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Cronström A, Creaby MW, Nae J, Ageberg E. Modifiable Factors Associated with Knee Abduction During Weight-Bearing Activities: A Systematic Review and Meta-Analysis. Sports Med 2018; 46:1647-1662. [PMID: 27048463 DOI: 10.1007/s40279-016-0519-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Increased knee abduction angle during activity is suggested to be a risk factor for sustaining an anterior cruciate ligament (ACL) injury or developing patellofemoral pain syndrome (PFPS). Knowledge of the modifiable mechanisms that are associated with increased knee abduction will aid in the appropriate design of preventive and rehabilitative strategies for these injuries. OBJECTIVE Our objective was to systematically review modifiable mechanisms contributing to increased knee abduction in healthy people and in individuals with an ACL injury or PFPS. METHODS We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the databases MEDLINE, CINAHL, and Embase until September 2015. Inclusion criteria were studies in healthy individuals and/or those with ACL injury or PFPS reporting (1) muscle strength, muscle activation, proprioception, and/or range of motion (ROM) and (2) knee abduction angle assessed with either motion analysis or visual observation during weight-bearing activity. RESULTS In total, 33 articles were included. Reduced trunk strength, reduced gluteus maximus amplitude, decreased ankle ROM, and increased hip external rotation ROM were moderately associated with increased knee abduction angle (r -0.34 or higher, standardized difference in means (SDM) greater than -0.39, p < 0.05, articles n = 3, total sample size n = 101-114) in healthy individuals. Decreased strength of hip abductors, external rotators, and extensors and knee flexors were at most weakly associated with increased knee abduction angle (r ≤ 0.21, p = 0.013-0.426, articles n = 2-9, total sample size n = 80-311). Too few articles included patients with knee injury to be included in any meta-analysis. CONCLUSION The associations identified in this review indicate that investigation of strengthening of the trunk muscles, and improvement of gluteus maximus activation and ankle ROM to change knee kinematics is merited. Studies on modifiable factors associated with increased knee abduction angle in people with knee injury are needed.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, QLD, Australia
| | - Jenny Nae
- Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden
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Cooper DJ, Scammell BE, Batt ME, Palmer D. Development and validation of self-reported line drawings of the modified Beighton score for the assessment of generalised joint hypermobility. BMC Med Res Methodol 2018; 18:11. [PMID: 29343224 PMCID: PMC5772709 DOI: 10.1186/s12874-017-0464-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/20/2017] [Indexed: 12/01/2022] Open
Abstract
Background The impracticalities and comparative expense of carrying out a clinical assessment is an obstacle in many large epidemiological studies. The purpose of this study was to develop and validate a series of electronic self-reported line drawing instruments based on the modified Beighton scoring system for the assessment of self-reported generalised joint hypermobility. Methods Five sets of line drawings were created to depict the 9-point Beighton score criteria. Each instrument consisted of an explanatory question whereby participants were asked to select the line drawing which best represented their joints. Fifty participants completed the self-report online instrument on two occasions, before attending a clinical assessment. A blinded expert clinical observer then assessed participants’ on two occasions, using a standardised goniometry measurement protocol. Validity of the instrument was assessed by participant-observer agreement and reliability by participant repeatability and observer repeatability using unweighted Cohen’s kappa (k). Validity and reliability were assessed for each item in the self-reported instrument separately, and for the sum of the total scores. An aggregate score for generalised joint hypermobility was determined based on a Beighton score of 4 or more out of 9. Results Observer-repeatability between the two clinical assessments demonstrated perfect agreement (k 1.00; 95% CI 1.00, 1.00). Self-reported participant-repeatability was lower but it was still excellent (k 0.91; 95% CI 0.74, 1.00). The participant-observer agreement was excellent (k 0.96; 95% CI 0.87, 1.00). Validity was excellent for the self-report instrument, with a good sensitivity of 0.87 (95% CI 0.81, 0.91) and excellent specificity of 0.99 (95% CI 0.98, 1.00). Conclusions The self-reported instrument provides a valid and reliable assessment of the presence of generalised joint hypermobility and may have practical use in epidemiological studies. Electronic supplementary material The online version of this article (10.1186/s12874-017-0464-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dale J Cooper
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England
| | - Brigitte E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England. .,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England. .,Nottingham University Hospitals NHS Trust, Nottingham, England.
| | - Mark E Batt
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England.,Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Debbie Palmer
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England.,School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland
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53
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Bukva B, Vrgoč G, Madić DM, Sporiš G, Trajković N. Correlation between hypermobility score and injury rate in artistic gymnastics. J Sports Med Phys Fitness 2018; 59:330-334. [PMID: 29327826 DOI: 10.23736/s0022-4707.18.08133-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Generalized joint hypermobility (GJH) is suggested as a contributing factor for injuries in young athletes and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of joint and soft tissue injuries during sports activities. The aim of this study was to determine the correlation between the hypermobility score (using the Beighton`s modification of the Carter-Wilkinson criteria of hypermobility) in gymnasts and injury rate, during the period of one year. METHODS This study observed 24 artistic gymnasts (11-26 years old), members of Qatar National Team in artistic gymnastics. We examined the Beighton joint hypermobility screen and a seasonal injury survey. The gymnasts characteristics (age, gender) and gymnastics characteristics (training per day and number of years in training artistic gymnastics) and their relations to injury rate were also included. RESULTS The most common injury was the lower back pain injury, followed by knee, shoulder, hip and ankle injuries. We found strong correlation of number of years gymnastics training and injury rate (P<0.001). There is no significant correlation in the numbers of training hours during one week and hypermobility score to numbers of injuries (P>0.05). CONCLUSIONS According to this study there is no correlation between GJH and injury rate in artistic gymnasts in Qatar. Total training period in gymnastics have greater contribution in injury rate.
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Affiliation(s)
- Bojan Bukva
- National Sports Medicine Program in Sports Medicine and Orthopedic Surgery Hospital Aspetar, Doha, Qatar
| | - Goran Vrgoč
- Department of Orthopaedic Surgery, Sveti Duh University Hospital, Zagreb, Croatia
| | - Dejan M Madić
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Goran Sporiš
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Nebojša Trajković
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia -
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ASTUR DIEGOCOSTA, LARA PAULOHENRIQUESCHMIDT, SANTOS MARCELOABDULKLECH, OLIVEIRA GABRIELTANIGUTIDE, ARLIANI GUSTAVOGONÇALVES, COHEN MOISÉS. INFLUENCE OF JOINT HIPERMOBILITY ON POSTOPERATIVE RESULTS OF KNEE SURGERY. ACTA ORTOPEDICA BRASILEIRA 2018; 26:19-21. [PMID: 29977138 PMCID: PMC6025503 DOI: 10.1590/1413-785220182601174568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the prevalence of joint hypermobility in patients undergoing knee surgery to treat traumatic injury to the meniscus and anterior cruciate ligament, and the influence of this hypermobility on postoperative results. Methods: This prospective study assessed joint hypermobility in patients who underwent surgical reconstruction of the anterior cruciate ligament (ACL), partial meniscectomy, or a procedure combining ACL reconstruction and partial meniscectomy during the period 2011-2015. The Beighton score was used to evaluate joint hypermobility and Tegner activity scale for postoperative assessment. Results: A total of 242 patients underwent surgery during the study period: 107 to treat ACL injuries, 75 to treat ACL injuries associated with meniscus injuries, and 60 to treat meniscus injuries. Of the total, 45 patients had joint hypermobility. We found no association between joint hypermobility and sex or type of injury. Postoperative Tegner scale results were not influenced by the presence of joint hypermobility. Conclusion: No association was found between joint hypermobility and the evaluated variables (gender and type of specific injury), and hypermobility did not have a negative impact on postoperative outcomes. Level of Evidence IV; Case series.
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Junge T, Henriksen P, Hansen S, Østengaard L, Golightly YM, Juul-Kristensen B. Generalised joint hypermobility and knee joint hypermobility: prevalence, knee joint symptoms and health-related quality of life in a Danish adult population. Int J Rheum Dis 2017; 22:288-296. [DOI: 10.1111/1756-185x.13205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Tina Junge
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
- Health Sciences Research Centre; University College Lillebaelt; Odense Denmark
| | - Peter Henriksen
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
- Health Sciences Research Centre; University College Lillebaelt; Odense Denmark
| | - Sebrina Hansen
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
| | - Lasse Østengaard
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
| | - Yvonne M. Golightly
- Department of Epidemiology; University of North Carolina; Chapel Hill North Carolina USA
- Thurston Arthritis Research Center; University of North Carolina; Chapel Hill North Carolina USA
- Injury Prevention Research Center; University of North Carolina; Chapel Hill North Carolina USA
- Division of Physical Therapy; University of North Carolina; Chapel Hill North Carolina USA
| | - Birgit Juul-Kristensen
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
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Engelbert RHH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JV. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:158-167. [PMID: 28306230 DOI: 10.1002/ajmg.c.31545] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.
