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Systematic review of the association between isolated musculoskeletal hypermobility and adolescent idiopathic scoliosis. Arch Orthop Trauma Surg 2022; 143:3055-3076. [PMID: 35841409 DOI: 10.1007/s00402-022-04508-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) affects 1-3% of the population, but its pathogenesis remains unclear. The coexistence of musculoskeletal hypermobility and scoliosis in many inherited syndromes raises the possibility that isolated musculoskeletal hypermobility may contribute to AIS development or progression. METHODS We performed a systematic review of the evidence for a relationship between isolated musculoskeletal hypermobility and AIS. A meta-analysis was planned, but if not possible, a narrative evidence synthesis was planned. RESULTS Nineteen studies met eligibility criteria for inclusion. One study was excluded due to insufficient quality. Substantial heterogeneity in study design and methodology negated meta-analysis, so a narrative review was performed. Of the 18 studies included, seven suggested a positive association and eight found no association. Three reported the prevalence of musculoskeletal hypermobility in individuals with AIS. Overall, there was no convincing population-based evidence for an association between musculoskeletal hypermobility and AIS, with only two case-control studies by the same authors presenting compelling evidence for an association. Although populations at extremes of hypermobility had a high prevalence of spinal curvature, these studies were at high risk of confounding. Wide variation in methods of measuring musculoskeletal hypermobility and the challenge of assessing AIS in population-based studies hinder study comparison. CONCLUSIONS There is a paucity of high-quality evidence examining the association between isolated musculoskeletal hypermobility and AIS. Large-scale prospective studies with adequate adjustment for potential confounding factors could clarify the relationship between musculoskeletal hypermobility and AIS to elucidate its role in the pathogenesis of AIS.
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Bale P, Easton V, Bacon H, Jerman E, Watts L, Barton G, Clark A, Armon K, MacGregor AJ. The effectiveness of a multidisciplinary intervention strategy for the treatment of symptomatic joint hypermobility in childhood: a randomised, single Centre parallel group trial (The Bendy Study). Pediatr Rheumatol Online J 2019; 17:2. [PMID: 30621718 PMCID: PMC6325876 DOI: 10.1186/s12969-018-0298-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/10/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Joint hypermobility is common in childhood and can be associated with musculoskeletal pain and dysfunction. Current management is delivered by a multidisciplinary team, but evidence of effectiveness is limited. This clinical trial aimed to determine whether a structured multidisciplinary, multisite intervention resulted in improved clinical outcomes compared with standard care. METHOD A prospective randomised, single centre parallel group trial comparing an 8-week individualised multidisciplinary intervention programme (bespoke physiotherapy and occupational therapy in the clinical, home and school environment) with current standard management (advice, information and therapy referral if deemed necessary). The primary endpoint of the study was between group difference in child reported pain from baseline to 12 months as assessed using the Wong Baker faces pain scale. Secondary endpoints were parent reported pain (100 mm visual analogue scale), parent reported function (child health assessment questionnaire), child reported quality of life (child health utility 9-dimensional assessment), coordination (movement assessment battery for children version 2) and grip strength (handheld dynamometer). RESULTS 119 children aged 5 to 16 years, with symptomatic hypermobility were randomised to receive an individualised multidisciplinary intervention (I) (n = 59) or standard management (S) (n = 60). Of these, 105 completed follow up at 12 months. No additional significant benefit could be shown from the intervention compared to standard management. However, there was a statistically significant improvement in child and parent reported pain, coordination and grip strength in both groups. The response was independent of the degree of hypermobility. CONCLUSION This is the first randomised controlled trial to compare a structured multidisciplinary, multisite intervention with standard care in symptomatic childhood hypermobility. For the majority, the provision of education and positive interventions aimed at promoting healthy exercise and self-management was associated with significant benefit without the need for more complex interventions. TRIAL REGISTRATION The trial was registered prospectively with the national database at the Clinical Research Network (UKCRN Portfolio 9366). The trial was registered retrospectively with ISRCTN ( ISRCTN86573140 ).
