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PubMed2005

Foot pressure measurement differences between boys and girls with reference to hallux valgus deformity and hypermobility.

BACKGROUND: Previous studies that compared foot pressures in boys and girls found that girls had greater peak pressures under the hallux than did boys. Only one of these studies considered plantar pressure measurements in children. The purpose of the study was to investigate the effect of gender on foot pressure measurements in children. METHODS: This is a comparative study using the F-Scan pressure platform (F-Mat; Texscan Boston, MA) on a sample of children attending a podiatric clinic. Pressure measurements and temporal parameters were measured in 61 children between the ages of 5 and 16 years. Associations between joint hypermobility and hallux valgus angle also were investigated. RESULTS: Girls were found to have significantly greater peak pressure under the hallux, faster timing of heel contact to first metatarsal head loading, and a more medially placed center of pressure trajectory. No associations were found between these significant variables and hypermobility scores or hallux valgus angle. CONCLUSION: The results indicate that there are differences in pressure measurements between boys and girls, but the reasons for these remain unclear. Differences in pressure measurements in the feet of boys and girls may be useful in establishing the cause of foot pathologies for which a prevalence has been shown in boys or girls, such as hallux valgus deformity, which is known to be more frequent in females of all ages.

Adolescent↗

PubMed1996

Radiographic assessment of the second metatarsal: measure of first ray hypermobility.

Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7 degrees (range, 4-14 degrees), the average hallux valgus angle was 11 degrees (range, 4 degrees of varus to 30 degrees of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0-5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small (r < or = 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.

Adult↗

PubMed1979

Tarsal hypermobility after ankle fusion--fact or fiction?

Thirty-seven patients have been reviewed after arthrodesis of the ankle in order to determine the reduction of dorsiflexion and plantarflexion of the foot, the incidence of tarsal hypermobility and its relevance to the clinical results of this procedure. Radiological methods of measuring movements in the foot and tarsus are described and applied to patients who had a normal foot on the opposite side which could be used as a control. Our findings suggest that tarsal hypermobility is not as common as has hitherto been supposed and that a stiff foot with minor radiological degenerative changes in the tarsal joints is quite compatible with an excellent result.

Ankle Joint↗

PubMed2004

The relationship between echocardiographic features of mitral valve and elastic properties of aortic wall and Beighton hypermobility score in patients with mitral valve prolapse.

The present study was designed to investigate the incidence of benign joint hypermobility syndrome (BJHMS) in mitral valve prolapse (MVP) and the correlation between the echocardiographic features of the mitral valve and elastic properties of the aortic wall and Beighton hypermobility score (BHS) in patients with MVP and BJHMS. Fourty-six patients with nonrheumatic, uncomplicated, and isolated mitral anterior leaflet prolapse (7 men and 39 women, mean age; 26.1 +/- 5.9) and 25 healthy subjects (3 men and 22 women, mean age, 25.4 +/- 4.3) were studied. Patients were divided into two groups according to their BHS (group I, MVP+BJHMS; group II, MVP-BJHMS). Individuals with accompanying cardiac or systemic disease were excluded. Echocardiographic examination was performed in all subjects. The presence of BJHMS was evaluated according to Beighton's criteria. The incidence of BJHMS in patients with MVP was found to be significantly higher than that of controls (45.6%, (21/46) vs 12% (3/25), P < 0.0001). Group I (MVP + BJHMS) had significantly increased anterior mitral leaflet thickness (AMLT, 3.4 +/- 0.4 vs 3.1 +/- 0.3; P < 0.005), maximal leaflet displacement (MLD, 2.4 +/- 0.4 vs 1.7 +/- 0.4; P < 0.005), and degree of mitral regurgitation (DMR, 17.1 +/- 7.2 vs 11.2 +/- 4.4; P < 0.01) compared to group II. However, the index of aortic stiffness (IAOS) was found to be lower (17.6 +/- 6.9 vs 23.9 +/- 7.6; P < 0.005) and aortic distensibility (AOD) to be higher (0.0035 +/- 0.007 vs 0.0024 +/- 0.005; P < 0.005) in group I. There was a significant correlation between AMLT, MLD and DMR, and BHS (r = 0.57/P = 0.007, r = 0.55/P < 0.009, r = 0.51/P < 0.01, respectively). In addition, AOD correlated positively with BHS (r = 0.53/P < 0.005), but the index of aortic stiffness correlated inversely with BHS (r = -0.49/P < 0.007). The incidence of BJHMS in patients with MVP was more frequent than the normal population and there was a significant correlation between the severity of BJHMS (according to BHS) and echocardiographic features of the mitral leaflets and elastic properties of the aortic wall.

