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Clinical assessment of generalized ligamentous laxity using a single test: is thumb-to-forearm apposition enough? J Pediatr Orthop B 2021; 30:296-300. [PMID: 32301823 DOI: 10.1097/bpb.0000000000000732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The complete Beighton criteria, commonly used to establish the diagnosis of generalized ligamentous laxity (GLL), include nine discrete examination maneuvers. However, busy examiners may perform only a single maneuver (e.g. passive apposition of the thumb to the forearm) as a rapid method of assessment. We hypothesize that the use of a single-joint hypermobility test does not reliably identify the presence of GLL. Healthy patients 2-18 years old presenting to a general pediatric orthopaedic clinic were screened for participation. Exclusion criteria included the presence of a systemic illness, neuromuscular disease, and inability to complete the examination. Subjects were assessed for GLL according to the Beighton criteria, using a cutoff score of 5. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio were calculated for the thumb-to-forearm apposition test with the composite Beighton score used as the gold standard. Two hundred and four patients were included in the study, 111 females and 93 males, with an average age of 10.7 years. The prevalence of GLL was 13.3%. When thumb-to-forearm apposition was performed unilaterally, the PPV was poor (34%). Conversely, the NPV was excellent (99%). Sensitivity of thumb-to-forearm motion was extremely high (99%), although the specificity of this test was modest (67%). The likelihood ratio was fair (+3.3). Performing the test bilaterally did not significantly change its utility. Thumb-to-forearm apposition testing was equally effective in identifying the presence of GLL in males and females. When performed in isolation, assessment of thumb-to-forearm apposition has a poor PPV, excellent NPV, and modest likelihood ratio. It is an extremely sensitive test, with only fair specificity. Other upper extremity tests of GLL perform similarly. Therefore, while single tests like thumb-to-forearm apposition may be helpful for 'ruling out' GLL, they are less reliable at identifying it correctly. When single tests are used to identify GLL in either clinical or research settings, the results should be interpreted with caution. Level of evidence Level I (diagnostic).
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Ishiguro H, Yagasaki H, Horiuchi Y. Ehlers-Danlos Syndrome in the Field of Psychiatry: A Review. Front Psychiatry 2021; 12:803898. [PMID: 35087434 PMCID: PMC8787077 DOI: 10.3389/fpsyt.2021.803898] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022] Open
Abstract
Ehlers-Danlos syndrome (EDS) comprises a series of rare hereditary connective tissue diseases characterized by joint hypermobility, joint dislocation, and hyperextensibility of the skin, as well as cardiovascular involvement. EDS is often associated with chronic widespread physical pain, which can lead to psychological pain. Poor awareness and limited diagnosis of EDS and related symptoms result in decreased self-esteem and confusion regarding physical sensation. Furthermore, EDS imposes substantial psychological burden on patients due to exercise restriction, scars, keloids, and subcutaneous fat accumulation on the extremities, which leads to parental overprotection and bullying experiences from other children at school age. Recent large-scale studies have suggested that patients with EDS have a higher risk of mood disorders than the general population. Other cohort studies indicated high prevalence of anorexia nervosa, addiction, obsessive compulsive disorder, and anxiety disorder were found in patients with EDS. Case reports instead indicated that some psychiatric disorders were secondary symptoms due to physical problems from EDS. Therefore, psychiatrists must be more knowledgeable and proactive about EDS in their practice. We review the previous case reports and literature for patients with EDS, along with our own case of complicated psychiatric problems, which are strongly related to early stressful situations through childhood and adolescence. This is to aid general psychiatrists in the discussion of appropriate medical management in such infrequent, yet challenging conditions.