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Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries. J Orthop Sports Phys Ther 2017; 47:792-800. [PMID: 28915772 DOI: 10.2519/jospt.2017.7682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional. Background Generalized joint hypermobility (GJH) may increase pain and likelihood of injuries and also decrease function and health-related quality of life (HRQoL) in elite-level adolescent athletes. Objective To assess the prevalence of GJH in elite-level adolescent athletes, and to study the association of GJH with pain, function, HRQoL, and musculoskeletal injuries. Methods A total of 132 elite-level adolescent athletes (36 adolescent boys, 96 adolescent girls; mean ± SD age, 14.0 ± 0.9 years), including ballet dancers (n = 22), TeamGym gymnasts (n = 57), and team handball players (n = 53), participated in the study. Generalized joint hypermobility was classified by Beighton score as GJH4 (4/9 or greater), GJH5 (5/9 or greater), and GJH6 (6/9 or greater). Function of the lower extremity, musculoskeletal injuries, and HRQoL were assessed with self-reported questionnaires, and part of physical performance was assessed by 4 postural-sway tests and 2 single-legged hop-for-distance tests. Results Overall prevalence rates for GJH4, GJH5, and GJH6 were 27.3%, 15.9%, and 6.8%, respectively, with a higher prevalence of GJH4 in ballet dancers (68.2%) and TeamGym gymnasts (24.6%) than in team handball players (13.2%). There was no significant difference in lower extremity function, injury prevalence and related factors (exacerbation, recurrence, and absence from training), HRQoL, or lengths of hop tests for those with and without GJH. However, the GJH group had significantly larger center-of-pressure path length across sway tests. Conclusion For ballet dancers and TeamGym gymnasts, the prevalence of GJH4 was higher than that of team handball players. For ballet dancers, the prevalence of GJH5 and GJH6 was higher than that of team handball players and the general adolescent population. The GJH group demonstrated larger sway in the balance tests, which, in the current cross-sectional study, did not have an association with injuries or HRQoL. However, the risk of having (ankle) injuries due to larger sway for the GJH group must be studied in future longitudinal studies. J Orthop Sports Phys Ther 2017;47(10):792-800. doi:10.2519/jospt.2017.7682.
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Oddy C, Johnson MI, Jones G. The effect of generalised joint hypermobility on rate, risk and frequency of injury in male university-level rugby league players: a prospective cohort study. BMJ Open Sport Exerc Med 2017; 2:e000177. [PMID: 28890803 PMCID: PMC5566262 DOI: 10.1136/bmjsem-2016-000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 11/12/2022] Open
Abstract
Background Rugby league is a collision sport where musculoskeletal injuries are common. There has been little research on generalised joint hypermobility (GJH) as a risk factor for injury in rugby league. The aim of this study was to investigate the role of GJH on the incidence of injuries in first and second team rugby league players from one British university. Methods We conducted a prospective cohort study of 45 student players from one British university first and second team rugby league squads (mean age 20.93±1.57 years). At the beginning of the season, GJH was determined using a 9-point Beighton scale, and injury and exposure data were collected on a weekly basis throughout the 2013–2014 season. Results The prevalence of GJH was 20%. There was no statistically significant difference in the frequency of injuries between GJH and non-GJH participants (p=0.938, Mann-Whitney U test).Participants categorised as having GJH did not experience a higher fequency of injury (p=0.722, Fisher's exact test) and there was no tendency to demonstrate a higher risk of injury for participants categorised as GJH (OR=0.64, 95% CI 0.15 to 2.78; relative risk (RR)=1.188, 95% CI 0.537 to 2.625). The most common site of injury was the ankle, but this was not statistically significant (OR=0.152, 95% CI 0.008 to 2.876; RR=0.195, CI 0.012 to 3.066). Conclusion British university rugby league players with GJH did not demonstrate a greater risk of injury than those without GJH.
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Affiliation(s)
- Cassie Oddy
- Faculty of Health & Social Sciences, Leeds Beckett University, Leeds, UK
| | - Mark I Johnson
- Faculty of Health & Social Sciences, Leeds Beckett University, Leeds, UK
| | - Gareth Jones
- Faculty of Health & Social Sciences, Leeds Beckett University, Leeds, UK
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Kumar B, Lenert P. Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain. Am J Med 2017; 130:640-647. [PMID: 28286166 DOI: 10.1016/j.amjmed.2017.02.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/24/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
Joint hypermobility syndrome, also known as benign hypermobility syndrome, is a connective tissue disease characterized by joint instability, chronic pain, and minor skin changes. It shares many clinical features of Ehlers-Danlos syndrome, Hypermobility Type; enough so that many authorities consider them as one disease process. Approximately 3% of the general population is believed to have joint hypermobility syndrome, but despite this high prevalence, due to lack of awareness, heterogeneity of clinical presentation, and reliance on physical examination for diagnosis, it is largely overlooked by primary care physicians as well as by specialists. This leads to delayed or missed opportunities for diagnosis, and inappropriate interventions that frustrate both providers and patients. We review the literature regarding the pathophysiology, diagnosis, treatment options, and prognosis of joint hypermobility syndrome, and advocate for primary care physicians to consider it in the differential diagnosis of patients with chronic pain.
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Affiliation(s)
- Bharat Kumar
- Division of Immunology, University of Iowa, Iowa City.
| | - Petar Lenert
- Division of Immunology, University of Iowa, Iowa City
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60
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Juul-Kristensen B, Østengaard L, Hansen S, Boyle E, Junge T, Hestbaek L. Generalised joint hypermobility and shoulder joint hypermobility, - risk of upper body musculoskeletal symptoms and reduced quality of life in the general population. BMC Musculoskelet Disord 2017; 18:226. [PMID: 28558742 PMCID: PMC5450151 DOI: 10.1186/s12891-017-1595-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/22/2017] [Indexed: 12/16/2022] Open
Abstract
Background Generalised Joint Hypermobility (GJH) is a hereditary condition with an ability to exceed the joints beyond the normal range. The prevalence of GJH in the adult population and its impact on upper body musculoskeletal health and quality of life has mostly been studied in selected populations. The aims of this study were therefore, firstly to study the prevalence of GJH and GJH including shoulder hypermobility (GJHS), in the general Danish adult population; secondly to test the associations between GJH or GJHS and upper body musculoskeletal symptoms and health-related quality of life (HRQoL). Methods The study was cross-sectional where 2072 participants, aged 25–65, randomly extracted from the Danish Civil Registration System), were invited to answer a questionnaire battery (Five-Part Questionnaire for classification of GJH, Standardised Nordic Questionnaire for musculoskeletal symptoms, EuroQoL-5D for HRQoL). Results Totally 1006 (49%) participants responded. The prevalence of GJH and GJHS were 30% (n = 300) and 5% (n = 51), respectively. Compared with Non GJH (NGJH), participants with GJH and GJHS had Odds Ratio (OR) of 1.5-3.5 for upper body musculoskeletal symptoms within the last 12 months (mostly shoulders and hands/wrists). GJH and GJHS also had OR 1.6–4.4 for being prevented from usual activities, mostly due to shoulder and neck symptoms. Furthermore, GJH and GJHS had OR 2.2–3.1 for upper body musculoskeletal symptoms lasting for more than 90 days (neck, shoulders, hand/wrists), and 1.5–3.5 for reduced HRQoL (all dimensions, but anxiety/depression) compared with NGJH. Generally, most OR for GJHS were about twice as high as for those having GJH alone. Conclusions GJH and GJHS are frequently self-reported musculoskeletal conditions in the Danish adult population. Compared with NGJH, GJH and especially GJHS, present with higher OR for upper body musculoskeletal symptoms, more severe symptoms and decreased HRQoL.
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Affiliation(s)
- Birgit Juul-Kristensen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Lasse Østengaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sebrina Hansen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tina Junge
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Lise Hestbaek
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Naal FD, Müller A, Varghese VD, Wellauer V, Impellizzeri FM, Leunig M. Outcome of Hip Impingement Surgery: Does Generalized Joint Hypermobility Matter? Am J Sports Med 2017; 45:1309-1314. [PMID: 28141941 DOI: 10.1177/0363546516688636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Generalized joint hypermobility (JH) might negatively influence the results of surgical femoroacetabular impingement (FAI) treatment, as JH has been linked to musculoskeletal pain and injury incidence in athletes. JH may also be associated with worse outcomes of FAI surgery in thin females. PURPOSE To (1) determine the results of FAI surgery at a minimum 2-year follow-up by means of patient-reported outcome measures (PROMs) and failure rates, (2) assess the prevalence of JH in FAI patients and its effect on outcomes, and (3) identify other risk factors associated with treatment failure. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We included 232 consecutive patients (118 females; mean age, 36 years) with 244 hips surgically treated for symptomatic FAI between 2010 and 2012. All patients completed different PROMs preoperatively and at a mean follow-up of 3.7 years. Satisfaction questions were used to define subjective failure (answering any of the 2 subjective questions with dissatisfied/ very dissatisfied and/or didn't help/ made things worse). Conversion to total hip replacement (THR) was defined as objective failure. JH was assessed using the Beighton score. RESULTS All PROM values significantly ( P < .001) improved from preoperative measurement to follow-up (Oxford Hip Score: 33.8 to 42.4; University of California at Los Angeles Activity Scale: 6.3 to 7.3; EuroQol-5 Dimension Index: 0.58 to 0.80). Overall, 34% of patients scored ≥4 on the Beighton score, and 18% scored ≥6, indicating generalized JH. Eleven hips (4.7%) objectively failed and were converted to THR. Twenty-four patients (10.3%) were considered as subjective failures. No predictive risk factors were identified for subjective failure. Tönnis grade significantly ( P < .001) predicted objective failure (odds ratio, 13; 95% CI, 4-45). There was a weak inverse association ( r = -0.16 to -0.30) between Beighton scores and preoperative PROM values. There were no significant associations between Beighton scores and postoperative PROM values or subjective failure rates, but patients who objectively failed had lower Beighton scores than did nonfailures (1.6 vs 2.6; P = .049). CONCLUSION FAI surgery yielded favorable outcomes at short- to midterm follow-up. JH as assessed by the Beighton score was not consistently associated with subjective and objective results. Joint degeneration was the most important risk factor for conversion to THR. Although statistical significance was not reached, female patients with no joint degeneration, only mild FAI deformity, and higher Oxford scores at the time of surgery seemed to be at increased risk for subjective dissatisfaction.
