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PubMedDate not supplied

Is joint hypermobility related to anxiety in a nonclinical population also?

This study examines the association between joint hypermobility syndrome and anxiety in a nonclinical sample. Subjects (N = 526) receiving a medical check-up were assessed with the Hospital del Mar hypermobility criteria and the State-Trait Anxiety Inventory. Scores for trait anxiety, and to a lesser extent state anxiety, were significantly higher among subjects with joint hypermobility syndrome than among subjects without this syndrome (median trait anxiety scores for women: 17 versus 11; median scores for men: 13 versus 1). These findings indicate that the association of joint hypermobility syndrome and anxiety holds even for subjects with no psychiatric diagnosis. Therefore, it seems that this benign connective tissue disorder is a predisposing factor for trait anxiety. However, it is necessary to further explore and define the biological basis of this syndrome, as well as its associations and clinical expressions, which interact with great complexity.

Adult↗

PubMedDate not supplied

Articular hypermobility and chondral injury in patients with acute patellar dislocation.

Thirty adolescents with acute, primary patellar dislocation were assessed for a relationship between articular hypermobility and chondral injury. The 15 patients without articular hypermobility had a 2.5 times increased frequency of articular lesions when compared with 15 patients with hypermobility. Assessment of articular hypermobility should be part of the examination in patients with patellar dislocation.

Acute Disease↗

PubMed1988

Hypermobility in hallux valgus.

Hypermobility has been implicated as one of the etiological components in common foot problems such as hallux valgus but has not been substantiated by experimental data. Twenty patients with symptomatic untreated hallux valgus and 20 controls were evaluated with a simple hypermobility scoring system. A statistically significant correlation was found to reveal that female patients aged 20 to 40 yr with symptomatic hallux valgus have a mild generalized hypermobility when compared to a similar group of control patients. The presence of such ligamentous laxity would seem to support the need for bony correction in such patients as soft tissue procedures would have a greater propensity for malalignment due to the underlying hypermobility in combination with everyday environmental stresses of trauma and overuse.

Adult↗

PubMed2006

Exercise tolerance in children and adolescents with musculoskeletal pain in joint hypermobility and joint hypomobility syndrome.

OBJECTIVES: Musculoskeletal pain is a common complaint in a pediatric health care practice, but exercise tolerance has never been described in detail in these children. Our objectives for this study were to evaluate the maximal exercise capacity, including peak heart rate and oxygen consumption, of children with pain-related musculoskeletal problems, particularly in children with (symptomatic) generalized joint hypermobility and hypomobility, during a bicycle ergometry test to exhaustion; to evaluate muscle strength, bone mineral density, and sports activities in these children and to associate these observations with exercise capacity; and to compare these results with reference values. METHODS: Thirty-two children (mean age: 12.1 years; SD: 3.4 years; range: 6.2-20.1 years; 62% male) with musculoskeletal pain-related syndromes (joint hypermobility syndrome [n = 13] and joint hypomobility syndrome [n = 19]) participated. The reference group consisted of 117 healthy primary school prepubertal children, 167 healthy secondary school adolescents, and 98 young adults (249 girls and 133 boys; mean age total reference group: 14.5 +/- 4.0 years; range: 8-20.8 years). Anthropometry, range of joint motion, muscle strength, bone mineral density (speed of sound and broadband ultrasound attenuation), sports activities, and a maximal exercise test using an electronically braked cycle ergometer were performed, and the patient stopped because of volitional exhaustion. Expired gas analysis and heart rate and transcutaneous oxygen saturation by pulse oximetry measurements also were performed. RESULTS: Children with joint hypomobility syndrome as well as children with joint hypermobility syndrome had a higher mean z score (SD) of weight and BMI compared with the reference group. A significantly decreased absolute peak oxygen consumption and relative peak oxygen consumption in both patient groups was found compared with control subjects. In 14 of 32 children with a z score relative peak oxygen consumption of less than -2, maximal heart rate was significantly decreased compared with 18 children with a z score relative peak oxygen consumption of -2 or more (mean [SD] z score speed of sound: -1.3 [0.8] vs -0.5 [1.0] and mean [SD] heart rate: 175.9 [11.5] vs 187.5 [10.9], respectively). In the total group, a high significant correlation between the z score of relative peak oxygen consumption and the z score of the speed of sound was found as well as with z score of BMI. Sixteen (50%) of 32 participated in sports activities with (mean: 0.9 hours/week; SD: 1.4 hours/week), whereas in the control group, 12% of did not participate in sports activities (mean: 2.8 hours/week; SD: 2.2 hours/week). Children who participated in sports activities had a (borderline) significant increased mean (SD) z score of absolute peak oxygen consumption and mean (SD) z score of broadband ultrasound attenuation compared with children who did not participate in sports activities (-0.3 [1.1] vs -1.2 [1.3] and -0.45 [0.8] vs -0.9 [0.5], respectively). CONCLUSIONS: In children with musculoskeletal pain-related syndromes, particular in children with (symptomatic) generalized joint hypermobility and hypomobility, maximal exercise capacity is significantly decreased compared with age- and gender-matched control subjects. The most probable explanation for the reduced exercise tolerance in our patients is deconditioning.

