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PubMed2003

Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder?

OBJECTIVES: Children with generalized hypermobility of the joints and musculoskeletal complaints frequently visit pediatric clinics, but many show no currently known collagen or other possibly related diseases. Whether the symptoms are confined to the musculoskeletal system is unknown. We assessed whether such children have detectable differences in laxity of connective tissue present in organ systems other than joints. We also assessed whether children with generalized joint hypermobility and musculoskeletal complaints have more profound systemic changes in connective tissue of various organ systems as compared with children with generalized joint hypermobility without musculoskeletal complaints. METHODS: Anthropometrics, range of joint motion, muscle strength, skin extensibility, blood pressure, quantitative ultrasound measurements of bone, and degradation products of collagen were studied in 15 prepubertal children with generalized joint hypermobility and musculoskeletal complaints and compared with a population-based reference group of 95 nonsymptomatic prepubertal children. Symptomatic hypermobile children were also compared with children of the population-based reference group who had asymptomatic hypermobility of the joints (n = 16). RESULTS: Children with symptomatic generalized joint hypermobility had significantly higher skin extensibility (5.6 mm/15 kPa, 95% confidence interval [CI]: 4.0-7.1), lower quantitative ultrasound measurements (speed of sound: -26.8 m/s; 95% CI: -41.1 to -12.6) in bone, and lower systolic and diastolic blood pressure (-8.0 mmHg, 95% CI: -13.3 to -2.8; and -6.0 mmHg, 95% CI: -10.0 to -2.2, respectively) as compared with the total reference group. Also, they had significantly lower excretion of urinary hydroxylysylpyridinoline cross-links (mean difference: -51.3 micro mol/mmol; 95% CI: -92.2 to -10.4) as well as lysylpyridinoline cross-links (-18.7 micro mol/mmol; 95% CI: -36.9 to -0.5). Age, gender, body weight, height, and particularly cross-links excretion did not explain group differences in clinical and bone characteristics. After adjustment for age, gender, body weight, and height, children with symptomatic generalized joint hypermobility (n = 15) had significantly higher total range of joint motion (117.8 degrees; 95% CI: 77.7-158.0), skin extensibility (3.5 mm/15 kPa; 95% CI: 1.6-5.3), lower quantitative ultrasound measurements in bone (speed of sound: -27.9 m/s; 95% CI: -48.4 to -7.5), borderline lower diastolic blood pressure (-4.9 mmHg; 95% CI: -10.7-0.9), and significantly higher degradation products in urine (hydroxyproline/creatinine: 21.2 micro mol/mmol; 95% CI: 2.3-40.1) as compared with asymptomatic hypermobile children of the total reference group (n = 16). After adjustment for possible confounders, children with generalized joint hypermobility without musculoskeletal complaints had a significantly higher total range of joint motion and more profound skin extensibility, as compared with the reference group (n = 79). CONCLUSIONS: Clinically manifested symptoms in otherwise healthy children with generalized joint hypermobility are accompanied by increases in the laxity of other body tissues. Thus, generalized joint hypermobility with musculoskeletal symptoms does not seem to be restricted to joint tissues. In symptomatic hypermobile children, a more systemic derangement was also present as compared with asymptomatic hypermobile children.

Anthropometry↗

PubMed2003

Observations on the function of the female urethra: I: relation between maximum urethral closure pressure at rest and urethral hypermobility.

AIMS: To study the relation between maximum urethral closure pressure at rest and urethral hypermobility in female patients. PATIENTS AND METHODS: We selected 255 patients aged 20 years and older, with a stable bladder on multichannel urodynamics, without known neurological pathology, and without a history of pelvic or anti-incontinence surgery. A resting urethral pressure profile and the degree of urethral hypermobility were registered. Two-tailed analyses of variance (ANOVA) with Fisher's post-hoc tests were used to detect any statistically significant difference (P < 0.05) in urethral closure pressure between groups with varying degrees of urethral hypermobility. RESULTS: Mean age was 45.6 +/- 12.7 (range 20-77) years. Mean maximum urethral closure pressure for the entire group was 62.7 +/- 29 (range 10-150) cm of water. A statistically significant inverse relationship was found between age and maximum urethral closure pressure (r = 0.489, P < 0.0001) when both analyzed as continuous variables, and with age categorized in 10-year increments (P < 0.0001). When comparing mean urethral closure pressure in each group examined for urethral hypermobility, a statistically significant difference was noted when grades I, II, and III were compared to grade 0 hypermobility. No significant difference was observed when grades I, II, and III were compared to each other. Even if statistically non-significant, there exists an inverse relationship between the degree of urethral hypermobility and the maximum urethral closure pressure: a higher hypermobility is associated with a lesser urethral closure pressure. CONCLUSIONS: Urethral closure pressure falls significantly when urethral hypermobility is present. This decrease is not related to patient's age or parity. Our observations demonstrate an inverse relation between urethral closure pressure and the degree of cysto-urethrocele. As hypermobility increases, closure pressure decreases, even if this decrease does not reach the level of statistical significance.