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Affiliation(s)
- Hiroki Ishiguro
- Center of Genetic Medicine, Hospital, University of Yamanashi, Kofu, Japan.,Cancer Counseling and Support Center, Hospital, University of Yamanashi, Kofu, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, University of Yamanashi, Kofu, Japan
| | - Hideaki Yagasaki
- Center of Genetic Medicine, Hospital, University of Yamanashi, Kofu, Japan
| | - Yasue Horiuchi
- Center of Genetic Medicine, Hospital, University of Yamanashi, Kofu, Japan.,Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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3
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Joint Hypermobility Classes in 9-Year-Old Children from the General Population and Anxiety Symptoms. J Dev Behav Pediatr 2019; 39:481-488. [PMID: 29847358 DOI: 10.1097/dbp.0000000000000577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To obtain joint hypermobility classes in children from the general population and to study their characteristics in relation to anxiety measures. METHODS A total of 336 nine-year-old children from the general population were clinically assessed through 9 items of hypermobility, and their parents reported about the severity of anxiety symptoms. Latent class analysis was estimated to group the children according to the presence of hypermobility symptoms, and the obtained classes were related to anxiety. RESULTS A 2-class solution, labeled as high hypermobility and low hypermobility, best fitted the data. Children in the high hypermobility group scored higher in separation anxiety, social phobia, physical injury fears, and total anxiety than did those in the low group. When applying the threshold reference scores to the total anxiety score, 7.4% of children in the high hypermobility group versus 6% in the low group were reported to experience clinical elevations on total anxiety. CONCLUSION High symptoms of hypermobility are associated with higher scores in anxiety symptoms in children from the general population. Children with frequent symptoms of hypermobility may benefit from screening for anxiety symptoms because a subset of them are experiencing clinical elevations and may need comprehensive physical and psychological treatment.
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Bulbena-Cabre A, Duñó L, Almeda S, Batlle S, Camprodon-Rosanas E, Martín-Lopez LM, Bulbena A. Joint hypermobility is a marker for anxiety in children. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:68-76. [PMID: 30926372 DOI: 10.1016/j.rpsm.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/12/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) has been found to be associated with anxiety disorders in clinical and nonclinical populations, but to date no studies have evaluated this association in children. The main goal of this study is to evaluate JHS along with anxiety, somatic and behavioral measures in children to clarify if JHS is associated with any of these variables in this age range. METHODS A sample of 160 children (74 girls and 86 boys) ranging from 5 to 17 o were recruited from a Child-Adolescent Mental Health clinic to participate in the study. All children underwent a diagnostic interview using the Mini International Neuropsychiatric Interview for Children and Adolescents. Instruments used include the Child Behavior Checklist (CBCL), the Screening Questionnaire to detect Hypermobility (SQ-CH) and the Children Manifested Anxiety Scale (CMAS-R). RESULTS The prevalence of JHS in this sample was 22%, and this was significantly higher in girls (31%) than in boys (14%) (χ2=6.83; P=.001). The JHS group scored significantly higher in the CMAS-R total anxiety (F=4.51; P=.035), CMAS-R Physiological anxiety (F=7.19; P=.008) and the CBCL somatic complaints (F=8.46; 0.004) and regression analyses showed that these 3 variables were predictors of JHS (χ2=36.77; P<.001; r2=0.22). The JHS group also scored higher in some behavioral measures. CONCLUSION Children with JHS have higher frequency of anxiety disorders and higher intensity of physiological anxiety, somatic complaints, and therefore, JHS might be used as marker for this anxiety phenotype in youngsters.
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Affiliation(s)
- Andrea Bulbena-Cabre
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, EE. UU.; Department of Psychiatry, New York Medical College, Nueva York, EE. UU.