Adult↗

PubMed2002

Degenerative lumbar spondylolisthesis-induced radicular compression: nonfusion-related decompression in selected patients without hypermobility on flexion-extension radiographs.

OBJECT: The authors conducted a study to determine the results of decompressive surgery without fusion in selected patients who presented with radicular compression syndromes caused by degenerative lumbar spondylolisthesis and in whom there was no evidence of hypermobility on flexion-extension radiographs. METHODS: The medical records and radiographs obtained in 49 patients were reviewed retrospectively. Clinical status was quantified by summing self-assessed Prolo Scale scores. All 49 patients (55% female, mean age 68.7 years) presented with leg pain accompanied by lumbalgia in 85.7% of the cases. Preoperatively the median sum of Prolo Scale scores was 4. The mean preoperative degree of forward vertebral displacement was 13.5% and was located at L-4 in 67% of the cases. Osseous decompression alone was performed in 53%, and an additional discectomy at the level of displacement was undertaken in the remaining patients because of herniated discs. Major complications (deep wound infection) occurred in 2%. During a mean follow-up period of 3.73 years, 10.2% of the patients underwent instrumentation-assisted lumbar fusion when decompression alone failed to resolve symptoms. At last follow up the median overall Prolo Scale score was 8. Excellent and good results were demonstrated in 73.5% of the patients. Prolonged back pain (r = 0.381) as well as the preoperative degree of displacement (r = 0.81) and disc space height (r = 0.424) influenced outcome (p < or = 0.05); additional discectomy for simultaneous disc herniation at the displaced level did not influence outcome (p > 0.05). CONCLUSIONS: These results appear to support a less invasive approach in this subgroup of elderly patients with degenerative lumbar spondylolisthesis-induced radicular compression syndromes and without radiographically documented hypermobility. Additional discectomy for simultaneous disc herniation of the spondylolisthetic level did not adversely influence the outcome. Complication rates are minimized and fusion can eventually be performed should decompression alone fail. A prospective controlled study is required to confirm these results.

Decompression, Surgical↗

PubMed2000

Hypermobility--not a circus act.

Joint hypermobility results from genetic variations in connective tissue matrix proteins resulting in stretchier tissues. For many it is an asset that confers greater facility for physical prowess. Others, less fortunate, fall prey to the associated effects of tissue fragility. The most frequently encountered constellation of traumatic and overuse injuries is termed the (benign joint) hypermobility syndrome (BJHS). This condition, poorly understood, frequently overlooked, misdiagnosed and inappropriately treated, is the cause of much needless suffering and anguish. Accumulating evidence suggests that BJHS represents a forme fruste of an heritable disorder of connective alongside Marfan syndrome, Ehlers-Danlos syndrome and osteogenesis imperfecta, with which it shares many overlapping features, but from which it can be phenotypically distinguished on the basis of clinical features and prognosis. The responsible gene defects have yet to be elucidated.

Adolescent↗

PubMed2004

[Genital prolapse in women and articular hypermobility syndrome in connective tissue dysplasia].

AIM: To examine relationships between genital prolapse and joint hypermobility (JHM), between GP severity and degree of JHM, to reveal causes of GP in JHM patients. MATERIAL AND METHODS: A total of 208 females with GP (mean age 38.9 years) entered the trial. They were divided into three groups by severity of connective tissue dysplasia (CTD): with mild CTD--16.3%, moderate CTD--35.6% and severe CTD--48.1%. The following methods of investigation were used: podometric Freedland's technique, ultrasonic investigation of the gall bladder, kidneys, echocardiography, morphological study of platelets, morphological and immunohistochemical study of the ligaments. RESULTS: In GP patients JHM occurred in 41.8% patients. Hypermobility of large joints reaches 38.9%, large--20.7%. Such associated manifestations of CTD as flatfoot, JHM, deformation of the spine, varicosity, predisposition to vegetovascular dysfunctions, mitral prolapse, arrhythmia, impaired conduction, refraction, gastroptosis, nephroptosis, hernias were observed in 69.2, 46.1, 38, 53.8, 49, 43.3, 38, 19.2, 12, 6.7, 14.4%, respectively. The morphological changes are explained by 40 +/- 15% type 1-3 collagen loss in the interstitial substance. Severe forms of GP in patients with JHM were observed in 84%. 52.4% females with JHM developed severe GP within 3 years after delivery of a child. Most of the examinees carried undifferentiated congenital dysplasias. CONCLUSION: JHM is a criterion of CTD diagnosis.

Adult↗

PubMed2006

Benign joint hypermobility syndrome: evaluation, diagnosis, and management.