Adult↗

PubMed2004

Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence.

AIMS: To analyze the relation between urethral hypermobility and urethral incompetence, and to summarize the interdependence between maximum urethral closure pressure (MUCP), urethral hypermobility, and urethral incompetence. PATIENTS AND METHODS: A group of 255 patients was selected from a large bank of cases. Inclusion criteria were age 20 years or above, no neurological disease, stable bladder, and no previous incontinence surgery or hysterectomy. The degree of hypermobility (cysto-urethrocele) and the degree of urethral incompetence (abdominal leak point pressure (ALPP)) were determined. Statistical analyses between urethral hypermobility and incompetence were performed with Spearman's correlation and the Jonckherre-Terpstra test. RESULTS: The Spearman's rank correlation test showed a statistically significant relation between urethral hypermobility and the degree of urethral incompetence (P = 0.0049). CONCLUSIONS: The statistically significant relation between urethral incompetence and hypermobility suggests that urethral incompetence will increase as the degree of urethral hypermobility does. Optimal conditions for urinary continence include a high maximum urethral closure pressure, absence of hypermobility, and a low degree of urethral incompetence. This last factor is assured by a strong support underneath the urethra permitting compression of the latter during straining. Failure of the urethral closure mechanism is highly probable with a diminished maximum closure pressure accompanied by urethral hypermobility often associated with a high degree of urethral incompetence. Clinically significant urinary incontinence may appear in many intermediate circumstances between these two extreme states, but stress urinary incontinence is essentially an activity-related phenomenon.

Adult↗

PubMed2004

[Joint hypermobility: prevalence and relationship with musculoskeletal pain].

OBJECTIVES: (1) To determine the prevalence of joint hypermobility in children aged 4-14 years old without organic disease of the locomotor system; (2) to compare the prevalence of hypermobility in children with and without arthralgia and (3) to analyze the influence of certain variables on the development of arthralgia. PATIENTS AND METHODS: We performed an observational study in a sample of children aged 4-14 years old living in Area 4 of the Community of Madrid (Spain). Joint hypermobility was evaluated using a goniometer. Hypermobility was defined using Beighton's criteria. RESULTS: A total of 222 subjects were analyzed: 176 in the primary care setting and 46 in the emergency department of a referral hospital. Of the 222 children, 43 reported arthralgia. The prevalence of hypermobility (> or = 4 criteria) was 55 % (123/222), reaching 71 % (49/69) in children aged less than 8 years. No significant differences were found in the prevalence of hypermobility in children with and without arthralgia (65 % and 53 % respectively). Of the variables analyzed (age, sex, country of origin, primary care/emergency department setting) only differences in the absolute number of Beighton criteria present in children with and without arthralgia (4.34 +/- 2.47 and 3.48 +/- 2.35, p = 0.03) were detected, which disappeared when at least four criteria (definition of hypermobility) were required. CONCLUSIONS: Fifty-five percent of the population studied and 71 % of those younger than 8 years old met the criteria for joint hypermobility. In the sample analyzed, the presence of joint hypermobility did not seem to favor the development of arthralgias.

Adolescent↗

PubMed2003

The relationship of joint hypermobility, bone mineral density, and osteoarthritis in the general population: the Chingford Study.