| | - Lourdes Duñó
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Sara Almeda
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Santiago Batlle
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Ester Camprodon-Rosanas
- Children and Adolescent Mental Health Research Group. Institut de Recerca Sant Joan de Déu Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
| | - Luis Miguel Martín-Lopez
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España; Centro de Investigación en red de Salud Mental (CIBERSAM), España
| | - Antonio Bulbena
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España; Centro de Investigación en red de Salud Mental (CIBERSAM), España
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Both anxiety and joint laxity determine the olfactory features in panic disorder. Psychiatry Res 2018; 262:420-426. [PMID: 28923431 DOI: 10.1016/j.psychres.2017.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 07/26/2017] [Accepted: 09/08/2017] [Indexed: 12/23/2022]
Abstract
Previous research showed a high sensitivity in sensorial modalities in panic disorder (PD). This disorder has been consistently associated to the joint hypermobility syndrome (JHS). In non-clinical samples, this collagen alteration has been also related to an enhanced sensitivity in some sensorial modalities. The main aim of this study is to explore the olfactory functioning in PD in relation to JHS. Sixty patients with PD and sixty healthy controls performed the Sniffin' Sticks Test (SST) (threshold subtest), and completed the Affective Impact of Odors scale (AIO), the Relational Scale of Olfaction (EROL), and the Odor Awareness Scale (OAS). Clinical symptom rating scales and JHS assessment were also obtained. PD patients showed enhanced odor acuity, greater reactivity to smells and also increased odor awareness compared to the healthy controls. Within the patients group, those suffering from JHS displayed higher functioning in all olfactory domains compared to the non-JHS ones. The JHS and anxiety measures emerged as predictor variables of the olfactory function. The present findings highlight the importance of the olfactory function in PD and underline that both, JHS and anxiety, determine the olfactory characteristics in this disorder.
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Chan C, Hopper L, Zhang F, Pacey V, Nicholson LL. The prevalence of generalized and syndromic hypermobility in elite Australian dancers. Phys Ther Sport 2018; 32:15-21. [PMID: 29655088 DOI: 10.1016/j.ptsp.2018.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 02/08/2018] [Accepted: 02/21/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine the prevalence of Generalized Joint Hypermobility (GJH) and Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT) among dancers using established validated measures. DESIGN Observational Cohort Study. SETTING Laboratory. PARTICIPANTS 85 dancers from two dance institutions. MAIN OUTCOME MEASURES GJH was determined using the Beighton score (cut-point ≥5/9) and the Lower Limb Assessment Scale (LLAS) (cut-point ≥7/12). Presence of JHS/EDS-HT was assessed using the Brighton and Villefranche criteria. Paired sample t-test was performed to compare LLAS side-to-side scores, and percentage disagreements calculated to determine differences between the two GJH and the two JHS/EDS-HT measures. RESULTS 72% of dancers met the Beighton cut-point for GJH, while 38% and 42% met the LLAS cut-point on the left and right respectively. The proportion of dancers identified with GJH was different when assessed using the Beighton compared to the left and right LLAS (both p < 0.001), a disagreement of 48% and 46% respectively, with Beighton classifying more participants as having GJH. The Villefranche identified more dancers with JHS/EDS-HT than the Brighton (84% vs 31%, p < 0.001), with 54% disagreement. CONCLUSIONS High prevalence of generalized and syndromic hypermobility was found regardless of the criteria used. A higher Beighton cut-point, e.g. ≥6/9, to identify true GJH amongst dancers maybe warranted.
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Affiliation(s)
- Cliffton Chan
- The University of Sydney, Discipline of Biomedical Science, Sydney Medical School, New South Wales, Australia. 75 East St, Lidcombe, New South Wales, 1825, Australia.
| | - Luke Hopper
- Western Australian Academy of Performing Arts, Edith Cowan University, Perth, Australia. 1/2 Bradford St, Menora, Western Australia, 6050, Australia.
| | - Feili Zhang
- The University of Sydney, Discipline of Physiotherapy, Faculty of Health Sciences, New South Wales, Australia. 75 East St, Lidcombe, New South Wales, 1825, Australia.
| | - Verity Pacey
- Macquarie University, Department of Health Professions, Faculty of Medicine and Health Sciences, New South Wales, Australia. 75 Talavera Rd, Macquarie, New South Wales, 2109, Australia.
| | - Leslie L Nicholson
- The University of Sydney, Discipline of Biomedical Science, Sydney Medical School, New South Wales, Australia. 75 East St, Lidcombe, New South Wales, 1825, Australia.