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Affiliation(s)
- Florian D Naal
- Technical University of Munich, Munich, Germany.,Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Aileen Müller
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Viju D Varghese
- Department of Orthopaedic Surgery, Christian Medical Center, Vellore, India
| | - Vanessa Wellauer
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | | | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
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Hypermobility and Musculoskeletal Pain in Adolescents. J Pediatr 2017; 181:213-221.e1. [PMID: 27863848 DOI: 10.1016/j.jpeds.2016.09.060] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/23/2016] [Accepted: 09/28/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of generalized joint hypermobility (GJH) in a large cohort of Australian children and determine the associations between GJH and musculoskeletal pain. STUDY DESIGN This is a cross-sectional analysis of the Western Australian Pregnancy Cohort (Raine) Study. Hypermobility was measured in 1584 participants at 14 years of age using the Beighton scoring system, along with a range of other factors including musculoskeletal pain status. Logistic regression models were used to assess independent associations of GJH with factors of interest. RESULTS The prevalence of GJH was 60.6% and 36.7% in girls and boys, respectively, when defined as a Beighton score of ≥4; when defined as ≥6, it was 26.1% and 11.5%. In girls, positive associations between GJH and higher socioeconomic status and better motor competence were observed. In boys, positive associations between GJH and lower body mass index were observed. After adjusting for potential confounders, an association between number of pain areas in the last month and made worse with sport were identified in boys but not girls. CONCLUSION The high prevalence rates of GJH as defined by commonly used Beighton cutoff values in this cohort highlight the need to question the appropriateness of these cutoffs in future studies. Future prospective studies of the association between GJH and musculoskeletal pain should be adjusted for confounding variables identified in this study, and be powered for sex-specific analyses owing to the differing prevalence rates and hypermobility correlates in male and female samples.
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Blokland D, Thijs KM, Backx FJG, Goedhart EA, Huisstede BMA. No Effect of Generalized Joint Hypermobility on Injury Risk in Elite Female Soccer Players: A Prospective Cohort Study. Am J Sports Med 2017; 45:286-293. [PMID: 28146401 DOI: 10.1177/0363546516676051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although it has been suggested that generalized joint hypermobility (GJH) is a risk factor for injury in soccer players, it remains unclear whether this applies to elite female soccer players. PURPOSE To investigate whether GJH is a risk factor for injury in elite female soccer players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Elite female soccer players in the Netherlands were screened at the start of the 2014-2015 competitive season. GJH was assessed using the Beighton score. Soccer injuries and soccer exposure were registered throughout the entire season. Poisson regression was performed to calculate incidence risk ratios (IRRs) using different cutoff points of the Beighton score (≥3, ≥4, and ≥5) to indicate GJH. RESULTS Of the 114 players included in the study, 20 were classified as hypermobile (Beighton score ≥4). The mean (±SD) injury incidence per player was 8.40 ± 9.17 injuries/1000 hours of soccer, with no significant difference between hypermobile and nonhypermobile players. GJH was not a risk factor for injuries when using Beighton score cutoff points of ≥3 (IRR = 1.06 [95% CI, 0.74-1.50]; P = .762), ≥4 (IRR = 1.10 [95% CI, 0.72-1.68]; P = .662), or ≥5 (IRR = 1.15 [95% CI, 0.68-1.95]; P = .602). Similarly, GJH was not a significant risk factor for thigh, knee, or ankle injuries evaluated separately. CONCLUSION This study indicates that GJH is not a risk factor for injuries in elite female soccer players, irrespective of Beighton score cutoff point. Hypermobile players at this elite level might have improved their active stability and/or used braces to compensate for joint laxity.
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Affiliation(s)
- Donna Blokland
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karin M Thijs
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands.,FIFA Medical Center, Royal Netherlands Football Association, Zeist, the Netherlands
| | - Frank J G Backx
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin A Goedhart
- FIFA Medical Center, Royal Netherlands Football Association, Zeist, the Netherlands
| | - Bionka M A Huisstede
- Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Physical Therapy & Sports, University Medical Center Utrecht, Utrecht, the Netherlands
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The Assessment of the Occurrence of Benign Hypermobility Joint Syndrome in Physiotherapy Students. CENTRAL EUROPEAN JOURNAL OF SPORT SCIENCES AND MEDICINE 2017. [DOI: 10.18276/cej.2017.4-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lee SM, Oh SC, Yeom JS, Shin JH, Park SG, Shin DS, Ahn MW, Lee GW. The impact of generalized joint laxity (GJL) on the posterior neck pain, cervical disc herniation, and cervical disc degeneration in the cervical spine. Spine J 2016; 16:1453-1458. [PMID: 27503265 DOI: 10.1016/j.spinee.2016.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 06/23/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Generalized joint laxity (GJL) can have a negative impact on lumbar spine pathology, including low back pain, disc degeneration, and disc herniation, but the relationship between GJL and cervical spine conditions remains unknown. PURPOSE To investigate the relationship between GJL and cervical spine conditions, including the prevalence of posterior neck pain (PNP), cervical disc herniation (CDH), and cervical disc degeneration (CDD), in a young, active population. STUDY DESIGN Retrospective 1:2 matched cohort (case-control) study from prospectively collected data PATIENT SAMPLE: Of a total of 1853 individuals reviewed, 73 individuals with GJL (study group, gruop A) and 146 without GJL (control group, Group B) were included in the study according to a 1:2 case-control matched design for age, sex, and body mass index. OUTCOME MEASURE The primary outcome measure was the prevalence and intensity of PNP at enrollment based on a visual analogue scale score for pain. The secondary outcome measures were (1) clinical outcomes as measured with the neck disability index (NDI) and 12-item short form health survey (SF-12) at enrollment, and (2) radiological outcomes of CDH and CDD at enrollment. METHODS We compared baseline data between groups. Descriptive statistical analyses were performed to compare the 2 groups in terms of the outcome measures. RESULTS The prevalence and intensity of PNP were significantly greater in group A (patients with GJL) than in group B (patients without GJL) (prevalence: p=.02; intensity: p=.001). Clinical outcomes as measured with NDI and SF-12 did not differ significantly between groups. For radiologic outcomes, the prevalence of CDD was significantly greater in group A than in group B (p=.04), whereas the prevalence of CDH did not differ significantly between groups (p=.91). CONCLUSIONS The current study revealed that GJL was closely related to the prevalence and intensity of PNP, suggesting that GJL may be a causative factor for PNP. In addition, GJL may contribute to the occurrence of CDD, but not CDH. Spine surgeons should screen for GJL in patientswith PNP and inform patients of its potential negative impact on disc degeneration of the cervical spine.
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Affiliation(s)
- Sun-Mi Lee
- Department of Family Medicine, Dongkang Hospital, 239, Taehwa-ro, Jung-gu, Ulsan 44455, Korea
| | - Su Chan Oh
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Ji-Hoon Shin
- Department of Orthopaedic Surgery, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea
| | - Sam-Guk Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea
| | - Duk-Seop Shin
- Department of Orthopaedic Surgery, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea
| | - Myun-Whan Ahn
- Department of Orthopaedic Surgery, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea
| | - Gun Woo Lee
- Department of Orthopaedic Surgery, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea.
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Akhtar MA, Bhattacharya R, Keating JF. Generalised ligamentous laxity and revision ACL surgery: Is there a relation? Knee 2016; 23:1148-1153. [PMID: 27856128 DOI: 10.1016/j.knee.2015.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 10/24/2015] [Accepted: 11/07/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of the present study was to investigate the relationship between generalised ligamentous laxity (GLL) and requirement for revision anterior cruciate ligament (ACL) reconstruction. METHODS The study cohort consisted of 139 patients undergoing primary ACL reconstruction, 44 patients undergoing revision ACL surgery and a control group of 70 patients without any knee ligament injury. A Beighton score of four or more was classified as generalised ligamentous laxity. RESULTS The primary and revision ACL surgery groups had an increased incidence of GLL compared to the control group (p<0.05). The revision ACL surgery group also had higher incidence of GLL as compared to primary ACL surgery group (p<0.05). There was a sub group within the revision cohort, who had failure of the original surgery without an identifiable cause (biological failure). The incidence of GLL in this group was significantly higher than the primary surgery group (p<0.05). CONCLUSIONS The findings of this study suggest that GLL may be associated with a higher risk of ACL injury and an increased risk of graft failure after primary ACL reconstruction. Based on the results of our study we feel that in the presence of GLL an autogenous graft may not be the best option for either primary or revision ACL reconstruction. LEVEL OF EVIDENCE 3 (III).
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Affiliation(s)
- M Adeel Akhtar
- The Knee Injury Clinic, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Scotland, United Kingdom.
| | - R Bhattacharya
- The Knee Injury Clinic, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Scotland, United Kingdom
| | - J F Keating
- The Knee Injury Clinic, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Scotland, United Kingdom
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Park KH, Lee JW, Suh JW, Shin MH, Choi WJ. Generalized Ligamentous Laxity Is an Independent Predictor of Poor Outcomes After the Modified Broström Procedure for Chronic Lateral Ankle Instability. Am J Sports Med 2016; 44:2975-2983. [PMID: 27480980 DOI: 10.1177/0363546516656183] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The modified Broström procedure for chronic lateral ankle instability (CLAI) has presented outstanding clinical results. However, after the procedure, some patients with generalized ligamentous laxity have experienced a recurrence of ankle instability. PURPOSE To understand the effect of generalized ligamentous laxity on prognosis and risk of recurrence in a cohort of patients with CLAI after the modified Broström procedure. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 199 ankles from 188 patients underwent the modified Broström procedure for CLAI with a mean follow-up of 60.1 months (range, 48-108 months). Generalized ligamentous laxity was assessed in all patients. The Karlsson-Peterson ankle score (Karlsson score), talar tilt angle, and anterior displacement of the talus were used to evaluate clinical and radiological outcomes. Risk factors associated with clinical outcomes were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan-Meier analysis. RESULTS Generalized ligamentous laxity was evident in 42 cases (21.1%). The average Karlsson score improved from 54.6 ± 7.1 preoperatively to 87.9 ± 7.2 at last follow-up (P < .001). The presence of generalized ligamentous laxity was significantly associated with poor clinical and radiological outcomes. The rates of clinical failure were 10.8% and 45.2% in the nonlaxity group and the laxity group, respectively (P < .001). According to bivariate analysis, generalized ligamentous laxity, syndesmosis widening, osteochondral lesion of the talus, high preoperative talar tilt angle (>15°), and high preoperative anterior displacement of the talus (>10 mm) were significantly associated with clinical failure. Multivariate logistic regression analysis revealed that generalized ligamentous laxity was the most important independent predictor of clinical failure after the modified Broström procedure. The cumulative success rates for the nonlaxity group were significantly superior to those for the laxity group in Kaplan-Meier curves (P < .001). CONCLUSION Generalized ligamentous laxity is an independent predictor of poor outcomes and a risk factor of recurrent instability following the modified Broström procedure for CLAI.