OBJECTIVE: The prevalence of hypermobility and its consequence in an aging female population is unknown. Case studies of patients with the benign joint hypermobility syndrome suggest both a tendency toward osteopenia and an association with premature osteoarthritis (OA). We assessed hypermobility and its relationship to bone mineral density (BMD) and OA in a postmenopausal female community population. METHODS: Joint hypermobility was assessed by the Beighton and the (more quantitative) Contompasis scores in 716 female subjects under followup in the Chingford Study (age range 53-72, mean 61 yrs, SD 5.8). RESULTS: We found 79 of 716 subjects (11%) had a hypermobility score > 1/9 on the Beighton scale (spine in 75/79); 82/716 had a Contompasis score > 22 (normal < 18). Only one had a 4/9 Beighton score indicative of generalized joint hypermobility. Subjects with Contompasis > 22 were more physically active and less likely to smoke. They had a reduced risk of knee OA (joint space narrowing) (OR 0.48, 95% CI 0.27-0.83, after adjusting for age, height, weight, and activity), but no change in risk of OA in spine or hands. Hip BMD was increased by 3% in this more hypermobile subgroup (p < 0.05). A similar effect was seen for knee OA, but not BMD in those with a Beighton score > 1. CONCLUSION: Our data suggest that in this postmenopausal population the tendency to joint hypermobility may be a marker for fitness, manifested by reduced knee OA and increased hip BMD. The incidence of generalized hypermobility (Beighton > 4/9) was very low (0.14%) compared with the localized form (seen in 11%) and other studies. Those with mild degrees of hypermobility showed no evidence of premature OA or reduced BMD, as reported in some of the rarer heritable disorders of connective tissue.

Aged↗

PubMed2005

Hypermobility syndrome increases the risk for low bone mass.

Few studies on the benign joint hypermobility syndrome suggest a tendency toward osteopenia, but there are conflicting results. We assessed bone mineral density in pre-menopausal women with hypermobility. Twenty-five consecutive Caucasian women diagnosed with benign hypermobility syndrome by Beighton score and 23 age- and sex-matched controls were included in the study. Age, menarch age, number of pregnancies, duration of lactation, physical activity and calcium intake were questioned according to European Vertebral Osteoporosis Study Group (EVOS) form. All subjects were pre-menopausal and none of them were on treatment with any drugs effecting bone metabolism or had any other systemic disease. No statistically significant difference was found for body mass index, menarch age, number of pregnancies, duration of lactation, calcium intake, calcium score and physical activity score between the two groups. Total femoral and trochanteric bone mineral density and t and z scores were significantly lower in hypermobile patients compared to the control group. Ward's triangle and femoral neck z scores were also found to be significantly low in hypermobile patients (p<0.05). Significant negative correlations were found between the Beighton scores and trochanteric BMD, t and z scores (r=-0.29, r=-0.30, and r=-0.32) in hypermobility patients. Low bone mass was more frequently found among subjects with hypermobility (p=0.03). Hypermobility was found to increase the risk for low bone mass by 1.8 times (95% confidence interval 1.01-3.38). Our study suggests that pre-menopausal women with joint hypermobility have lower bone mineral density when compared to the controls and hypermobility increases the risk for low bone mass.

Adult↗

PubMed1995

Pulled elbow--not the effect of hypermobility of joints.

A detailed description of pulled elbow is missing from standard orthopaedic text books. Recently it has been reported that the prevalence of hypermobility among children with pulled elbow is higher than that in the normal population and that pulled elbow can be considered to be a consequence of joint hypermobility. Two hundred children with pulled elbow comprising 106 girls and 94 boys (age range 3-84 months, mean age 24 months) were treated and evaluated for signs of hypermobility in a prospective study. Hypermobility of joints was noted in 17 (8.5 per cent) of children who had a pulled elbow while in the 71 children in whom there had been more than one episode, the rate of hypermobility was 8.4 per cent. Comparison of these results with a control group of 100 normal children, in whom 10 (10 per cent) exhibited hypermobility, showed no association between joint hypermobility and an increased incidence of pulled elbow. The anatomical construction of the radial head, relative plasticity of the cartilage and the immature annular ligament in young children possibly predisposes them to pulled elbow, the incidence of which is increasing in our modern physically competitive society where children are participating in a wide range of physically demanding sports activities. Pulled elbows can also occur in children with hypermobility of joints, but there is no evidence that the incidence has increased.

Child↗

PubMed1997

Hypermobility in two Dutch school populations.