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Wells R, Spurrier AJ, Linz D, Gallagher C, Mahajan R, Sanders P, Page A, Lau DH. Postural tachycardia syndrome: current perspectives. Vasc Health Risk Manag 2017; 14:1-11. [PMID: 29343965 PMCID: PMC5749569 DOI: 10.2147/vhrm.s127393] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Postural tachycardia syndrome (POTS) is the combination of an exaggerated heart rate response to standing, in association with symptoms of lightheadedness or pre-syncope that improve when recumbent. The condition is often associated with fatigue and brain fog, resulting in significant disruptions at a critical time of diagnosis in adolescence and young adulthood. The heterogeneity of the underlying pathophysiology and the variable response to therapeutic interventions make management of this condition challenging for both patients and physicians alike. Here, we aim to review the factors and mechanisms that may contribute to the symptoms and signs of POTS and to present our perspectives on the clinical approach toward the diagnosis and management of this complex syndrome.
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Affiliation(s)
- Rachel Wells
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Departments of Cardiology and Medicine, Royal Adelaide Hospital.,Department of Medicine, Royal Adelaide Hospital
| | | | - Dominik Linz
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Departments of Cardiology and Medicine, Royal Adelaide Hospital
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Departments of Cardiology and Medicine, Royal Adelaide Hospital
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Departments of Cardiology and Medicine, Royal Adelaide Hospital
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Departments of Cardiology and Medicine, Royal Adelaide Hospital
| | - Amanda Page
- Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Departments of Cardiology and Medicine, Royal Adelaide Hospital
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Physical and Psychosocial Characteristics of Current Child Dancers and Nondancers With Systemic Joint Hypermobility: A Descriptive Analysis. J Orthop Sports Phys Ther 2017; 47:782-791. [PMID: 28870141 DOI: 10.2519/jospt.2017.7331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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 study. Background The effect of current participation in dance training on joint pain and instability, fatigue, and quality of life is unknown. Objectives To examine differences in joint pain, instability, gross motor skills, nonmusculoskeletal systemic manifestations, health-related quality of life (HRQoL), and fatigue between children with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type (JHS/EDS-HT) who currently undertake formal dance training and those who do not. Methods Children with JHS/EDS-HT and 1 parent completed reports providing data on demographic variables, symptoms, organized activity participation, HRQoL, and fatigue. Physical and functional measures included extent of hypermobility, aerobic fitness, balance, and muscle endurance. Results Of the 102 participating children, 22 currently undertook dance classes, averaging 3.3 h/wk. While the dancers reported a number of painful joints similar to that reported by nondancers (mean ± SD, 5.5 ± 3.7 versus 6.4 ± 3.9 joints, respectively; P = .36), they reported significantly lower pain levels on a 0-to-10 scale (3.8 ± 3.3 versus 5.6 ± 3.4, P = .04) and found pain to be less problematic, affecting less of their body. They reported fewer unstable joints (1.0 ± 1.0 versus 2.0 ± 1.8 joints, P = .001), despite being more hypermobile (Beighton score, 7.3 ± 1.4 versus 6.6 ± 1.6 on a 9-point scale, P = .047; Lower Limb Assessment Score, 9.2 ± 2.0 versus 8.1 ± 1.9 on a 12-point scale, P = .02). The dancers had significantly better HRQoL in the subdomain of school functioning (P = .004) and reported less fatigue (P = .024). Conclusion Children with JHS/EDS-HT who are currently undertaking formal dance training have fewer joint pain and instability symptoms, less fatigue, and better HRQoL; however, the cross-sectional nature of the study means that causation cannot be determined. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2017;47(10):782-791. Epub 4 Sep 2017. doi:10.2519/jospt.2017.7331.