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Affiliation(s)
- Kwang Hwan Park
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Kyeonggi-do, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Wan Suh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung Ho Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Jin Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
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Sueyoshi T, Emoto G, Yuasa T. Generalized Joint Laxity and Ligament Injuries in High School-Aged Female Volleyball Players in Japan. Orthop J Sports Med 2016; 4:2325967116667690. [PMID: 27761474 PMCID: PMC5054354 DOI: 10.1177/2325967116667690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Generalized joint laxity has been linked to ligamentous injuries such as anterior cruciate ligament tear and ankle sprain. Purpose/Hypothesis: The purpose of this study was to investigate generalized joint laxity and incidence of ligament injuries in high school–aged female volleyball players. It was hypothesized that volleyball players with a past history of sprains would have increased generalized joint laxity compared with those without any history and that athletes with multiple sprains would demonstrate with a higher generalized joint laxity score than those who had only 1 sprain. Study Design: Case-control study; Level of evidence, 3. Methods: Forty-seven subjects were tested for generalized joint laxity using the Beighton and Horan Joint Mobility Index (BHJMI). They were categorized into 2 groups based on the presence of past ligament injury: injury group (IG) and noninjury group (NG). The IG group was further divided into 2 groups based on whether they had a single ligamentous injury (IGS) or multiple injuries (IGM) in the past to study whether there was any difference in scores between the subgroups. The collected data were analyzed statistically with 1-way analysis of variance. Results: Subjects in the IG group scored significantly higher on the BHJMI than those in the NG group. The mean score for the IG group was 2.40 ± 1.42, as opposed to 1.24 ± 1.09 for the NG group (P = .006). Eleven subjects in the IG group had suffered multiple injuries or recurrent injuries (IGM) and scored significantly higher than the remaining 19 individuals in the IG group, who had only sustained a single injury (IGS). The mean BHJMI scores were 3.18 ± 1.47 and 1.95 ± 1.22 for IGM and IGS, respectively (P = .02). Conclusion: Female athletes with a high generalized joint laxity score may be more prone to ligament injury and potentially to recurrent ligament injuries.
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Affiliation(s)
- Ted Sueyoshi
- Physiotherapy Associates, Scottsdale, Arizona, USA
| | - Gen Emoto
- Emoto Knee and Sport Clinic, Fukuoka, Japan
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Jensen BR, Sandfeld J, Melcher PS, Johansen KL, Hendriksen P, Juul-Kristensen B. Alterations in neuromuscular function in girls with generalized joint hypermobility. BMC Musculoskelet Disord 2016; 17:410. [PMID: 27716255 PMCID: PMC5048689 DOI: 10.1186/s12891-016-1267-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/24/2016] [Indexed: 01/11/2023] Open
Abstract
Background Generalized Joint Hypermobility (GJH) is associated with increased risk of musculoskeletal joint pain. We investigated neuromuscular performance and muscle activation strategy. Methods Girls with GJH and non-GJH (NGJH) performed isometric knee flexions (90°,110°,130°), and extensions (90°) at 20 % Maximum Voluntary Contraction, and explosive isometric knee flexions while sitting. EMG was recorded from knee flexor and extensor muscles. Results Early rate of torque development was 53 % faster for GJH. Reduced hamstring muscle activation in girls with GJH was found while knee extensor and calf muscle activation did not differ between groups. Flexion-extension and medial-lateral co-activation ratio during flexions were higher for girls with GJH than NGJH girls. Conclusions Girls with GJH had higher capacity to rapidly generate force than NGJH girls which may reflect motor adaptation to compensate for hypermobility. Higher medial muscle activation indicated higher levels of medial knee joint compression in girls with GJH. Increased flexion-extension co-activation ratios in GJH were explained by decreased agonist drive to the hamstrings.
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Affiliation(s)
- Bente Rona Jensen
- Department of Nutrition, Exercise and Sport, Integrative Physiology, Biomechanics and Motor Control Laboratory, University of Copenhagen, Copenhagen, Denmark. .,Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
| | - Jesper Sandfeld
- Department of Nutrition, Exercise and Sport, Integrative Physiology, Biomechanics and Motor Control Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Pia Sandfeld Melcher
- Department of Nutrition, Exercise and Sport, Integrative Physiology, Biomechanics and Motor Control Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Lyders Johansen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Peter Hendriksen
- Department of Nutrition, Exercise and Sport, Integrative Physiology, Biomechanics and Motor Control Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Health Sciences, Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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Konopinski M, Graham I, Johnson MI, Jones G. The effect of hypermobility on the incidence of injury in professional football: A multi-site cohort study. Phys Ther Sport 2016; 21:7-13. [DOI: 10.1016/j.ptsp.2015.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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Saremi H, Yavarikia A, Jafari N. Generalized Ligamentous Laxity: An Important Predisposing Factor for Shoulder Injuries in Athletes. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e38903. [PMID: 27621940 PMCID: PMC5010880 DOI: 10.5812/ircmj.38903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 05/31/2016] [Accepted: 06/12/2016] [Indexed: 12/03/2022]
Abstract
Background Generalized ligamentous laxity is defined as an increased range of joint motion compared to that of the general population. It is a predisposing factor for sports injuries, especially in the lower extremities. Nevertheless, there is little evidence about the relationship between generalized ligamentous laxity and sports injuries in the upper extremities. Objectives To evaluate the relationship of generalized ligamentous laxity with acute and chronic shoulder injuries in athletes. Patients and Methods Our study comprised 118 volunteer athletes with a history of at least six months of sports activities and a shoulder injury in the three years prior to participation in our study. The athletes were divided into two groups: those with or without generalized ligamentous laxity. Acute and chronic shoulder injuries, shoulder pain, shoulder instability, and functional status assessed via the QuickDASH measure were determined and compared between the two groups. A P value of less than 0.05 was considered significant. Results Group A (with ligamentous laxity) consisted of 43 participants (36.4%) and group B (without ligamentous laxity) consisted of 75 participants (63.6%). The athletes in group A had more shoulder pain (P = 0.016), chronic shoulder injuries (P = 0.032), and shoulder instability (P = 0.004), and less functionality (P = 0.030) than those in group B. If fracture were not considered an acute injury in both groups, the athletes with generalized ligamentous laxity would have had more acute shoulder injuries. Conclusions Generalized ligamentous laxity is an important predisposing factor for acute and chronic shoulder injuries in athletes. Prescreening programs for beginners and rehabilitation shoulder programs for sports athletes at high risk are strongly recommended.
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Affiliation(s)
- Hossein Saremi
- Department of Orthopaedic and Trauma Surgery, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Alireza Yavarikia
- Department of Orthopaedic and Trauma Surgery, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, IR Iran
- Corresponding Author: Alireza Yavarikia, Department of Orthopaedic and Trauma Surgery, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, IR Iran. Tel: +98-8138218541; +98-9183136215, Fax: +98-8112561515, E-mail:
| | - Nasibeh Jafari
- Department of Corrective Exercises and Sport Pathology, Islamic Azad University, Borujerd Branch, Borujerd, IR Iran
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Vallis A, Wray A, Smith T. Inter- and intra-rater reliabilities of the Beighton Score compared to the Contompasis Score to assess Generalised Joint Hypermobility. ACTA ACUST UNITED AC 2016. [DOI: 10.3109/10582452.2016.1140255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Amy Vallis
- aPhysiotherapy Department, East Coast Community Healthcare, Lowestoft, Norfolk, VA, USA,
| | - Alison Wray
- bPhysiotherapy Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, VA, USA, and
| | - Toby Smith
- cSchool of Health Sciences, University of East Anglia, Norwich, Norfolk, VA, USA
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Jindal P, Narayan A, Ganesan S, MacDermid JC. Muscle strength differences in healthy young adults with and without generalized joint hypermobility: a cross-sectional study. BMC Sports Sci Med Rehabil 2016; 8:12. [PMID: 27119015 PMCID: PMC4845357 DOI: 10.1186/s13102-016-0037-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/13/2016] [Indexed: 01/23/2023]
Abstract
Background Generalized joint hypermobility (GJH), in the absence of symptoms, is a common clinical finding. The joint instability present due to excessive musculoskeletal flexibility in hypermobile joints impairs the external force production during muscle contraction. However, whether GJH is associated with muscle weakness is unclear. This study evaluated differences in upper and lower limb muscle strengths among asymptomatic young adults with and without GJH. Methods One hundred six young adults (53 hypermobile, i.e. 25 male (mean age 22 ± 1.8); 28 female (mean age 21 ± 1.8), and 53 non-hypermobile, i.e. 25 male (mean age 19 ± 1.06); 28 female (mean age 20 ± 1.4) were selected using a cut-off ≥ 4 on Beighton and Horan Joint Mobility Index. Isometric strength of elbow and knee extensors was measured using an isokinetic dynamometer. Independent sample t- tests were done to compare the muscle strengths of hypermobile and non-hypermobile participants. One-way ANCOVA was applied to control the effect of height and body mass on muscle strength. Results Male hypermobile participants had significantly less strength than non-hypermobile males in the right (71.7 Nm, SD = 23.1, vs 97.6 Nm, SD = 47.4, p = 0.006*) and left (74.8 Nm, SD = 24.3, vs 97.7 Nm, SD = 45.5, p = 0.007*) elbow extensors and right knee extensors (188.7 Nm, SD = 83.3, vs 228.3 Nm, SD = 106.7, p = 0.03*). In females, both elbow extensors (right: 51.9 Nm, SD = 16.2 vs 48.8 Nm, SD = 17.8, p = 0.4; left: 48.9 Nm, SD = 17.2, vs 44.7 Nm, SD = 15.1, p = 0.2) and knee extensors (right: 161.3 Nm, SD = 74.9 vs 145.5 Nm, SD = 75.8, p = 0.3; left: 155.2 Nm, SD = 73 vs 124.3 Nm, SD = 69.6, p = 0.07) strength were not statistically different between hypermobile and non-hypermobile participants. Conclusion The findings indicate that male participants with GJH have less isometric muscle strength in both elbow extensors and right knee extensors compared to non-hypermobile male participants. Female hypermobile participants did not show any significant differences in muscle strength compared to non-hypermobile female participants. Electronic supplementary material The online version of this article (doi:10.1186/s13102-016-0037-x) contains supplementary material, which is available to authorized users.