Adolescent↗

PubMed2002

Joint hypermobility syndrome among undergraduate students.

OBJECTIVE: To assess the prevalence of joint hypermobility syndrome among undergraduate students of the University of Port Harcourt, Nigeria using the Beighton's criteria. DESIGN: Cross- sectional prospective study of 550 randomly selected undergraduate students. SETTING: Departments of Anatomy and Human Physiology, College of Health Sciences, University of Port Harcourt, Nigeria. MAIN OUTCOME MEASURES: The overall prevalence, and the male/female prevalence of joint hypermobility syndrome. RESULTS: Five hundred and fifty subjects (250 males and 300 females) were assessed. Seventy one (12.91%) subjects consisting of 20 (8.0%) males and 51 ( 17.0%) females, had features of joint hypermobility syndrome, suggesting a higher female prevalence. Knee joint, back and wrist joint pains, in descending order were found to be the commonest type of joint complaints. CONCLUSION: The study indicates that joint hypermobility syndrome is not rare in Nigerians and suggests that it should attract the attention of Nigerian medical practitioners.

Adolescent↗

PubMed2000

Fibromyalgia, hypermobility, and breast implants.

OBJECTIVE: To examine possible relationships among fibromyalgia (FM, American College of Rheumatology 1990 criteria), hypermobility, and breast implants. METHODS: The medical records of 2,500 female patients (ages 25-65) who had been seen for the first time in a rheumatology practice in Atlanta, GA, during 1986-92 were abstracted and analyzed. In each analysis, patients whose records indicated that the patient met the full case criteria were compared with patients whose records had no indication of the disease. Patients whose medical records indicated the clinical onset of FM prior to breast implantation were identified. RESULTS: Univariate and multivariate regression analyses were performed, adjusting for age, income, and the presence of connective tissue disease or rheumatoid arthritis. Significant associations were found between hypermobility and FM (adjusted OR 2.20, 95% CI 1.73, 2.80) and between hypermobility and breast implantation (adjusted OR 1.80, 95% CI 1.19, 2.69). No association was found between breast implantation and subsequent FM (adjusted OR 0.74, 95% CI 0.42, 1.32). CONCLUSION: Hypermobility was found to be independently associated with both FM and with breast implantation, but FM and breast implantation were not found to be independently associated with each other.

Adult↗

PubMed2001

Benign familial hypermobility syndrome and Trendelenburg sign in a painting "The Three Graces" by Peter Paul Rubens (1577-1640).

Clinical features suggestive of hypermobility syndrome and a positive Trendelenburg sign are described in a painting "The Three Graces" (1638-1640) by Peter Paul Rubens, Prado, Madrid. The most obvious findings are scoliosis, positive Trendelenburg sign, and hyperextension of the metacarpal joints, hyperlordosis, and flat feet. The sitters, presumably Hélène Fourment (second wife of Rubens) and her sisters, support the hereditary familial aspect of hypermobility. Manifest hypermobility of the hand has also been found in two other ancient paintings: "Saint Cyriaque" in the Heller Retable by Mathias Grünewald (1450-1528), Frankfurt, and "The wounded man" by Gaspare Traversi, Venice (1732-1769). The finding of signs of hypermobility in ancient paintings shows that artists who are keen observers of nature could describe, or at least record, this condition long before doctors did. The art of the past can be a useful tool in the field of paleopathology.

Female↗

PubMed2006

[Occupational differentiation in dentistry 3. Hypermobility of the temporomandibular joint and condylar position at maximal mouth opening].

Hypermobility of the temporomandibular joint is only noted when it interferes with smooth mandibular movements. These interferences may result from a condylar dislocation beyond the temporal eminence at maximum mouth opening. Aim of this study was to test whether the condyle of a symptomatically hypermobile temporomandibular joint is positioned more anterosuperiorly to the temporal eminence at maximum mouth opening than a condyle without hypermobility. Nine persons with a hypermobile temporomandibular joint and 9 control persons participated. Diagnostics were based upon opto-electronic mandibular movement recordings. Condylar positions at maximum mouth opening were assessed by magnetic resonance imaging. A small significant difference in condylar position was found between groups. Condyles of persons with a hypermobile temporomandibular joint moved beyond the temporal eminence. However, this was also true for nearly half of the control persons. This suggests that condylar position alone is not a sufficient condition for symptomatic hypermobility of the temporomandibular joint. Maybe, symptoms of hypermobility only become apparent in combination with a particular line of action of the masticatory muscles.