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Pain-Related Fear and Its Disabling Impact in Hypermobile Adolescents With Chronic Musculoskeletal Pain. J Orthop Sports Phys Ther 2017; 47:775-781. [PMID: 28898137 DOI: 10.2519/jospt.2017.7282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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 study. Background Chronic musculoskeletal pain (CMP) has a negative impact on physical functioning. During adolescence, joint hypermobility is a potential risk factor for developing CMP, and pain-related fear contributes to the persistence of CMP. Whether pain-related fear and hypermobility are related, and even reinforce each other, resulting in a stronger association with perceived level of disability, is still unknown. Objectives To evaluate whether pain-related fear has a stronger association with disability in hypermobile compared to nonhypermobile adolescents with CMP. Methods The study included 116 adolescents with CMP. The presence of hypermobility was assessed using the Beighton score. Measures of pain intensity, age, sex, and pain-related fear were collected and included in the multivariable model. Hierarchical regression analysis, with disability as the dependent variable, was used to examine the interaction between hypermobility and pain-related fear. Results Hypermobile adolescents with CMP do not have more pain-related fear compared to nonhypermobile adolescents with CMP. There was no interaction effect between hypermobility and pain-related fear in explaining disability (β = .20, P = .42). Similarly, perceived harmfulness of balance-related activities was not more strongly associated with disability in hypermobile adolescents with CMP. Conclusion The association of pain-related fear with the perceived level of disability is not more pronounced in hypermobile compared to nonhypermobile adolescents with CMP. J Orthop Sports Phys Ther 2017;47(10):775-781. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7282.
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Affiliation(s)
- Becky Purkaple
- 1 University of Oklahoma Heath Science Center, Oklahoma City, OK, USA
| | - Amy Middleman
- 1 University of Oklahoma Heath Science Center, Oklahoma City, OK, USA
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11
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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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12
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Klingler W, Velders M, Hoppe K, Pedro M, Schleip R. Clinical relevance of fascial tissue and dysfunctions. Curr Pain Headache Rep 2015; 18:439. [PMID: 24962403 DOI: 10.1007/s11916-014-0439-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fascia is composed of collagenous connective tissue surrounding and interpenetrating skeletal muscle, joints, organs, nerves, and vascular beds. Fascial tissue forms a whole-body, continuous three-dimensional viscoelastic matrix of structural support. The classical concept of its mere passive role in force transmission has recently been disproven. Fascial tissue contains contractile elements enabling a modulating role in force generation and also mechanosensory fine-tuning. This hypothesis is supported by in vitro studies demonstrating an autonomous contraction of human lumbar fascia and a pharmacological induction of temporary contraction in rat fascial tissue. The ability of spontaneous regulation of fascial stiffness over a time period ranging from minutes to hours contributes more actively to musculoskeletal dynamics. Imbalance of this regulatory mechanism results in increased or decreased myofascial tonus, or diminished neuromuscular coordination, which are key contributors to the pathomechanisms of several musculoskeletal pathologies and pain syndromes. Here, we summarize anatomical and biomechanical properties of fascial tissue with a special focus on fascial dysfunctions and resulting clinical manifestations. Finally, we discuss current and future potential treatment options that can influence clinical manifestations of pain syndromes associated with fascial tissues.
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Affiliation(s)
- W Klingler
- Fascia Research Group, Division of Neurophysiology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
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Chang TH, Yuh DY, Wu YT, Cheng WC, Lin FG, Shieh YS, Fu E, Huang RY. The association between temporomandibular disorders and joint hypermobility syndrome: a nationwide population-based study. Clin Oral Investig 2015; 19:2123-32. [PMID: 25687768 DOI: 10.1007/s00784-015-1422-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to investigate the risk factors of temporomandibular disorders (TMDs), including disc or non-disc-related disorders, and joint hypermobility syndrome (JHS) retrospectively and to analyze the factors by estimating the magnitude of the association between the two conditions using a nationwide population-based dataset. MATERIALS AND METHODS A total of 975,788 eligible patients' de-identified data were obtained from a representative database composed of one million of Taiwan's population since 2004 to 2008. All associated factors, such as gender, age, facial trauma, and psychosis, which correlated with TMDs and JHS were examined. Multiple logistic regression modeling adjusted for confounding variables to determine the odds ratio of variables that made an important contribution to TMDs and JHS. RESULTS For all TMDs patients, only 1.47% patients had disc-related disorders. For all JHS patients, only 3.85% patients are diagnosed with concomitant TMDs. Statistically significant association was observed between joint hypermobility and TMDs. Furthermore, the prevalence of JHS patients shows significant difference within TMD subgroups, in which 9.52% of JHS patients have disc disorders and 90.48% of JHS patients do not. All associated factors, such as gender, age, JHS, facial trauma, and psychosis, had a significant impact on the TMDs. Interestingly, patients with TMJ articular disc disorders are 6.7 times more likely to be diagnosed with JHS compared to patients without disc-related disorders. CONCLUSIONS Our results confirm that there is a significant positive association between TMDs and JHS, highlighting that patients with disc-related TMDs are more likely to experience JHS than patients with TMDs without disc disorders. CLINICAL RELEVANCE Individuals with TMD associated with JHS should be carefully evaluated by inter-disciplinary specialists as these factors may eventually have impact on the prognosis of TMDs and JHS.