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Huang B, Kim YT, Kim JU, Shin JH, Park YW, Kim HN. Modified Broström Procedure for Chronic Ankle Instability With Generalized Joint Hypermobility. Am J Sports Med 2016; 44:1011-6. [PMID: 26786901 DOI: 10.1177/0363546515623029] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic ankle instability with generalized joint hypermobility (GJH) is considered a contraindication for the modified Broström procedure. The most widely accepted definition of GJH is a Beighton score of ≥4 on a 9-point scale. However, it is not clear whether this criterion can be applied to determine the GJH that would lead to a poor outcome after a modified Broström procedure. Some of the previous studies that report unfavorable outcomes do not specify the tests or cutoff scores used to determine the GJH, and, in fact, some of the patients with GJH in these studies had good outcomes. HYPOTHESIS The modified Broström procedure results in satisfactory outcomes in patients who have chronic ankle instability with GJH if the contralateral uninjured ankle shows a normal varus talar tilt and anterior talar translation during stress tests. STUDY DESIGN Case series; Level of evidence, 4. METHODS Modified Broström procedure was performed in 32 patients with chronic ankle instability with GJH if the contralateral uninjured ankle showed a normal varus talar tilt and anterior talar translation on stress tests. The mean patient age at surgery was 21.7 years, and the mean follow-up duration was 27.4 months. RESULTS The Karlsson-Peterson ankle score significantly improved from a mean ± SD of 63.6 ± 7.1 preoperatively to 90.4 ± 6.7 at the final postoperative follow-up (P < .001). Sixteen patients were very satisfied with the results, 10 patients were satisfied, 3 patients rated their satisfaction as fair, and 1 patient was dissatisfied with the results. Nine patients sustained ankle sprains after the surgery, 6 of which were mild sprains. Although 3 of these 9 patients had a mechanically unstable ankle on stress radiographs, they were satisfied with the postoperative results. None of the patients required a reoperation. CONCLUSION GJH was not a contraindication for the modified Broström procedure if the contralateral uninjured ankle showed a normal varus talar tilt and a normal anterior talar translation on stress tests. Further studies are needed to better define GJH affecting the ankle.
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Affiliation(s)
- Bingzhe Huang
- Department of Orthopaedic Surgery, The Second Hospital, Jilin University, Changchun, China
| | - Yong Tae Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung Uk Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung Hoon Shin
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yong Wook Park
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyong Nyun Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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JUNGE TINA, RUNGE LISBETH, JUUL-KRISTENSEN BIRGIT, WEDDERKOPP NIELS. Risk Factors for Knee Injuries in Children 8 to 15 Years. Med Sci Sports Exerc 2016; 48:655-62. [DOI: 10.1249/mss.0000000000000814] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Scheper MC, Juul-Kristensen B, Rombaut L, Rameckers EA, Verbunt J, Engelbert RH. Disability in Adolescents and Adults Diagnosed With Hypermobility-Related Disorders: A Meta-Analysis. Arch Phys Med Rehabil 2016; 97:2174-2187. [PMID: 26976801 DOI: 10.1016/j.apmr.2016.02.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/05/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To (1) establish the association of the most common reported symptoms on disability; and (2) study the effectiveness of treatment on disability in patients with Ehlers-Danlos syndrome-hypermobility type (EDS-HT)/hypermobility syndrome (HMS). DATA SOURCES An electronic search (Medical Subject Headings and free-text terms) was conducted in bibliographic databases CENTRAL/MEDLINE. STUDY SELECTION Comparative, cross-sectional, longitudinal cohort studies and (randomized) controlled trials including patients with HMS/EDS-HT aged ≥17 years were considered for inclusion. A class of symptoms was included when 5 publications were available. In regards to treatment (physical, cognitive interventions), only (randomized) controlled trials were considered. Surgical and medicinal interventions were excluded. DATA EXTRACTION Bias was assessed according to the methodological scoring tools of the Cochrane collaboration. Z-score transformations were applied to classify the extent of disability in comparison with healthy controls and to ensure comparability between studies. DATA SYNTHESIS Initially, the electronic search yielded 714 publications, and 21 articles remained for analysis after selection. The following symptoms were included for meta-analysis: pain (n=12), fatigue (n=6), and psychological distress (n=7). Pain (r=.64, P=.021), fatigue (r=.91, P=.011), and psychological distress (r=.86, P=.018) had a significant impact on disability. Regarding treatment, a significant pain reduction was achieved by a variety of physical and cognitive approaches. Treatment effectiveness on disability was not established. CONCLUSIONS Disability can affect patients with HMS/EDS-HT significantly and is highly correlated with both physical and psychological factors. Although evidence is available that physical and psychological treatment modalities can induce significant pain reduction, the evidence regarding disability reduction is lacking.
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Affiliation(s)
- Mark C Scheper
- Amsterdam Center for Innovative Health Practice, Center for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands.
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Lies Rombaut
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Eugene A Rameckers
- Department of Rehabilitation Medicine, Maastricht University Medical Center, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Master of Pediatric Physical Therapy, University of Applied Sciences, AVANS+, Breda, The Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Maastricht University Medical Center, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Raoul H Engelbert
- Amsterdam Center for Innovative Health Practice, Center for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands
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Read PJ, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. Assessment of Injury Risk Factors in Male Youth Soccer Players. Strength Cond J 2016. [DOI: 10.1519/ssc.0000000000000184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Johannessen EC, Reiten HS, Løvaas H, Maeland S, Juul-Kristensen B. Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type. Disabil Rehabil 2016; 38:1382-90. [DOI: 10.3109/09638288.2015.1102336] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Helle Sundnes Reiten
- Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | | | - Silje Maeland
- Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Birgit Juul-Kristensen
- Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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80
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Managing Chronic Pain in Children and Adolescents: A Clinical Review. PM R 2015; 7:S295-S315. [DOI: 10.1016/j.pmrj.2015.09.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/19/2022]
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81
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Juul-Kristensen B, Johansen K, Hendriksen P, Melcher P, Sandfeld J, Jensen BR. Girls with generalized joint hypermobility display changed muscle activity and postural sway during static balance tasks. Scand J Rheumatol 2015; 45:57-65. [PMID: 26324783 DOI: 10.3109/03009742.2015.1041154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To study knee muscle activity and static postural sway in girls with generalized joint hypermobility (GJH). METHOD Sixteen girls with GJH and 11 girls with non-GJH (NGJH) aged 14 years, randomly recruited among schoolchildren, participated in this study. GJH inclusion criteria were: Beighton score minimum 6/9 and one hypermobile knee; for NGJH: Beighton score maximum 5/9 and no knees with hypermobility. The participants performed a static two-legged balance test with eyes open (2EO) and eyes closed (2EC) and a one-legged stance test with eyes open (1EO). Postural sway (centre of pressure path length, COPL) was calculated, along with rambling and trembling components. Surface electromyography (sEMG) from the quadriceps (Q), hamstrings (H), and gastrocnemius (G) muscles was recorded, expressed as a percentage of the maximum voluntary EMG (%MVE), and the co-contraction index (CCI) of Q, H, and G muscle activity was calculated. Knee function was self-reported using the Knee Injury and Osteoarthritis Outcome Score for children (KOOS-Child). RESULTS GJH had a significantly lower lateral HQ CCI and a higher medial/lateral HQ CCI ratio in all balance tasks. Group mean EMG varied from 1.3%MVE in Q (during 2EO) to 15.7%MVE in G (during 1EO). GJH had larger postural sway length than NGJH during 2EC (COPL 1.64 vs. 1.37 m/min, p < 0.001). Rambling and trembling components did not differ between groups. CONCLUSIONS Girls with GJH and at least one hypermobile knee performed, compared with NGJH, static balance tasks with higher medial knee muscle activity relative to the lateral activity, and larger postural sway when vision was eliminated. The short- and long-term consequences should be studied further.
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Affiliation(s)
- B Juul-Kristensen
- a Institute of Sports Science and Clinical Biomechanics , University of Southern Denmark , Odense , Denmark.,b Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences , Bergen University College , Norway
| | - Kl Johansen
- a Institute of Sports Science and Clinical Biomechanics , University of Southern Denmark , Odense , Denmark
| | - P Hendriksen
- c Integrated Physiology, Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
| | - P Melcher
- c Integrated Physiology, Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
| | - J Sandfeld
- c Integrated Physiology, Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark.,d Metropolitan University College , Copenhagen , Denmark
| | - B R Jensen
- c Integrated Physiology, Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
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Abstract
Dancers require extreme ranges of motion in their hips. They require this for many styles and performances. Hip pain and hip injury in dancers can lead to lost work and performance time. There are many potential causes for hip pain in the dancer, including dysplasia, hyperlaxity, both intra- and extra-articular impingement, and soft tissue injuries. This article will review the current literature on these topics in dancers and how they can be applied to the dancer patient.