OBJECTIVE: To determine the presence of hypermobility and differences between females and males in a Dutch population. STUDY DESIGN: Joint mobility was measured in a primary and a secondary school population. Beighton and Biro measurements were used. The data were evaluated statistically. RESULTS: Using the Beighton score, 15.5% of group I (n = 252; 4-13 years) and 13.4% of group II (n = 658; 12-17 years) were hypermobile. Hypermobility was found more in females than in males, the difference being significant in the older group. Overall, hypermobility did not significantly diminish with ageing, although the individual joints did not show a significant decrease in mobility with ageing. Hypermobility was significantly more pronounced at the non-dominant body side in both groups. The Quetelet-index did not show a significant relation to hypermobility. CONCLUSION: Hypermobility was found more in females than in males, with a trend of decrease of hypermobility with ageing. The non-dominant body side proved to be more hypermobile and the Quetelet-index did not show a relation to hypermobility. Beighton's measurements proved best, since Biro considers the two body sides being equal.

Adolescent↗

PubMed2005

Joint hypermobility syndrome in childhood. A not so benign multisystem disorder?

OBJECTIVES: Joint hypermobility (JH) or "ligamentous laxity" is felt to be an underlying risk factor for many types of musculoskeletal presentation in paediatrics, and joint hypermobility syndrome (JHS) describes such disorders where symptoms become chronic, often more generalized and associated with functional impairment. Clinical features are felt to have much in common with more severe disorders, including Ehlers-Danlos syndrome (EDS), osteogenesis imperfecta and Marfan syndrome, although this has not been formally studied in children. We defined the clinical characteristics of all patients with joint hypermobility-related presentations seen from 1999 to 2002 in a tertiary referral paediatric rheumatology unit. METHODS: Patients were identified and recruited from paediatric rheumatology clinic and ward, and a dedicated paediatric rheumatology hypermobility clinic at Great Ormond Street Hospital. Data were collected retrospectively on the patients from the paediatric rheumatology clinics (1999-2002) and prospectively on patients seen in the hypermobility clinic (2000-2002). Specifically, historical details of developmental milestones, musculoskeletal or soft tissue diagnoses and symptoms, and significant past medical history were recorded. Examination features sought included measurements of joint and soft tissue laxity, and associated conditions such as scoliosis, dysmorphic features, cardiac murmurs and eye problems. RESULTS: One hundred and twenty-five children (64 females) were included on whom sufficient clinical data could be identified and who had clinical problems ascribed to JH present for longer than 3 months. Sixty-four were from the paediatric rheumatology clinic and 61 from the hypermobility clinic. No differences were found in any of the measures between the two populations and results are presented in a combined fashion. Three-quarters of referrals came from paediatricians and general practitioners but in only 10% was hypermobility recognized as a possible cause of joint complaint. The average age at onset of symptoms was 6.2 yr and age at diagnosis 9.0 yr, indicating a 2- to 3-yr delay in diagnosis. The major presenting complaint was arthralgia in 74%, abnormal gait in 10%, apparent joint deformity in 10% and back pain in 6%. Mean age at first walking was 15.0 months; 48% were considered "clumsy" and 36% as having poor coordination in early childhood. Twelve per cent had "clicky" hips at birth and 4% actual congenital dislocatable hip. Urinary tract infections were present in 13 and 6% of the female and male cases, respectively. Thirteen and 14%, respectively, had speech and learning difficulties diagnosed. A history of recurrent joint sprains was seen in 20% and actual subluxation/dislocation of joints in 10%. Forty per cent had experienced problems with handwriting tasks, 48% had major limitations of school-based physical education activities, 67% other physical activities and 41% had missed significant periods of schooling because of symptoms. Forty-three per cent described a history of easy bruising. Examination revealed that 94% scored > or =4/9 on the Beighton scale for generalized hypermobility, with knees (92%), elbows (87%), wrists (82%), hand metacarpophalangeal joints (79%), and ankles (75%) being most frequently involved. CONCLUSIONS: JHS is poorly recognized in children with a long delay in the time to diagnosis. Although there is a referral bias towards joint symptoms, a surprisingly large proportion is associated with significant neuromuscular and motor development problems. Our patients with JHS also show many overlap features with genetic disorders such as EDS and Marfan syndrome. The delay in diagnosis results in poor control of pain and disruption of normal home life, schooling and physical activities. Knowledge of the diagnosis and simple interventions are likely to be highly effective in reducing the morbidity and cost to the health and social services.