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Affiliation(s)
- Ting-Han Chang
- Department of Dentistry, Taiwan Adventist Hospital, Taipei, Taiwan.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Da-Yo Yuh
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Wan-Chien Cheng
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Fu-Gong Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Shing Shieh
- Department of Oral Diagnosis and Pathology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Earl Fu
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
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A unifying neuro-fasciagenic model of somatic dysfunction - underlying mechanisms and treatment - Part I. J Bodyw Mov Ther 2015; 19:310-26. [PMID: 25892388 DOI: 10.1016/j.jbmt.2015.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 02/06/2023]
Abstract
This paper offers an extensive review of the main fascia-mediated mechanisms underlying various dysfunctional and pathophysiological processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the diverse fascial influences that may come into play in its genesis and maintenance. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of dysfunctional process as being partially, if not entirely, mediated by the fascia.
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Russek LN, LaShomb EA, Ware AM, Wesner SM, Westcott V. United States Physical Therapists' Knowledge About Joint Hypermobility Syndrome Compared with Fibromyalgia and Rheumatoid Arthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2014; 21:22-35. [DOI: 10.1002/pri.1613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 02/17/2014] [Accepted: 09/22/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Leslie N. Russek
- Clarkson University; Potsdam NY USA
- Canton-Potsdam Hospital; Potsdam NY USA
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Sanches SB, Osório FL, Louzada-Junior P, Moraes D, Crippa JAS, Martín-Santos R. Association between joint hypermobility and anxiety in Brazilian university students: gender-related differences. J Psychosom Res 2014; 77:558-61. [PMID: 25219975 DOI: 10.1016/j.jpsychores.2014.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/23/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anxiety disorders may be associated with several non-psychiatric disorders. Current literature has been investigating the association between anxiety and joint hypermobility (JHM), with special interest in non-articular symptoms that may be related to autonomic dysfunction. This study investigated the association between anxiety and JHM in a sample of Brazilian university students. METHODS Data were cross-sectionally collected in two Brazilian universities (N=2600). Participants completed three validated self-rating anxiety scales: Beck Anxiety Inventory (BAI), Social Phobia Inventory (SPIN) and the brief-version of SPIN (Mini-SPIN). They also answered the self-rating screening questionnaire for JHM: the Five-part Questionnaire for Identifying Hypermobility. RESULTS Hypermobile women showed significantly higher scores in all the anxiety scales, when compared with men: BAI total score (t=3.77; p<0.001), its four subscales, SPIN score (t=2.71; p<0.007) and Mini-SPIN (t=2.58; p<0.01). Among BAI subscales, the autonomic subscale was shown to be more significantly (t=3.89; p<0.001) associated with joint hypermobility in women. CONCLUSIONS The results of the present study support earlier evidence on the relationship between anxiety and JHM in women, showing specific gender-related features in this field. It also directs attention to non-articular symptoms that may be enrolled in this association.