Benign joint hypermobility syndrome (BJHS) is a connective tissue disorder with hypermobility in which musculoskeletal symptoms occur in the absence of systemic rheumatologic disease. Although BJHS has been well recognized in the rheumatology and orthopedic literature, it has not been discussed in the family medicine literature. Because most patients with musculoskeletal complaints are first seen by family physicians, it behooves primary care physicians to be familiar with recognizing and diagnosing BJHS. When patients with this syndrome are first seen by a physician, their chief complaint is joint pain, so BJHS can be easily overlooked and not considered in the differential diagnosis. Use of the Brighton criteria facilitates the diagnosis of BJHS. Treatment modalities include patient education, activity modification, stretching and strengthening exercises for the affected joint, and osteopathic manipulative treatment.

Diagnosis, Differential↗

PubMedDate not supplied

[Hypermobility of the knee joint in osteoarthrosis].

In order to study the status of the ligamentous-muscular system of the knee joint in patients with osteoarthrosis using functional roentgenological method hypermobility of the knee joint was determined. Hypermobility of the joint was observed even in the early stage of osteoarthrosis which progressed with the development of the disease.

Adult↗

PubMedDate not supplied

Does generalised articular hypermobility predispose to generalised osteoarthritis?

Three elderly female patients are reported who had constitutional hypermobility with associated osteoarthritis; none had extensive involvement of either their inter-phalangeal joints or hips. The findings in these cases suggest that osteoarthritis occurring in hypermobile subjects has a restricted rather than a generalised distribution. Osteoarthritis seen in the elderly may be the result of differing mechanisms at different anatomical sites, and articular hypermobility may be a predisposing factor in only a limited number of joints.

Aged↗

PubMed1983

[Constitutional hypermobility as a problem in the rehabilitation of "vertebragenous" pain syndromes].

Load-dependent pain in the locomotion system in generally a sign of muscular incoordinations. The type of muscle disturbance is used as an indicant for purposeful physiotherapy. Patients with "constitutional hypermobility" belong to the physiotherapeutic problem patients. Such patients show signs of minimal brain dysfunction like those described by Janda for adults. It is suspected that constitutional hypermobility is only a single expression of a complex motor control disturbance in which muscular hypotonia plays an important role. This always involves considerable problems in connection with rehabilitation.

Adult↗

PubMed1998

Joint hypermobility in patients with fibromyalgia syndrome.

OBJECTIVE: To test the hypothesis that joint hyperlaxity can play some role in the pathogenesis of pain in primary fibromyalgia. METHODS: A total of 66 women with fibromyalgia (according to the 1990 American College of Rheumatology criteria) and 70 women with other rheumatic diseases were examined for joint laxity based on 5 criteria (The Non-Dominant Spanish modification). Individuals meeting 4 or 5 criteria were considered to be hyperlax. RESULTS: Joint hyperlaxity was detected in 18 (27.3%) of the patients with fibromyalgia and 8 (11.4%) of those with another rheumatic disorder. The statistical analysis revealed significant differences (P < 0.05) between both groups. CONCLUSION: The results of this study suggest that joint hypermobility and fibromyalgia are associated. Joint hyperlaxity may play a prominent role in the pathogenesis of pain in fibromyalgia.

Adolescent↗

PubMed1992

The molecular defect in a family with mild atypical osteogenesis imperfecta and extreme joint hypermobility: exon skipping caused by an 11-bp deletion from an intron in one COL1A2 allele.

We have investigated a family with an autosomal dominantly inherited connective-tissue defect causing extreme joint hypermobility, premature osteoporosis and late-onset fractures. Analysis of collagenous proteins from affected individuals showed a deletion in some alpha 2(I) chains. Peptide mapping localized this to the CB peptide alpha 2CB4, which covers the N-terminal one-third of the protein chain. Polymerase chain reaction amplification and sequencing of cDNA derived from this region of the mRNA identified a heterozygous deletion of the 54 bp comprising exon 9. Similar analysis of the genomic DNA revealed an 11-bp deletion from bp3 to bp13 of IVS-9. This disrupts the consensus 5' splice signal (GTAAGT) and leads to exon skipping. In a family study of 13 affected and unaffected family members using both heteroduplex formation and direct analysis for the deletion, all of the affected, but no unaffected individuals, were found to carry the deletion. This generated a positive Lod score of 2.6 with the Liped programme.

Alleles↗

PubMed1988

Benign joint hypermobility with neuropathies: documentation and mechanism of median, sciatic, and common peroneal nerve compression.