Adolescent↗

PubMed2002

Association between hypermobility and congenital limb deficiencies.

OBJECTIVE: To determine the prevalence of hypermobility in individuals with congenital limb deficiencies and whether congenital limb loss is associated with increased laxity in the remaining joints. STUDY DESIGN: All data were collected during the individuals' visits to the prosthetic clinic. SETTING: The subjects were evaluated at the Subregional Disablement Services Centre at University Hospital of South Manchester, UK. SUBJECTS: Forty-five individuals with congenital limb deficiencies were studied (male/female 27 :18; ages 6-31 years). OUTCOME MEASURE: A modified version of the nine-point Beighton Score for hypermobility was used, using the presently accepted criteria for diagnosing hypermobility. Any individual who scored 3 or more points was considered to have joint hypermobility. RESULT: Of the 45 individuals with congenital limb deficiencies, 71% had at least one hypermobile joint, whereas 38% had three or more features of hypermobility, with female/male ratio of 2.75:1. CONCLUSION: Our results show an increase in joint hypermobility (laxity) in individuals born with congenital limb deficiencies compared with the prevalence of this condition in the general population. As joint hypermobility may predispose individuals to low back pain, joint effusion, recurrent joint dislocation and ligament rupture, it is useful to identify those individuals with hypermobility.

Adolescent↗

PubMed1996

Joint hypermobility is not a contributing factor to musculoskeletal pain in pre-adolescents.

OBJECTIVE: To study the prevalence of joint hypermobility and the association of hypermobility with musculoskeletal pain in pre-adolescents. METHODS: Finnish school children in the 3rd and 5th grade, n = 1637, mean ages 9.8 and 11.8 years, were studied by Beighton criteria for joint hypermobility, with total score > or = 6 as a cutoff point for hypermobility, pretested questionnaire for musculoskeletal pain, and classification to different pain groups on the basis of painful body area and frequency of pain. RESULTS: The mean Beighton scores were 2.7 and 2.4 for the 3rd and 5th grade children, respectively. Total score was > or = 6 in 7.8% of the children. No association of hypermobility with musculoskeletal pain was found. Of the hypermobile children, 29.9% (95% CI 22.3 to 38.8), and of the nonhypermobile children, 32.3% (95% CI 29.9 to 34.7) had musculoskeletal pain at least once a week. Children with hypermobility did not have more pain due to injuries. Disability caused by musculoskeletal pain did not correlate with Beighton total score. CONCLUSION: Both joint hypermobility and musculoskeletal pain are common in pre-adolescents. Hypermobility appears not to be a contributing factor to musculoskeletal pain in pre-adolescents.

Activities of Daily Living↗

PubMed1985

Hypermobility of the joints in juvenile episodic arthritis/arthralgia.

It has been suggested that hypermobility of the joints may predispose children to the development of arthritis or arthralgia. To determine the normal frequency of hypermobility, 260 normal schoolchildren (5 to 17 years of age) were examined. In addition, 34 patients with juvenile rheumatoid arthritis (JRA) and 32 children with juvenile episodic arthritis/arthralgia (JEA) were tested. Any child who met at least three of the following criteria was considered to have joint hypermobility: (1) passive apposition of the thumbs to the flexor aspect of the forearms; (2) passive hyperextension of the fingers so that they lie parallel with the extensor aspect of the forearms; (3) hyperextension of the elbows greater than 10 degrees; (4) hyperextension of the knees greater than 10 degrees; (5) flexion of the trunk with knees extended so the palms rest on the floor. Thirty-two (12%) of 260 normal schoolchildren and 21 (66%) of 32 with JEA had hypermobility. Further, a significantly higher proportion (23 of 126) of normal girls than normal boys (nine of 134) had hypermobility (chi 2 = 8.0, P less than 0.005). Hypermobility was not common in children with JRA. These findings support the hypothesis that hypermobility may be an important factor in the cause of JEA.

Adolescent↗

PubMed1999

Joint hypermobility in African non-pregnant nulliparous women.