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Affiliation(s)
- Peter Bale
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK.
| | - Vicky Easton
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Holly Bacon
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Emma Jerman
- grid.439334.aNorfolk Community Health and Care NHS Trust, Norwich, UK
| | - Laura Watts
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK ,0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Garry Barton
- 0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- 0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Kate Armon
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Alex J. MacGregor
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK ,0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
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Benhamu-Benhamu S, Garcia-de-la-Peña R, Gijon-Nogueron G, Jimenez-Cristino MD, Gordillo-Fernández LM, Dominguez-Maldonado G. Range of Ankle Dorsiflexion in a Group of Adults with Ligamentous Laxity. J Am Podiatr Med Assoc 2018; 108:245-252. [PMID: 29932759 DOI: 10.7547/16-060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ligamentous or joint laxity is a clinical entity characterized by increased joint mobility beyond the range of motion regarded as normal, and joint mobility is an effective indicator of the degree of laxity. We examined the influence of ligamentous laxity on the range of ankle dorsiflexion with the knee flexed and extended, comparing lax adults with a control (nonlax) group. METHODS The sample comprised 400 individuals: 200 in the control group (mean ± SD age, 32.49 ± 11.06 years) and 200 in the lax group (mean ± SD age, 29.82 ± 9.40 years). The Beighton criteria were applied to each participant to diagnose laxity or nonlaxity, and sex, age, and angle range of bilateral dorsiflexion with the knee extended and flexed were recorded. RESULTS The mean ± SD dorsiflexion range with the knee straight was 16.14° ± 5.29° left ankle and 21.21° ± 4.93° right ankle in the lax group and 12.94° ± 4.17° left ankle and 17.08° ± 4.40° right ankle in the control group. The respective values with the knee flexed were 15.84° ± 5.31° and 21.21° ± 4.80° in the lax group and 12.95° ± 3.95 and 17.23° ± 4.25° in the control group. CONCLUSIONS In this sample, ankle dorsiflexion range in the lax group was 4° bigger than that in the control group in both knee positions.
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Czaprowski D, Kędra A, Pawłowska P, Kolwicz-Gańko A, Leszczewska J, Tyrakowski M. The examination of the musculoskeletal system based only on the evaluation of pelvic-hip complex muscle and trunk flexibility may lead to failure to screen children for generalized joint hypermobility. PLoS One 2015; 10:e0121360. [PMID: 25786251 PMCID: PMC4364744 DOI: 10.1371/journal.pone.0121360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/31/2015] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of the study was to evaluate whether the clinical assessment of the pelvic-hip complex muscle and trunk flexibility is sufficient for diagnosing generalized joint hypermobility (GJH). Design A cross-sectional study. Setting Center of Body Posture in Olsztyn, North East Poland. Participants The study included 136 females and 113 males aged 10–13 years. Main outcome measures In order to assess muscle flexibility, the straight leg raise (SLR) test (for hamstring) and modified Thomas test for one- (O-JHF) and two-joint (T-JHF) hip flexors were performed. To evaluate trunk flexibility the fingertip-to-floor (FTF) and lateral trunk flexion (LTF) tests were used. The GJH occurrence was assessed with the use of nine-point Beighton scale (threshold value ≥5 points for females, ≥4 for males). The analysis was carried out separately for females and males. Results There were no significant differences between females with versus without GJH, and males with versus without GJH regarding SLR (p = 0.86, p = 0.19 for females and males, respectively), O-JHF (p = 0.89, p = 0.35 for females and males, respectively), T-JHF (p = 0.77, p = 0.4 for females and males, respectively), FTF (p = 0.19, p = 0.84 for females and males, respectively) and LTF (p = 0.58, p = 0.35 for females and males, respectively) tests results. Conclusions Clinical examination of the pelvic-hip complex muscles and trunk flexibility by use of SLR, O-JHF, T-JHF, FTF and LTF revealed to be insufficient in diagnosing GJH in children aged 10–13 years. Thus, the Beighton scale should be considered a standard element of physiotherapeutic examination of the musculoskeletal system in children and youth.
