criteria do not replace the Beighton score but instead use the previous criteria in conjunction with other symptoms. HMS is diagnosed in the presence of either two major criteria, one major and two minor criteria, or four minor criteria. The criteria are as follows:

Major criteria[edit]
Minor criteria[edit]

Beighton score[edit]

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 Beighton Criteria. The Beighton score is measured by adding 1 point for each of the following:

Treatments[edit]

Physical therapy[edit]

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 increase joint stability. 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. In many cases alternating the two (hot and cold) helps relieve the pain.[11]

Medication[edit]

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. 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.

Lifestyle modification[edit]

For some people with hypermobility, lifestyle changes decrease the severity of symptoms. For example:

Other treatments[edit]

References[edit]

  1. ^ a b c d Simpson, MR (September 2006). "Benign joint hypermobility syndrome: evaluation, diagnosis, and management.". The Journal of the American Osteopathic Association 106 (9): 531–536. PMID 17079522. 
  2. ^ WebMD (2013). Found by http://www.webmd.com/fibromyalgia/guide/fibromyalgia-causes
  3. ^ Gazit Y, Nahir AM, Grahame R, Jacob G. (2003). "Dysautonomia in the joint hypermobility syndrome". American Journal of Medicine 115: 33–40. PMID 12867232. 
  4. ^ Martin-Santos R, Bulbena A, Porta M, Gago J, Molina L, Duró JC (November 1998). "Association Between Joint Hypermobility Syndrome and Panic Disorder". American Journal of Psychiatry 155 (11): 1578–1583. PMID 9812121. 
  5. ^ Keer, Rosemary; Rodney Grahame (2003). Hypermobility syndrome : recognition and management for physiotherapists. Edinburgh: Butterworth-Heinemann. p. 71. ISBN 0-7506-5390-6. "Asian Indians were found by Wordsworth et al. (1987) to be significantly more mobile than English Caucasians." 
  6. ^ "Joint hypermobility". Arthritis Research UK. 
  7. ^ Levy, Howard (2004). “The Ehlers Danlos Syndrome, Hypermobility Type.” University of Washington: NIH. Retrieved from http://newtons-online.net/documents/EDS%20b.pdf
  8. ^ "Rare illnesses and disabilities". 
  9. ^ Zweers MC, Kucharekova M, Schalkwijk J (March 2005). "Tenascin-X: a candidate gene for benign joint hypermobility syndrome and hypermobility type Ehlers-Danlos syndrome?". Ann. Rheum. Dis. 64 (3): 504–5. doi:10.1136/ard.2004.026559. PMC 1755395. PMID 15708907. 
  10. ^ Grahame R. The revised (Beighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000;27:1777–1779
  11. ^ Anecdotal evidence from patients receiving therapies

Grahame R. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000;27:1777–1779

[10] Genetics Home Reference - [1]

External links[edit]