OBJECTIVE: To investigate the prevalence of joint hypermobility in non-pregnant nulliparous women and the influences of age and Quetelet-index in a rural, female population in Tanzania. STUDY DESIGN: A cross-sectional study. Joint mobility was measured according to the scoring systems of Beighton and Biro. RESULTS: According to the Beighton criteria with a score of 0 to 9 points, 50.5% of 705 non-pregnant nulliparous women scored 3, while 30.8% scored > or =4 and 18.6% > or =5. There were no correlations between hypermobility and age or Quetelet-index. The prevalence of hypermobility at the dominant body side was significantly lower (19.2%) than at the non-dominant side (23.4%) (p<0.001). CONCLUSION: This study confirms that there are ethnic differences in the prevalence of hypermobility. The prevalence of hypermobility in Tanzanian non-pregnant nulliparous women is about 1.5-times higher as compared to Dutch non-pregnant nulliparous women. Prevalence of hypermobility was higher at the non-dominant body side. The most predictive test for the diagnosis of hypermobility was the hyperextension of the elbows >10 degrees.

Adolescent↗

PubMed2004

Predictive value of maximum urethral closure pressure, urethral hypermobility and urethral incompetence in the diagnosis of clinically significant female genuine stress incontinence.

PURPOSE: We determined the value of urethral hypermobility, maximum urethral closure pressure (MUCP) and urethral incompetence in the diagnosis of stress urinary incontinence (SUI). MATERIALS AND METHODS: In this study 369 women with clinical symptoms suggestive of SUI without symptoms of bladder overactivity were evaluated in regard to urethral incompetence, urethral hypermobility and mean MUCP. The cohort was divided into 2 groups according to continence/incontinence status. ROC curves were used to test the performance of the various predicting factors. These factors were combined in forward stepwise logistic regression to find the cutoff point that simultaneously optimized sensitivity and specificity. RESULTS: Continent and incontinent patients differed with regards to urethral incompetence and hypermobility (each p <0.0001). Incontinent patients had a greater probability of a higher grade of each factor. Even after adjusting for the older age of incontinent patients by ANCOVA. MUCP was significantly lower in the incontinent group (p <0.001). The best univariate optimized cutoff point for discriminating continence from incontinence was obtained with urethral incompetence greater than grade I. CONCLUSIONS: The best single predictor of clinically significant SUI is urethral incompetence, followed by urethral hypermobility and MUCP. When combining several factors, namely grade II urethral incompetence with grade III hypermobility, grade III urethral incompetence with grades I to III hypermobility and grade IV urethral incompetence with or without urethral hypermobility, all indicated more than a 90% probability of clinically significant SUI.

Adult↗

PubMed2006

Differences in urodynamic study, perineal sonography and treatment outcome according to urethrovesical junction hypermobility in stress urinary incontinence.

AIMS: To evaluate the differences in urodynamic study (UDS) and the perineal ultrasonography parameters between stress urinary incontinence (SUI) patients with or without urethrovesical junction (UVJ) hypermobility. Treatment outcomes following a retropubic urethropexy were also compared. METHODS: The records of 164 SUI patients ( or=30, and a non-hypermobility group when <30. All patients underwent UDS and perineal ultrasonography (US) preoperatively. A Burch urethropexy was performed regardless of the Q-tip result. All patients were reevaluated at 1 month and 3 months, postoperatively, and every 3 months thereafter. RESULTS: Ninety-eight patients (60%) had an accompanying UVJ hypermobility and 66 (40%) did not. No significant differences regarding age, parity, body mass index (BMI), menopausal status, hormone replacement status, history of previous gynecologic surgery, or other medico-surgical illness were noted. UDS parameters demonstrated a significant difference between the groups, but were in the normal range. The significant difference noted in the perineal US was the bladder neck descent (BND). Following retropubic urethropexy, the success rates after 1 year were 94% and 91% for the hypermobility group and the non-hypermobility group, respectively, showing no statistical significance. CONCLUSION: The success rates of Burch urethropexy in the two groups were similar. This result suggests that either the Q-tip is an inaccurate method of evaluating UVJ hypermobility or the presence of UVJ hypermobility does not negatively affect the treatment outcome of a Burch urethropexy.

Aged↗

PubMed1996

Ehlers-Danlos syndrome: relationship between joint hypermobility, urinary incontinence, and pelvic floor prolapse.