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Affiliation(s)
- Dariusz Czaprowski
- Department of Rehabilitation, University of Physical Education, Marymoncka 34, 00-968 Warsaw, Poland
- Department of Physiotherapy, Józef Rusiecki University College in Olsztyn, Bydgoska 33, 10-243 Olsztyn, Poland
- * E-mail:
| | - Agnieszka Kędra
- Department of Posture Correction and Compensation, Faculty of Physical Education and Sport in Biała Podlaska, Józef Piłsudski University of Physical Education in Warsaw, Akademicka 2, 21-500 Biała Podlaska, Poland
| | - Paulina Pawłowska
- Department of Physical Education, University of Physical Education, Marymoncka 34, 00-968 Warsaw, Poland
| | - Aleksandra Kolwicz-Gańko
- Department of Physical Education, University of Physical Education, Marymoncka 34, 00-968 Warsaw, Poland
| | - Justyna Leszczewska
- Department of Physical Education, University of Physical Education, Marymoncka 34, 00-968 Warsaw, Poland
| | - Marcin Tyrakowski
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, The Centre of Postgraduate Medical Education in Warsaw, Konarskiego 13, 05-400 Otwock, Poland
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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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Joint hypermobility syndrome in children with idiopathic scoliosis. SCOLIOSIS 2012. [PMCID: PMC3304918 DOI: 10.1186/1748-7161-7-s1-o69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Czaprowski D, Kotwicki T, Pawłowska P, Stoliński L. Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner. SCOLIOSIS 2011; 6:22. [PMID: 21981906 PMCID: PMC3204294 DOI: 10.1186/1748-7161-6-22] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/07/2011] [Indexed: 11/25/2022]
Abstract
Background Generalized joint hypermobility (JHM) refers to increased joint mobility with simultaneous absence of any other systemic disease. JHM involves proprioception impairment, increased frequency of pain within joints and tendency to injure soft tissues while performing physical activities. Children with idiopathic scoliosis (IS) often undergo intensive physiotherapy requiring good physical capacities. Further, some physiotherapy methods apply techniques that increase joint mobility and thus may be contraindicated. The aim of this paper was to assess JHM prevalence in children with idiopathic scoliosis and to analyze the relationship between JHM prevalence and the clinical and radiological parameters of scoliosis. The methods of assessment of generalized joint hypermobility were also described. Materials and methods This case-control study included 70 subjects with IS, aged 9-18 years (mean 13.2 ± 2.2), Cobb angle range 10°-53° (mean 24.3 ± 11.7), 34 presenting single curve thoracic scoliosis and 36 double curve thoracic and lumbar scoliosis. The control group included 58 children and adolescents aged 9-18 years (mean 12.6 ± 2.1) selected at random. The presence of JHM was determined using Beighton scale complemented with the questionnaire by Hakim and Grahame. The relationship between JHM and the following variables was evaluated: curve severity, axial rotation of the apical vertebra, number of curvatures (single versus double), number of vertebrae within the curvature (long versus short curves), treatment type (physiotherapy versus bracing) and age. Statistical analysis was performed with Statistica 8.1 (StatSoft, USA). The Kolmogorov-Smirnov test, U Mann-Whitney test, Chi2 test, Pearson and Spermann correlation rank were conducted. The value p = 0.05 was adopted as the level of significance. Results JHM was diagnosed in more than half of the subjects with idiopathic scoliosis (51.4%), whilst in the control group it was diagnosed in only 19% of cases (p = 0.00015). A significantly higher JHM prevalence was observed in both girls (p = 0.0054) and boys (p = 0.017) with IS in comparison with the corresponding controls. No significant relation was found between JHM prevalence and scoliosis angular value (p = 0.35), apical vertebra rotation (p = 0.86), the number of vertebrae within curvature (p = 0.8), the type of applied treatment (p = 0.55) and the age of subjects (p = 0.79). JHM prevalence was found to be higher in children with single curve scoliosis than in children with double curve scoliosis (p = 0.03). Conclusions JHM occurs more frequently in children with IS than in healthy sex and age matched controls. No relation of JHM with radiological parameters, treatment type and age was found. Systematically searched in IS children, JHM should be taken into account when physiotherapy is planned.
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Affiliation(s)
- Dariusz Czaprowski
- Faculty of Physiotherapy, Józef Rusiecki University College in Olsztyn, 10-243 Olsztyn, Bydgoska 33, Poland.
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Yazgan P, Geyikli İ, Zeyrek D, Baktiroglu L, Kurcer MA. Is joint hypermobility important in prepubertal children? Rheumatol Int 2008; 28:445-51. [DOI: 10.1007/s00296-008-0528-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 01/01/2008] [Indexed: 11/28/2022]
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