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Affiliation(s)
- Brad R Moser
- The Minnesota Dance Medicine Foundation, Minnesota Orthopedics Sports Medicine Institute at Twin Cities Orthopedics (MOSMI), Minneapolis, MN
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83
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Weber AE, Bedi A, Tibor LM, Zaltz I, Larson CM. The Hyperflexible Hip: Managing Hip Pain in the Dancer and Gymnast. Sports Health 2015; 7:346-58. [PMID: 26137181 PMCID: PMC4481673 DOI: 10.1177/1941738114532431] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Context: Dance, gymnastics, figure skating, and competitive cheerleading require a high degree of hip range of motion. Athletes who participate in these sports use their hips in a mechanically complex manner. Evidence Acquisition: A search of the entire PubMed database (through December 2013) and additional searches of the reference lists of pertinent articles. Study Design: Systematic review. Level of Evidence: Level 3. Results: Whether innate or acquired, dancers and gymnasts have some hypermobility that allows their hips to be placed in potentially impinging or unstable positions required for their given activity. Such extremes of motion can result in both intra-articular and extra-articular impingement as well as compensatory osseous and muscular pathology. In addition, dancers and gymnasts are susceptible to impingement-induced instability. Dancers with innate generalized hyperlaxity are at increased risk of injury because of their activities and may require longer recovery times to return to play. Both nonoperative and operative treatments (arthroscopic and open) have an important role in returning flexibility athletes to their preoperative levels of sport and dance. Conclusion: Because of the extreme hip motion required and the compensatory soft tissue laxity in dancers and gymnasts, these athletes may develop instability, impingement, or combinations of both. This frequently occurs in the setting of subtle pathoanatomy or in patients with normal bony anatomy. With appropriate surgical indications and the correct operative technique, the treating surgeon can anticipate high levels of return to play for the gymnast and dancer with hip pain.
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Affiliation(s)
- Alexander E Weber
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lisa M Tibor
- Kaiser Permanente Medical Center, South San Francisco, CA
| | - Ira Zaltz
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan
| | - Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute, Arthroscopic Hip Joint Preservation MOSMI, Twin Cities Orthopedics, Edina, Minnesota
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84
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Junge T, Larsen LR, Juul-Kristensen B, Wedderkopp N. The extent and risk of knee injuries in children aged 9-14 with Generalised Joint Hypermobility and knee joint hypermobility - the CHAMPS-study Denmark. BMC Musculoskelet Disord 2015; 16:143. [PMID: 26065679 PMCID: PMC4465013 DOI: 10.1186/s12891-015-0611-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022] Open
Abstract
Background Generalised Joint Hypermobility (GJH) is suggested as an aetiological factor for knee injuries in adolescents and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of knee injuries during challenging situations like jumping and landing. The aim was to study the extent and risk of knee injuries in children with GJH and knee hypermobility. Methods In total, 999 children (9–14 years) were tested twice during spring 2012 and 2013 with Beighton´s Tests (BT) for hypermobility, a 0–9 scoring system. GJH was classified with cut-point ≥5/9 on both test rounds. On basis of weekly cell phone surveys of knee pain, children requiring clinical examination were seen. Traumatic and overuse knee injuries were registered by WHO ICD-10 diagnoses. Logistic regression and Poisson regression models with robust standard errors were used to examine the association between GJH and knee injuries, taking into account clustering on school class levels. Results Totally, 36 children were classified GJH on both test rounds. Overuse knee injuries were the most frequent injury type (86 %), mainly apophysitis for both groups (61 %), other than patella-femoral pain syndrome for the control group (13 %). For traumatic knee injuries, distortions and contusions were most frequent in both groups (51 % resp. 36 %), besides traumatic lesions of knee tendons and muscles for the control group (5 %). No significant association was found between overuse knee injuries and GJH with/without knee hypermobility (OR 0.69, p = 0.407 resp. OR 0.75, p = 0.576) or traumatic knee injuries and GJH with/without knee hypermobility (OR 1.56, p = 0.495 resp. OR 2.22, p = 0.231). Conclusions Apophysitis, distortions and contusions were the most frequent knee injuries. Despite the relatively large study, the number of children with GJH and knee injuries was low, with no significant increased risk for knee injuries for this group. This questions whether GJH is a clinically relevant risk factor for knee injuries in school children aged 9–14 years. A fluctuation in the individual child´s status of GJH between test rounds was observed, suggesting that inter- and intra-tester reproducibility of BT as well as growth may be considered important confounders to future studies of children with GJH.
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Affiliation(s)
- Tina Junge
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Department of Physiotherapy, University College Lillebaelt, Odense, Denmark. .,Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark. .,IRS, SDU, Winsløwparken 19,3. 5000, Odense C, Denmark.
| | - Lisbeth Runge Larsen
- Centre for Welfare Technology Research and Development, University College Lillebaelt, Odense, Denmark.
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. .,Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway.
| | - Niels Wedderkopp
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark.
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85
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Junge T, Wedderkopp N, Thorlund JB, Søgaard K, Juul-Kristensen B. Altered knee joint neuromuscular control during landing from a jump in 10–15year old children with Generalised Joint Hypermobility. A substudy of the CHAMPS-study Denmark. J Electromyogr Kinesiol 2015; 25:501-7. [DOI: 10.1016/j.jelekin.2015.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/17/2015] [Accepted: 02/26/2015] [Indexed: 11/26/2022] Open
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The impact of generalized joint laxity on the clinical and radiological outcomes of single-level posterior lumbar interbody fusion. Spine J 2015; 15:809-16. [PMID: 25523376 DOI: 10.1016/j.spinee.2014.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/29/2014] [Accepted: 12/08/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Recent reports have suggested that excessive motion of the lumbar spine might be associated with low back pain and accelerated disc degeneration and may negatively influence the outcome of posterior lumbar interbody fusion (PLIF) surgery. These findings suggest that generalized joint laxity (GJL) might be a negative factor affecting PLIF outcome, although this relationship has not been well studied. In addition, the impact of GJL on adjacent segment pathology (ASP) after PLIF has not been reported. PURPOSE To explore the relationship between GJL and the outcome of single-level PLIF, we compared fusion rates, clinical outcomes, and ASP in PLIF patients with and without GJL. STUDY DESIGN Retrospective comparative study. PATIENT SAMPLE A total of 256 patients who underwent PLIF and were followed for at least 2 years after surgery were classified into two groups: Group A (37 patients with GJL) and Group B (219 patients without GJL). OUTCOME MEASURES The primary outcome measure was the fusion rate on dynamic radiographs and computed tomography scans. The secondary outcome measures were pain intensity in the low back based on a visual analog scale, functional outcome based on the Oswestry Disability Index, and prevalence and severity of ASP on lumbar spine magnetic resonance imaging 2 years postoperatively compared with preoperative images. METHODS We compared baseline data for the two groups studied. To evaluate the effects of GJL on the outcome of PLIF, we also compared outcome measures between the two groups. No funds were received in support of this work. RESULTS Successful fusion 2 years after surgery was achieved in 91.9% of patients in Group A and 91.8% of patients in Group B according to dynamic radiographs (p=.85) and in 86.5% of patients in Group A and 90% of patients in Group B according to computed tomography scans (p=.14). Secondary endpoints including pain intensity (visual analog scale) and Oswestry Disability Index scores were not significantly different between the two groups (p=.71 and .86, respectively). Adjacent segment pathology was present in both the superior and inferior adjacent segments in both groups and was not significantly different (p=.07 and .06, respectively), although severe degeneration that was greater than Grade III on modified Pfirrmann classification was more frequently observed in Group A (15 of 37, 40.5%, at the superior segment and 11 of 20, 55%, at the inferior segment) than in Group B (60 of 219, 27.4%, at the superior segment and 30 of 111, 27%, at the inferior segment), which was statistically significant (p=.02 and .01, respectively). Moreover, ASP was more prominent at the superior adjacent segment compared with the inferior adjacent segment and was most commonly observed at the inferior adjacent segment (L5-S1) after L4-L5 PLIF and the superior adjacent segment (L4-L5) after L5-S1 PLIF (p=.02 and .03, respectively). CONCLUSIONS Generalized joint laxity at baseline does not impact fusion rate or clinical outcome with respect to pain intensity or functional status but could negatively impact ASP compared with that in patients without GJL. Consequently, GJL should be evaluated preoperatively, and patients with GJL undergoing PLIF should be informed of the potential risks of surgery.
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87
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Pacey V, Tofts L, Wesley A, Collins F, Singh-Grewal D. Joint hypermobility syndrome: a review for clinicians. J Paediatr Child Health 2015; 51:373-80. [PMID: 25290912 DOI: 10.1111/jpc.12731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 01/03/2023]
Abstract
The term 'joint hypermobility' describes synovial joints that move beyond a normal range of motion. 'Joint hypermobilty syndrome' may also be associated with significant symptoms and impaired quality of life. The purpose of this review is to help the generalist to recognise the condition, exclude significant alternative diagnoses and understand the multidisciplinary approach to management.