We report three patients in whom carpal tunnel syndrome was due to neurapraxis as a consequence of unusual sleep postures enabled by their benign joint hypermobility syndrome (BJHS). A fourth patient also had bilateral sensory sciatic neuropathy and a common peroneal palsy, similarly due to regularly adopted unusual postures. Recognition of such cause-effect mechanisms and their simple solution in BJHS should obviate needless investigation and unnecessary surgery.

Adult↗

PubMed2000

Benign hypermobility syndrome in Greek schoolchildren.

Since the incidence of benign hypermobility syndrome is significantly high in otherwise healthy children, paediatricians should consider this benign entity when they evaluate musculoskeletal complaints in childhood.

Adolescent↗

PubMed2004

[Concomitant diseases in primary joint hypermobility syndrome].

The primary joint hypermobility syndrome (pJH) is an overlap disorder of connective-tissue dysplasias, which incorporates features seen in the Marfan syndromes (MFS), Ehlers-Danlos syndromes (EDS), and osteogenesis imperfecta. Patients with pJH usually present arthralgia, back pain, soft-tissue lesions, recurrent joint dislocation, or subluxation. Extraarticular features may include, e. g., striae cutis, keratoconus, easy bruising, mitral valve prolapse, aortic incompetence, aneurysms, pneumothorax, hernia, urinary incontinence, and pelvic floor prolapse. Due to the high frequency of critical dissection and rupture, the early recognition of rare life-threatening complications such as dilatation of the aortic root and aneurysms is important. Therefore, patients (and their family members) with pJH should also be examined for life-threatening features seen in MFS and EDS.

Adolescent↗

PubMed2003

The association of obstructive defecation, lower urinary tract dysfunction and the benign joint hypermobility syndrome: a case-control study.

It has been suggested that, apart from obstetric trauma, chronic straining at stool may also result in pudendal nerve damage, contributing to the etiology of genuine stress incontinence (GSI). The benign joint hypermobility syndrome (BJHS) has been associated with rectal as well as uterovaginal prolapse, suggesting that connective tissue abnormalities may also be implicated. This study was undertaken in order to further investigate whether - and if so, why - an association may exist between symptoms of obstructive defecation, lifetime constipation, chronic heavy lifting and lower urinary tract (LUT) dysfunction. Cases were female patients referred for urodynamic assessment with symptoms of LUT dysfunction. Controls were age-, sex- and postcode-matched community controls. Both cases and controls were assessed using a detailed questionnaire that also asked about symptoms of BJHS. Cases were also divided into their urodynamic classification of LUT dysfunction. All symptoms of obstructive defecation (52.3% vs 33.6%, P=0.00003), as well as chronic straining at stool (38.6% vs 23.4%, P=0.0005), were significantly more common in women with LUT dysfunction than in community controls. BJHS, chronic heavy lifting and a history of uterovaginal prolapse were significantly associated with patients with LUT and obstructive defecation compared to those with LUT dysfunction alone. Overall, symptoms of obstructed defecation were not more prevalent in any one urodynamic diagnostic group than in others. However, childhood constipation and current constipation were significantly more prevalent in women with voiding dysfunction than in those with other urodynamic diagnoses (16.7% vs 5.5%, P = 0.0030 and 13.0% vs 5.7%, P = 0.017). We concluded that women with LUT dysfunction are more likely to have symptoms of obstructive defecation than are community controls. Connective tissue disorders such as BJHS may be an important factor in this association.

Case-Control Studies↗

PubMed1999

Vaginal nylon sling: loop length and surgical outcomes in those with urethral hypermobility and intrinsic sphincter deficiency.

Fifty-four women with stress incontinence underwent a vaginal nylon sling procedure. Of these, 15 were diagnosed as having type I, 27 as type II, and 12 as type III genuine stress incontinence. Follow-up averaged 25 months (range 6-42). The total suture length prior to ligation, which supports the bladder neck with no tension, varied from 200 to 313 mm and demonstrated weak correlation with body mass index (R2 = 0.076, P = 0.043) and body weight (R2 = 0.082, P = 0.036). The objective success rate was 89% (48 of 54 patients) 25 months later; the subjective rate was 93% (50 of 54 patients). Kaplan-Meier analysis demonstrated that the cumulative continence rate was 85.6% at 42 months for those with type I, 88.4% at 42 months for those with type II, and 91.7% at 40 months for those with type III incontinence (P>0.05). The main postoperative complication was retention or difficulty in urination. It was concluded that the total suture length cannot be determined in relation to patient's physical parameters, but rather on surgical experience, and that this operation is recommended to those with not only intrinsic sphincter deficiency but also with urethral hypermobility, provided surgery is executed with safe precautions.

Adult↗