Adult↗

PubMed1991

[Joint hypermobility in Palma school children].

Joint mobility was examined on 1.136 schoolchildren of both sexes at the ages of 11 and 14 years. At the same time, they were asked if they had a history of bone fractures and about their weekly consumption of liver. The results were that 13% of the boys and 21% of the girls had hypermobility of their joints. A description is made of a short test to detect hypermobility. It was found that liver consumption and hypermobility are related, also that only in boys hypermobility is contrarily related with the history of fractures.

Adolescent↗

PubMed1995

Conservative management of posttraumatic cervical intersegmental hypermobility and anterior subluxation.

OBJECTIVE: To discuss the case of a young male football player who sustained a hyperflexion cervical injury, including radiographic evidence of intersegmental hypermobility and translational displacement with cervical hypolordosis and anterior subluxation. CLINICAL FEATURES: The patient suffered from neck pain, spasm, limited range of motion and mild sclerogenous referred arm pain. The results of neurological exams were normal. Radiographs of the cervical spine revealed cervical hypolordosis, intersegmental hypermobility and anterior subluxation. MRI was normal, with no evidence of disk herniation. INTERVENTION AND OUTCOME: The patient was immobilized for the first 10 days with a cervical collar and was administered adjunctive physiotherapy. Light cervical manipulative techniques were added in the subacute stage, as were isometric and tubing exercises. The patient responded quickly and favorably to care. Subsequent radiographs revealed a reversal and resolution of the abnormal findings of the cervical hypolordosis, anterior subluxation and intersegmental hypermobility that were initially seen. CONCLUSION: Conservative chiropractic management of hyperflexion injuries may be useful in reducing clinical symptoms, cervical hypolordosis, anterior subluxation and intersegmental hypermobility, as seen in follow-up radiographs. Chiropractic sports physicians have the diagnostic and therapeutic expertise to manage these types of athletic injuries.

Adolescent↗

PubMed1997

Prevalence and features of joint hypermobility among adolescent athletes.

OBJECTIVE: To determine the prevalence of joint hypermobility in a group of adolescent, interscholastic athletes. DESIGN: Cross-sectional; descriptive or observational. SETTING: Free preparticipation physical examinations for sports. SUBJECTS: Two hundred and sixty-four athletes (150 male, 114 female; average age, 15.5 years) comprised the entire set of athletes who came to our clinic for free physical examinations. INTERVENTION AND MAIN OUTCOME MEASURES: We screened 264 athletes using the widely accepted Carter-Wilkinson-Beighton method, which examines range of motion at the knees, trunk, fingers, thumbs, and elbows bilaterally and employs a 0 to 9 scoring scheme (5 = hypermobile). We also used an "injury allowance," whereby if an athlete screened positive for only one side of a bilateral test but had a history of injury to the corresponding side, he or she was given an injury allowance point. RESULTS: Thirty-two scored 5 or higher, with another 2 screening positive for hypermobility by the injury allowance, for a total of 34 hypermobile athletes (12.9%). There was a highly significant difference between sexes (P < .001), with 25 female (22%) and 9 male subjects (6%) testing positive. CONCLUSIONS: The overall prevalence of hypermobility and the significant sex difference found in this group of adolescent athletes were similar to nonathletes populations of comparable age. Research on nonathletes has been relied on by many to recommend that hypermobile persons avoid strenuous physical activity; however, research on athletes is less than conclusive. Given that a significant segment of young athletes, especially females, may be hypermobile, prospective studies are warranted to investigate this question before we can justify depriving hypermobile youths of the many known benefits of regular or strenuous exercise.

Adolescent↗

PubMed2004

A modified vaginal wall patch sling technique as a first-line surgical approach for genuine stress incontinence with urethral hypermobility: long-term follow up.

We describe our long-term outcome for patients with genuine stress incontinence (GSI) and urethral hypermobility using a modified vaginal wall patch sling technique. Fifty-three patients were studied. Preoperatively, all patients had a positive standing stress test and urethral hypermobility on Q-tip testing. On urodynamics, all patients had absence of detrusor contractions on subtracted cystometry. The mean age of the patients was 45+10.2 years. Forty-four patients demonstrated complete symptomatic and urodynamic improvement. Five patients had a noticeable failure observed within the first 12 months of follow up and four patients developed later recurrence despite initial success. The overall success rate after 5 years of follow up was 83% (n=44/53). The modified vaginal wall patch sling technique appears to have a good long-term success rate with low operative morbidity and minimal postoperative voiding dysfunction. The patch sling can be used as a first-line surgical approach for GSI with urethral hypermobility and be combined with other vaginal surgery.