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Affiliation(s)
- Verity Pacey
- Department of Physiotherapy, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
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Lee GW, Lee SM, Suh BG. The impact of generalized joint laxity on the occurrence and disease course of primary lumbar disc herniation. Spine J 2015; 15:65-70. [PMID: 25011096 DOI: 10.1016/j.spinee.2014.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/17/2014] [Accepted: 06/30/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Generalized joint laxity (GJL) has been associated with spine-related disorders such as low back pain, accelerated disc degeneration, and recurrence after discectomy surgery for primary lumbar disc herniation (p-LDH). Generalized joint laxity might be a causative factor of p-LDH, but this relationship is poorly understood. In addition, the impact of GJL on outcomes after the treatment for p-LDH has not been reported. PURPOSE To explore relationship between GJL and p-LDH and to compare clinical and radiological outcomes post-therapy in p-LDH patients with or without GJL. STUDY DESIGN A retrospective comparative study. PATIENT SAMPLE The study group included 203 males, and the control group included 362 males who were matched for age, race, and body mass index with the study group. OUTCOME MEASURES The primary outcome was the presence or absence of GJL according to the Beighton scale. The secondary outcome measures included the clinical outcome according to a visual analog scale and the Oswestry disability index and the radiological outcome. METHODS We compared baseline data between groups, and we evaluated the impact of GJL on outcomes after different types of several treatment for LDH. RESULTS The prevalence of GJL was significantly higher in the study group (10.8%) than in the matched control group (4.4%) (p=.003). In multivariate logistic regression analysis, GJL was the only significant predictor (p=.012). For all treatment methods, patients with GJL had worse clinical outcomes than did patients without GJL. In the patients treated with lumbar discectomy surgery, the differential Cobb value at the last follow-up was higher in the GJL patients than in the non-GJL patients (p=.001). CONCLUSIONS Generalized joint laxity was closely related to p-LDH and may be a causative factor. In addition, patients with GJL had worse clinical and radiological outcomes than patients without GJL. Consequently, GJL should be evaluated preoperatively, and this information should be communicated to p-LDH patients with GJL.
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Affiliation(s)
- Gun Woo Lee
- Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yongam-ri, 49-1, Eunhyeon-myeon, Yangju-si, Gyeonggi-do 482-863, Republic of Korea.
| | - Sun-Mi Lee
- Department of Family Medicine, Myongji Hospital, Kwandong University College of Medicine, 55 Hwasu-ro, 14 beon-gil, Deokyang-gu, Goyang, Gyeonggi, 412-826, Republic of Korea
| | - Bo-Gun Suh
- Department of Orthopaedic Surgery, Pohang Semyeng Christianty Hospital, Dae-do dong 94-5, Namgu, Pohang, Kyeongbuk, 790-822, Republic of Korea
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89
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The influence of joint hypermobility on functional movement control in an elite netball population: A preliminary cohort study. Phys Ther Sport 2014; 16:127-34. [PMID: 25443229 DOI: 10.1016/j.ptsp.2014.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To ascertain the prevalence of General Joint Hypermobility (GJH) and Joint Hypermobility Syndrome (JHS) in elite level netballers. To investigate whether GJH influences functional movement control and explore whether symptoms of dysautonomia are reported in this population. DESIGN Observational within-subject cross-sectional design. SETTING Field based study. PARTICIPANTS 27 elite level netballers (14-26 years). MAIN OUTCOME MEASURES GJH and JHS were assessed using the Beighton scale, 5 point questionnaire and the Brighton Criteria. Functional movement control was measured using posturography on a force platform and the Star Excursion Balance Test (SEBT). RESULTS The prevalence of GJH was 63% (n = 17) (Beighton score ≥4/9) and JHS was 15% (n = 4). Symptoms of dysautonomia were minimally prevalent. A trend was observed in which participants with GJH demonstrated increased postural instability on the functional tests. Following Bonferroni adjustment, this was statistically significant only when comparing posturographic data between the distinctly hypermobile participants and the rest of the group for path area (p = 0.002) and velocity (p = 0.002) on the left side. CONCLUSIONS A high prevalence of GJH was observed. A trend towards impairment of functional movement control was observed in the netballers with GJH. This observation did not reach statistical significance except for posturographic path area and velocity.
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90
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Naal FD, Hatzung G, Müller A, Impellizzeri F, Leunig M. Validation of a self-reported Beighton score to assess hypermobility in patients with femoroacetabular impingement. INTERNATIONAL ORTHOPAEDICS 2014; 38:2245-50. [PMID: 24993650 DOI: 10.1007/s00264-014-2424-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/11/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The prevalence of joint hypermobility (JH) in patients with femoroacetabular impingement (FAI) and its association with outcomes is yet widely unknown. This study aimed to validate a self-reported version of the Beighton score for FAI patients, and to determine possible associations between JH and clinical and radiographic parameters. METHODS The study included 55 consecutive patients (18 females, mean age 29 years) with a diagnosis of FAI. Patients completed a self-reported Beighton score before clinical assessment, and a clinician blinded to the self-reported form filled the examiner-based version. Reliability of the self-reported version was assessed using kappa statistics. The prevalence of JH and associations with clinical and radiographic parameters were determined. RESULTS The patients scored a mean of 2.6 points on the self-reported Beighton score. Agreement between self-assessment and examination was good to excellent for all single items and for the total score. Considering a Beighton score of ≥4 as cutoff for JH, the prevalence in the present cohort was 32.7% (50% of females and 24.3% of males). Significant associations were found between Beighton scores and hip joint motion. While no direct correlations were found between Beighton scores and the radiographic parameters; the group of patients with JH differed considerably from that without JH regarding gender distribution and FAI type. CONCLUSIONS The patient-oriented Beighton score proved to be feasible and reliable in FAI patients. The prevalence of JH in these patients seems to be high and future investigations about the association of JH with FAI and treatment outcomes are therefore warranted.
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Affiliation(s)
- Florian D Naal
- Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland,
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91
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Bout-Tabaku S, Klieger SB, Wrotniak BH, Sherry DD, Zemel BS, Stettler N. Adolescent obesity, joint pain, and hypermobility. Pediatr Rheumatol Online J 2014; 12:11. [PMID: 24678578 PMCID: PMC3973833 DOI: 10.1186/1546-0096-12-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/19/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obesity associated with joint pain of the lower extremities is likely due to excessive mechanical load on weight bearing joints. Additional mechanical factors may explain the association between obesity and joint pain. FINDINGS We characterized the association between obesity and non-traumatic lower extremity (LE) joint pain in adolescents and examined the modifying effect of hypermobility on this association.We performed a cross-sectional analysis of data from subjects enrolled in a clinical trial examining the impact of weight loss on bone health in adolescents. Anthropometric data were collected and body mass index (BMI = kg/m2) was calculated. Subjects were categorized as obese or healthy weight controls based on CDC 2000 growth curves for age and gender. We assessed any musculoskeletal pain and LE pain by the PEDS™ Pediatric Pain Questionnaire™. Hypermobility was assessed with the modified Beighton scoring system. Multivariate logistic regression models adjusted for covariates were performed to examine the association between weight status and joint pain.Out of 142 subjects, 91 were obese and 51 were healthy weight. Obesity was not associated with any musculoskeletal pain (OR 0.86, CI 0.49-1.50), LE pain (OR 1.02, CI 0.49-2.15) or hypermobility (OR 1.23, CI 0.72-2.14, p = 0.3). There was no effect modification on the association between obesity and any musculoskeletal pain (OR 0.80, CI 0.45 -1.42) or LE pain (OR 0.98, CI 0.46 - 2.08) by hypermobility status. CONCLUSIONS We found no association between LE pain and obesity, and hypermobility did not modify this association.
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Affiliation(s)
- Sharon Bout-Tabaku
- Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA.
| | - Sarah B Klieger
- Department of Pediatrics, Division of Infection Diseases, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Brian H Wrotniak
- Department of Physical Therapy, D’Youville College, Buffalo, USA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David D Sherry
- Department of Pediatrics, Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, USA,University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Babette S Zemel
- Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, USA,University of Pennsylvania School of Medicine, Philadelphia, USA
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92
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Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Clin J Sport Med 2014; 24:3-20. [PMID: 24366013 DOI: 10.1097/jsm.0000000000000060] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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93
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Kwon JW, Lee WJ, Park SB, Kim MJ, Jang SH, Choi CK. Generalized joint hypermobility in healthy female koreans: prevalence and age-related differences. Ann Rehabil Med 2013; 37:832-8. [PMID: 24466518 PMCID: PMC3895523 DOI: 10.5535/arm.2013.37.6.832] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/23/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Objective To evaluate the prevalence of generalized joint hypermobility (GJH) in healthy female Koreans and to determine whether the degree of GJH differs between children and adults. METHODS Two groups of females were enrolled, a group of girls from an elementary school (n=404) and women from a call center (n=266). GJH was diagnosed using the Beighton score, which is composed of an evaluation of bilateral knees, elbows, thumbs, and fifth fingers as well as thoracolumbar joint. The GJH and localized hypermobility of each joint was compared between the two groups, and the pattern of hypermobility according to age and dominant hand was investigated. RESULTS Total prevalence of GJH was 50.0% (335/750), and it was more frequently observed in the group of girls (58.9%, 238/404) than women (36.5%, 97/266). The degree of GJH expressed in terms of Beighton score was inversely correlated with age (p<0.05). Significant differences in localized hypermobility of the thumb and fifth finger were found between the two groups and were postulated as the cause for the decline in GJH with age. The pattern of decreased mobility proportional to aging differed between the two joints. Decreased mobility occurred equally on both sides of the thumb but was biased toward the fifth finger of the dominant side (mostly the right). CONCLUSION The female Koreans appeared to have a high prevalence of GJH. The incidence of GJH decreased as age increased as a result of decreased mobility of the fifth finger on the dominant side.