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Affiliation(s)
- S B Sanches
- Neuroscience and Behavior Department, Faculty of Medicine of Ribeirão Preto - University of São Paulo, Brazil; Departments of Psychiatry and Psychology, Hospital Clínic, University of Barcelona, Institut d'Investigació Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain.
| | - F L Osório
- Neuroscience and Behavior Department, Faculty of Medicine of Ribeirão Preto - University of São Paulo, Brazil
| | - P Louzada-Junior
- Division of Clinical Immunology, Center for Research in Inflammatory Disease, Faculty of Medicine of Ribeirão Preto - University of São Paulo, Brazil
| | - D Moraes
- Division of Clinical Immunology, Center for Research in Inflammatory Disease, Faculty of Medicine of Ribeirão Preto - University of São Paulo, Brazil
| | - J A S Crippa
- Neuroscience and Behavior Department, Faculty of Medicine of Ribeirão Preto - University of São Paulo, Brazil
| | - R Martín-Santos
- Departments of Psychiatry and Psychology, Hospital Clínic, University of Barcelona, Institut d'Investigació Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain
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17
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Mallorquí-Bagué N, Garfinkel SN, Engels M, Eccles JA, Pailhez G, Bulbena A, Critchley HD. Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility. Front Psychol 2014; 5:1162. [PMID: 25352818 PMCID: PMC4196473 DOI: 10.3389/fpsyg.2014.01162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/24/2014] [Indexed: 12/23/2022] Open
Abstract
Objective: Anxiety is associated with increased physiological reactivity and also increased “interoceptive” sensitivity to such changes in internal bodily arousal. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders. This study explored the link between anxiety, interoceptive sensitivity and hypermobility in a sub-clinical population using neuroimaging and psychophysiological evaluation. Methods: Thirty-six healthy volunteers undertook interoceptive sensitivity tests, a clinical examination for hypermobility and completed validated questionnaire measures of state anxiety and body awareness tendency. Nineteen participants also performed an emotional processing paradigm during functional neuroimaging. Results: We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex. Conclusions: Our findings highlight the dependence of anxiety state on bodily context, and increase our understanding of the mechanisms through which vulnerability to anxiety disorders arises in people bearing a common variant of collagen.
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Affiliation(s)
- Núria Mallorquí-Bagué
- Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autonoma de Barcelona Barcelona, Spain ; Department of Psychiatry, Psychology and Psychosomatics, Hospital Universitari Quirón Dexeus Barcelona, Spain
| | - Sarah N Garfinkel
- Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Mood and Anxiety Research in Sussex (MARS), Sussex Partnership NHS Foundation Trust Sussex, UK ; Sackler Centre for Consciousness Science, University of Sussex Falmer, UK
| | - Miriam Engels
- Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University Maastricht, Netherlands
| | - Jessica A Eccles
- Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Mood and Anxiety Research in Sussex (MARS), Sussex Partnership NHS Foundation Trust Sussex, UK
| | - Guillem Pailhez
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autonoma de Barcelona Barcelona, Spain ; Anxiety Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Universitat Autònoma de Barcelona Barcelona, Spain ; Hospital del Mar Medical Research Institute Barcelona, Spain
| | - Antonio Bulbena
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autonoma de Barcelona Barcelona, Spain ; Anxiety Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Universitat Autònoma de Barcelona Barcelona, Spain ; Hospital del Mar Medical Research Institute Barcelona, Spain
| | - Hugo D Critchley
- Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Mood and Anxiety Research in Sussex (MARS), Sussex Partnership NHS Foundation Trust Sussex, UK ; Sackler Centre for Consciousness Science, University of Sussex Falmer, UK
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18
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Pantoja Zarza L, Díez Morrondo C, Alexis D. Hyperlax Ehlers-Danlos syndrome: benign hypermobility? REUMATOLOGIA CLINICA 2014; 10:189-190. [PMID: 24055257 DOI: 10.1016/j.reuma.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/14/2013] [Accepted: 06/07/2013] [Indexed: 06/02/2023]
Affiliation(s)
| | | | - Duckens Alexis
- Servicio de Medicina Interna, Hospital El Bierzo, Ponferrada, León, España