Adult↗

PubMed2006

Hypermobility disorders in children and adolescents.

It is well recognized that many if not most children and adolescents attending paediatric rheumatology clinics will have a non-inflammatory origin for their complaints or disorder. Mechanical causes are frequently identified, and hypermobility or ligamentous laxity of joints is increasingly recognized as an aetiological factor in the presentation. Such conditions include 'growing pains', recurrent lower-limb arthralgia, anterior knee pain syndromes, and back pain. Studies of significant cohorts of such patients have now been published supporting the link of ligamentous laxity to particular symptom complexes. However, much disagreement remains as to the validity of hypermobility as an aetiogical factor. What seems clear is that not all hypermobile individuals will be symptomatic or indeed possibly have any risk for specific musculoskeletal disorders in later life. Screening tools such as the Beighton score are likely to be inadequate in many paediatric populations. Along with increasing recognition of these disorders in childhood and adolescence has been the development of a multidisciplinary management approach, which usually involves predominantly allied health professionals such as podiatrists, physiotherapists and occupational therapists. The challenge remains to interpret symptoms correctly as being related to the hypermobility and to predict why such children become symptomatic. The answer is likely to involve physiological and psychosocial factors. In addition, early identification and modification of risk factors may have major implications for subsequent prevalence of many adult medical disorders such as low back pain, chronic pain syndromes and degenerative osteoarthritis.

Adolescent↗

PubMed2003

Dysautonomia in the joint hypermobility syndrome.

PURPOSE: Extraarticular manifestations of the joint hypermobility syndrome may include the peripheral nervous system. The purpose of this study was to investigate autonomic function in patients with this syndrome. METHODS: Forty-eight patients with the joint hypermobility syndrome who fulfilled the 1998 Brighton criteria and 30 healthy control subjects answered a clinical questionnaire designed to evaluate the frequency of complaints related to the autonomic nervous system. Next, 27 patients and 21 controls underwent autonomic evaluation: orthostatic testing, cardiovascular vagal and sympathetic functions, catecholamine levels, and adrenoreceptor responsiveness. RESULTS: Symptoms related to the autonomic nervous system, such as syncope and presyncope, palpitations, chest discomfort, fatigue, and heat intolerance, were significantly more common among patients. Orthostatic hypotension, postural orthostatic tachycardia syndrome, and uncategorized orthostatic intolerance were found in 78% (21/27) of patients compared with in 10% (2/21) of controls. Patients with the syndrome had a greater mean (+/- SD) drop in systolic blood pressure during hyperventilation than did controls (-11 +/- 7 mm Hg vs. -5 +/- 5 mm Hg, P = 0.02) and a greater increase in systolic blood pressure after a cold pressor test (19 +/- 10 mm Hg vs. 11 +/- 13 mm Hg, P = 0.06). Patients with the syndrome also had evidence of alpha-adrenergic (as assessed by administration of phenylephrine) and beta-adrenergic hyperresponsiveness (as assessed by administration of isoproterenol). CONCLUSION: The autonomic nervous system-related symptoms of the patients have a pathophysiological basis, which suggests that dysautonomia is an extraarticular manifestation in the joint hypermobility syndrome.

Adolescent↗

PubMed2000

Modified Pereyra bladder neck suspension in patients with intrinsic sphincter deficiency and bladder neck hypermobility: patient satisfaction with a mean follow-up of 4 years.