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Affiliation(s)
- Ji-Won Kwon
- Department of Physical Medicine & Rehabilitation, VHS Medical Center, Seoul, Korea
| | - Won-Jae Lee
- Department of Physical Medicine & Rehabilitation, VHS Medical Center, Seoul, Korea
| | - Si-Bog Park
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Ho Jang
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Kweon Choi
- Department of Physical Medicine & Rehabilitation, VHS Medical Center, Seoul, Korea
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94
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Nikolajsen H, Larsen PK, Simonsen EB, Alkjær T, Falkerslev S, Kristensen JH, Jensen BR, Remvig L, Juul-Kristensen B. Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study. BMC Musculoskelet Disord 2013; 14:341. [PMID: 24308706 PMCID: PMC4029179 DOI: 10.1186/1471-2474-14-341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background To study differences in gait patterns in 10-year-old children with Generalized Joint Hypermobility (GJH) and with no GJH (NGJH). Methods A total of 37 children participated (19 GJH, 18 NGJH, mean age 10.2 (SD 0.5) years). Inclusion criteria for GJH were a Beighton score of ≥5, with at least one hypermobile knee joint; for NGJH a Beighton score of ≤4, and no hypermobile knees and for both groups no knee pain during the previous week. All children were recorded by five video cameras, while they walked across three force platforms. Net joint moments were calculated in 3D by inverse dynamics and peak values provided input to statistical analyses. Results In the frontal plane, children with GJH had a significantly lower peak knee abductor moment and peak hip abductor moment. In the sagittal plane, the peak knee flexor moment and the peak hip extensor moment were significantly lower in the GJH group although the absolute difference was small. Conclusions The walking pattern was the same for children with GJH and for healthy children, as there were no differences in kinematics, but it was, however, performed with different kinetics. Children with GJH walked with lower ankle, knee and hip joint moments compared to children with NGJH. However, the clinical importance of these differences during normal gait is unknown. To obtain this knowledge, children with GJH must be followed longitudinally. Trial registration The study was approved by the Committee on Biomedical Research Ethics for Copenhagen and Frederiksberg, Denmark (jnr. KF01-2006-178).
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Affiliation(s)
- Helene Nikolajsen
- Department of Rheumatology (COHYPCO), University Hospital of Copenhagen, 2100, Copenhagen Ø, Denmark.
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95
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Bin Abd Razak HR, Bin Ali N, Howe TS. Generalized ligamentous laxity may be a predisposing factor for musculoskeletal injuries. J Sci Med Sport 2013; 17:474-8. [PMID: 24315955 DOI: 10.1016/j.jsams.2013.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/13/2013] [Accepted: 11/11/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this study is to determine if generalized ligamentous laxity may be a predisposing factor for musculoskeletal injuries in young males. We hypothesized that generalized ligamentous laxity would be more common in individuals with musculoskeletal injuries compared with controls. DESIGN Prospective Age- and Gender-matched Case-Control Study examined generalized ligamentous laxity in 100 consecutive individuals aged 18-25 who reported with musculoskeletal injuries to a primary healthcare center in the military. The Beighton score was used to measure joint laxity, which was determined to be present by overall scores equal to or exceeding 4. The control group comprised 100 age- and gender-matched individuals without any musculoskeletal injuries or complaints. The prevalence of generalized ligamentous laxity was then compared between cases and controls. Subgroup analyses were also performed to evaluate the epidemiology of injury within the cases. METHODS This prospective case-control study examined generalized ligamentous laxity in 100 consecutive individuals aged 18-25 who reported with musculoskeletal injuries to a primary healthcare center in the military. The Beighton score was used to measure joint laxity, which was determined to be present by overall scores equal to or exceeding 4. The control group comprised 100 age- and gender-matched individuals without any musculoskeletal injuries or complaints. The prevalence of generalized ligamentous laxity was then compared between cases and controls. RESULTS Generalized ligamentous laxity was present in 12% of the cases compared with 4% of controls Clearer to be presented as (P-value: 0.043). Individuals who presented with musculoskeletal injuries were 3.35 times more likely to have generalized ligamentous laxity as compared to controls. Lower limb injuries were more common than upper limb injuries amongst the cases. CONCLUSIONS Generalized ligamentous laxity was more common in individuals who presented with a musculoskeletal injury. Hence, it may be a predisposing factor for musculoskeletal injuries.
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Affiliation(s)
| | | | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169608, Singapore
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96
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Jensen BR, Olesen AT, Pedersen MT, Kristensen JH, Remvig L, Simonsen EB, Juul-Kristensen B. Effect of generalized joint hypermobility on knee function and muscle activation in children and adults. Muscle Nerve 2013; 48:762-9. [PMID: 24037762 DOI: 10.1002/mus.23802] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 01/09/2023]
Abstract
INTRODUCTION We investigated muscle activation strategy and performance of knee extensor and flexor muscles in children and adults with generalized joint hypermobility (GJH) and compared them with controls. METHODS Muscle activation, torque steadiness, electromechanical delay, and muscle strength were evaluated in 39 children and 36 adults during isometric knee extension and flexion. Subjects performed isometric maximum contractions, submaximal contractions at 25% maximum voluntary contraction (MVC), and explosive contractions. RESULTS Agonist activation was reduced, and coactivation ratio was greater in GJH during knee flexion compared with controls. Torque steadiness was impaired in adults with GJH during knee flexion. No effect of GJH was found on muscle strength or electromechanical delay. Correlation analysis revealed an association between GJH severity and function in adults. CONCLUSIONS The results indicate that muscle activation strategy and quality of force control were significantly affected in adults with GJH during knee flexion, whereas only muscle activation strategy was affected in children with GJH.
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Affiliation(s)
- Bente R Jensen
- Biomechanics and Motor Control Laboratory, Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Alle 51, 2200 Copenhagen N, Denmark, Denmark
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Scheper MC, Engelbert RHH, Rameckers EAA, Verbunt J, Remvig L, Juul-Kristensen B. Children with generalised joint hypermobility and musculoskeletal complaints: state of the art on diagnostics, clinical characteristics, and treatment. BIOMED RESEARCH INTERNATIONAL 2013; 2013:121054. [PMID: 23971021 PMCID: PMC3736514 DOI: 10.1155/2013/121054] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/13/2013] [Accepted: 07/04/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To provide a state of the art on diagnostics, clinical characteristics, and treatment of paediatric generalised joint hypermobility (GJH) and joint hypermobility syndrome (JHS). METHOD A narrative review was performed regarding diagnostics and clinical characteristics. Effectiveness of treatment was evaluated by systematic review. Searches of Medline and Central were performed and included nonsymptomatic and symptomatic forms of GJH (JHS, collagen diseases). RESULTS In the last decade, scientific research has accumulated on all domains of the ICF. GJH/JHS can be considered as a clinical entity, which can have serious effects during all stages of life. However research regarding the pathological mechanism has resulted in new potential opportunities for treatment. When regarding the effectiveness of current treatments, the search identified 1318 studies, from which three were included (JHS: n = 2, Osteogenesis Imperfecta: n = 1). According to the best evidence synthesis, there was strong evidence that enhancing physical fitness is an effective treatment for children with JHS. However this was based on only two studies. CONCLUSION Based on the sparsely available knowledge on intervention studies, future longitudinal studies should focus on the effect of physical activity, fitness, and joint stabilisation. In JHS and chronic pain, the effectiveness of a multidisciplinary approach should be investigated.
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Affiliation(s)
- M C Scheper
- Education of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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98
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Remvig L, Kümmel C, Kristensen JH, Boas G, Juul-Kristensen B. Prevalence of generalized joint hypermobility, arthralgia and motor competence in 10-year-old school children. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1753615411y.0000000009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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99
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Association of benign joint hypermobility with spinal segmental motion and its clinical implication in active young males. Spine (Phila Pa 1976) 2013; 38:E1013-9. [PMID: 23846448 DOI: 10.1097/brs.0b013e31828ffa15] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case-control analysis of prospectively collected data. OBJECTIVE First, to evaluate spinal intervertebral mobility in patients with joint hypermobility (JHM) and matched controls without JHM, and second, to investigate the influence of JHM on back pain, disability, and general health status in young males. SUMMARY OF BACKGROUND DATA Despite the significance of benign JHM in the musculoskeletal feature, there have been no studies regarding low back pain and segmental motion in subjects with JHM. Furthermore, the clinical significance of the excessive segmental motion in young males with JHM remains unknown. METHODS The JHM group included 32 subjects who had Beighton scale score of 4 or more according to 9° Beighton scale. The age-matched 32 young males without JHM were selectively included in the control group. In both groups, Oswestry Disability Index (ODI), visual analogue pain scale (VAS) for back pain, and Short-Form 36 was assessed. Radiological sagittal plane motions for each segment and whole lumbar spine were calculated as the difference between the Cobb angle measurements in the flexion and extension plain radiographs. In the lateral radiograph with neutral standing position, the intervertebral disc heights were also measured at each segment. RESULTS The JHM group showed significantly larger range of motion and higher intervertebral disc height at each matched segment than the control group. The JHM group had significant increased VAS for back pain and ODI score, compared with control group. The Short-Form 36 physical function, role physical, role emotional, and physical component summary in the JHM group were significantly lower than in the control group. CONCLUSION This study shows that young males with JHM were found to have excessive lumbar segmental motion that was associated with increased low back pain, disability, and limited physical activity.
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100
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Howells NR, Eldridge JD. Medial patellofemoral ligament reconstruction for patellar instability in patients with hypermobility: a case control study. ACTA ACUST UNITED AC 2013. [PMID: 23188907 DOI: 10.1302/0301-620x.94b12.29562] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hypermobility is an acknowledged risk factor for patellar instability. In this case control study the influence of hypermobility on clinical outcome following medial patellofemoral ligament (MPFL) reconstruction for patellar instability was studied. A total of 25 patients with hypermobility as determined by the Beighton criteria were assessed and compared with a control group of 50 patients who were matched for age, gender, indication for surgery and degree of trochlear dysplasia. The patients with hypermobility had a Beighton Score of ≥ 6; the control patients had a score of < 4. All patients underwent MPFL reconstruction performed using semitendinosus autograft and a standardised arthroscopically controlled technique. The mean age of the patients was 25 years (17 to 49) and the mean follow-up was 15 months (6 to 30). Patients with hypermobility had a significant improvement in function following surgery, with reasonable rates of satisfaction, perceived improvement, willingness to repeat and likelihood of recommendation. Functional improvements were significantly less than in control patients (p < 0.01). Joint hypermobility is not a contraindication to MPFL reconstruction although caution is recommended in managing the expectations of patients with hypermobility before consideration of surgery.
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Affiliation(s)
- N R Howells
- Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
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