OBJECTIVE: To compare the incidence of joint hypermobility and prolapse in incontinent and continent women with Ehlers-Danlos syndrome (EDS). METHODS: Forty-six patients with EDS were evaluated by history and physical examination. The degree of joint mobility of shoulder, elbow, wrist, hip, knee, and ankle was evaluated by orthopedic surgeons and physical therapists. Joint range of motion measurements were obtained using an orthopedic goniometer. RESULTS: The two EDS groups, incontinent (n = 28) and continent (n = 18) women, had a statistically similar mean age, weight, and parity (p = NS). In the EDS population overall joint hypermobility averaged 34.3%. Individuals with EDS type 3 had significantly more joint hypermobility than those with type 1 and 2 EDS. However, logistic regression analysis demonstrated no significant relationship between prolapse and joint hypermobility. Wrist dorsiflexion (p < 0.05) and palmar flexion (p = 0.05) were the only variables related to incontinence. CONCLUSION: It has previously been reported that hypermobility was correlated with pelvic floor prolapse. Of 18 joint measures per patient, hypermobility of both wrist dorsiflexion and palmar flexion was associated with symptoms of incontinence. We were unable to document an association between joint hypermobility and prolapse in the EDS population.

Ehlers-Danlos Syndrome↗

PubMed1998

Association between joint hypermobility syndrome and panic disorder.

OBJECTIVE: The purpose of this study was to assess whether joint hypermobility syndrome is more frequent in patients with panic disorder, agoraphobia, or both than in control subjects and, if so, to determine whether mitral valve prolapse modifies or accounts in part for the association. METHOD: A case-control study was conducted in a general teaching hospital outpatient clinic. Subjects were 99 patients, newly diagnosed and untreated, with panic disorder, agoraphobia, or both and two groups of age- and sex-matched control subjects: 99 psychiatric patients and 64 medical patients who had never suffered from any anxiety disorder. Measures consisted of the Structured Clinical Interview for DSM-III-R, Beighton's criteria for joint hypermobility syndrome, and two-dimensional and M-mode echocardiogram. The presence of mitral valve prolapse and joint hypermobility syndrome was explored by raters who were blind to subjects' psychiatric status. RESULTS: Joint hypermobility syndrome was found in 67.7% of patients with anxiety disorder but in only 10.1% of psychiatric and 12.5% of medical control subjects. On the basis of statistical analysis, patients with anxiety disorder were over 16 times more likely than control subjects to have joint laxity. These findings were not altered after the presence of mitral valve prolapse was taken into account. Of the patients with anxiety disorder, those who had joint hypermobility syndrome were younger and more often women and had an earlier onset of the disorder than those without joint hypermobility syndrome. CONCLUSIONS: Joint laxity is highly prevalent in patients with panic disorder, agoraphobia, or both and may reflect a constitutional disposition to suffer from anxiety. Mitral valve prolapse plays a secondary role in the association between joint hypermobility and anxiety.

Adult↗

PubMed2003

A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain.

The aim of the study was to develop a simple and reproducible self-reporting questionnaire that identifies individuals with hypermobility. Two hundred and twelve consecutive hypermobile female new attendees to the hypermobility clinic at two London teaching hospitals and a random selection of 57 healthy volunteers completed a 10-part questionnaire. Questions were selected from clinical experience (RG), and assessed musculoskeletal symptoms and past and present physical agility. Of the 212 cases, 30 were hypermobile with no other underlying disorder and 182 fulfilled the 1998 Brighton criteria for benign joint hypermobility syndrome (BJHS). Odds ratios for the presence of hypermobility were calculated for each question. Six questions were found to be significant and the model of 'best fit' for sensitivity and specificity contained five of these. To demonstrate the reproducibility of the five-part questionnaire a second cohort of 170 hypermobile cases with BJHS and 50 controls was surveyed. Analysis demonstrated that a positive answer to any two questions in the five-part questionnaire gave the highest combined sensitivity and specificity for detecting hypermobility. The sensitivity and specificity was 84% and 89% respectively in the first cohort and reproduced with values of 84% and 80% in the second cohort. Overall the questionnaire correctly identified 84% of all cases and controls. This simple and reproducible questionnaire for detecting hypermobility could be of particular use as an adjunct in the clinical assessment of chronic, diffuse pain syndromes where hypermobility is often missed yet is potentially treatable.

Adolescent↗