OBJECTIVES: To determine the long-term success rate for the modified Pereyra bladder neck suspension and to identify preoperative characteristics that create differences in surgical outcome. We attempted retrospectively to separate those patients with what we now recognize was significant intrinsic sphincter deficiency (ISD) before routine use of Valsalva leak point pressures (VLPPs) was available. METHODS: The charts and videourodynamic reports of 208 patients who underwent a modified Pereyra bladder neck suspension from June 1988 to June 1996 were reviewed, and survey questionnaires were mailed to all patients. All videourodynamic study reports and charts were reviewed to identify those with what we now recognize was significant ISD and compare them with a group that we believed had more pure descent problems. RESULTS: A total of 135 patients or 65% of the population responded. The mean time after surgery was 4.14 years. At the follow-up survey, 14% reported no leakage at all, 42% reported very little or mild leakage, 38% reported moderate leakage, and 6% reported severe leakage. Fifty-three percent of patients continued to wear pads. Seventy-nine percent reported improvement in their leakage compared with the preoperative state, and 69% were satisfied with the results. When patients with preoperative ISD were compared with patients with pure bladder neck hypermobility, the ISD group had more leakage and less improvement after surgery than patients with bladder neck hypermobility. CONCLUSIONS: With an average follow-up of greater than 4 years, most women continued to leak with symptoms of stress urinary incontinence. Even though 79% reported improvement over their preoperative condition and 69% were satisfied, the results were disappointing. Patients with significant ISD had a worse outcome (2.6% dry) than patients with pure bladder neck hypermobility (20% dry). Given the above data, significant ISD is a contraindication for a modified Pereyra transvaginal needle suspension, and these data cast further doubt on the ability of the modified Pereyra needle suspension to consistently cure even anatomic incontinence.

Female↗

PubMed1999

Hypermobility and peripartum pelvic pain syndrome in pregnant South African women.

OBJECTIVE: To determine the incidence and correlation of joint hypermobility (HM) and peripartum pelvic pain (PPPP) in an homogeneous pregnant South African population. STUDY DESIGN: A cross-sectional study among Cape Coloured pregnant women. Joint mobility was measured by Beighton score; PPPP with a specially developed PPPP score. RESULTS: Using the Beighton scores with a cut-off point of HM > or = 5/9, only 4.9% of the 509 pregnant women were hypermobile. Hyperextension of the elbow was the largest contributor to HM (35.4%). No correlation of HM with the incidence of PPPP was established. Only 20 very mild cases of PPPP were recorded. Back pain increased significantly during pregnancy to a mean of 38%. Right handedness occurred in 95.9%. No significant relation was found between HM and the non-dominant side. CONCLUSION: Hypermobility in pregnant Cape Coloured women was surprisingly low (4.9%) with a decrease with age, but no increase during pregnancy. Peripartum pelvic pain is virtually absent and has no correlation with joint laxity. Back pain increased during pregnancy to a mean of 38%. Right handedness was high (96%) in comparison with the world-wide figure of 85%. No correlation was found between the dominant body side and hypermobility.

Adolescent↗

PubMed2003

Reduced skin thickness: a new minor diagnostic criterion for the classical and hypermobility types of Ehlers-Danlos syndrome.

BACKGROUND: The diagnosis of Ehlers-Danlos syndrome (EDS) is mainly based on clinical criteria, although in some instances a sound molecular diagnosis is available. Clinical signs can be divided into two categories: one with high diagnostic specificity and the other with low specificity. Despite the fact that reduced skin thickness is one of the dermatological features in patients with EDS, this issue has not been analysed in greater detail. OBJECTIVES: To determine skin thickness in patients with the classical and the hypermobility types of EDS. METHODS: In 21 patients with classical type of EDS and in nine patients with hypermobility type of EDS, skin thickness was analysed at different body sites by cross-sectional b-mode scans obtained with a 20-MHz ultrasound system. RESULTS: We found a significant decrease in skin thickness in both types of EDS, which was highest at the chest and at the distal part of the lower leg. CONCLUSIONS: We propose that the reduced thickness of the dermis as determined by high-resolution 20-MHz ultrasound can be used as a new minor criterion in the diagnosis of the classical and the hypermobility types of EDS.

Ehlers-Danlos Syndrome↗

PubMed1993

Temporomandibular joint osteoarthrosis and temporomandibular joint hypermobility.

For studying the relationship between condylar hypermobility of the temporomandibular joint (TMJ) and osteoarthrosis (OA), 13 patients with bilateral condylar hypermobility were evaluated clinically and radiographically, 30 years after non-surgical treatment. The evaluation included range of motion, joint and muscle tenderness to palpation, joint sounds and masticatory function. Radiographs of the TMJs were evaluated for the absence or presence of degenerative changes. The hypermobile group (HG) was compared with a control group (CG) (n = 13). The CG was evaluated in the same way as the HG. Statistics included t-tests (to compare ranges of motion in the HG over time and to compare ranges of motion in HG and CG), non-parametric tests (to compare tenderness of muscles and joints, joint sounds, masticatory function and radiographic changes over time in the HG). The tests were also used to compare the same variables between the HG and CG group. The groups' only difference was the presence of radiographic signs of OA. In the HG the number of joints with radiographic degenerative changes increased significantly over time and was significantly higher than the CG. Clinically and functionally, the HG and CG did not differ. Therefore, it is concluded that TMJ hypermobility is a subsidiary factor in the development of TMJ OA.

Adolescent↗