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19
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Pasquini M, Celletti C, Berardelli I, Roselli V, Mastroeni S, Castori M, Biondi M, Camerota F. Unexpected association between joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type and obsessive–compulsive personality disorder. Rheumatol Int 2013; 34:631-6. [DOI: 10.1007/s00296-013-2901-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 11/06/2013] [Indexed: 12/20/2022]
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20
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Castori M, Morlino S, Celletti C, Ghibellini G, Bruschini M, Grammatico P, Blundo C, Camerota F. Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet A 2013; 161A:2989-3004. [DOI: 10.1002/ajmg.a.36315] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 09/29/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Silvia Morlino
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Claudia Celletti
- Division of Physical Therapy and Rehabilitation, Department of Orthopedic Sciences; Sapienza University, Umberto I University Hospital; Rome Italy
| | - Giulia Ghibellini
- Division of Pharmacotherapy and Experimental Therapeutics; School of Pharmacy, University of North Carolina at Chapel Hill; North Carolina
| | - Michela Bruschini
- Unit of Cognitive and Behavioral Neurology, Division of Neurology and Neurophysiopathology; San Camillo-Forlanini Hospital; Rome Italy
| | - Paola Grammatico
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Carlo Blundo
- Unit of Cognitive and Behavioral Neurology, Division of Neurology and Neurophysiopathology; San Camillo-Forlanini Hospital; Rome Italy
| | - Filippo Camerota
- Division of Physical Therapy and Rehabilitation, Department of Orthopedic Sciences; Sapienza University, Umberto I University Hospital; Rome Italy
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Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor AJ. The relationship between benign joint hypermobility syndrome and psychological distress: a systematic review and meta-analysis. Rheumatology (Oxford) 2013; 53:114-22. [DOI: 10.1093/rheumatology/ket317] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Mulvey MR, Macfarlane GJ, Beasley M, Symmons DPM, Lovell K, Keeley P, Woby S, McBeth J. Modest Association of Joint Hypermobility With Disabling and Limiting Musculoskeletal Pain: Results From a Large-Scale General Population-Based Survey. Arthritis Care Res (Hoboken) 2013; 65:1325-33. [DOI: 10.1002/acr.21979] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/29/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | | | | | | | - Steve Woby
- The Pennine Acute Hospitals NHS Trust; Manchester UK
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23
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Castori M. Ehlers-danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN DERMATOLOGY 2012; 2012:751768. [PMID: 23227356 PMCID: PMC3512326 DOI: 10.5402/2012/751768] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/14/2012] [Indexed: 12/20/2022]
Abstract
Ehlers-Danlos syndrome, hypermobility type, constituting a phenotypic continuum with or, perhaps, corresponding to the joint hypermobility syndrome (JHS/EDS-HT), is likely the most common, though the least recognized, heritable connective tissue disorder. Known for decades as a hereditary condition with predominant rheumatologic manifestations, it is now emerging as a multisystemic disorder with widespread manifestations. Nevertheless, the practitioners' awareness of this condition is generally poor and most patients await years or, perhaps, decades before reaching the correct diagnosis. Among the various sites of disease manifestations, skin and mucosae represent a neglected organ where the dermatologist can easily spot diagnostic clues, which consistently integrate joint hypermobility and other orthopedic/neurologic manifestations at physical examination. In this paper, actual knowledge on JHS/EDS-HT is summarized in various sections. Particular attention has been posed on overlooked manifestations, including cutaneous, mucosal, and oropharyngeal features, and early diagnosis techniques, as a major point of interest for the practicing dermatologist. Actual research progresses on JH/EDS-HT envisage an unexpected link between heritable dysfunctions of the connective tissue and a wide range of functional somatic syndromes, most of them commonly diagnosed in the office of various specialists, comprising dermatologists.
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Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine, San Camillo-Forlanini Hospital, Sapienza University, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
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