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Anieto EM, Anieto IB, Ituen OA, Naidoo N, Ezema CI, Smits-Engelsman B. The relationship between kinaesthesia, motor performance, physical fitness and joint mobility in children living in Nigeria. BMC Pediatr 2023; 23:526. [PMID: 37872483 PMCID: PMC10591369 DOI: 10.1186/s12887-023-04348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE This study aimed to determine the relationship between kinaesthesia, motor performance, fitness, and joint mobility in children. METHODS A descriptive cross-sectional study was conducted involving children from two primary schools in the South-Eastern part of Nigeria. The Beighton criteria were used to measure joint mobility. Motor performance, fitness, and kinaesthesia were measured in all the children. Spearman's rank correlation was used to evaluate the relationship between the outcomes. RESULTS A total of 91 children (51.6% girls) participated in the study. The mean age of the children was 8.20 ± 1.98 years. Using a Beighton score of ≥ 6, Generalized Joint Hypermobility (GJH) was identified in a total of 35 (38.46%) children and was more prevalent in females (60.0%). Joint mobility had significant correlations with most fitness and motor performance items, but not kinaesthesia. Agility & power, and motor performance seem to be reduced if mobility is larger. Kinaesthesia was correlated with most fitness and motor performance items, indicating that better fitness and better motor performance cooccur with better kinaesthesia or vice versa. CONCLUSION Joint mobility may have a significant influence on fitness and motor performance in children. Hence, it may be useful for future studies to investigate how fitness and motor performance modulate the onset and progression of musculoskeletal symptoms in GJH.
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Affiliation(s)
- Ebuka Miracle Anieto
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, G4 0BA, Glasgow, Scotland, U.K..
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Ijeoma Blessing Anieto
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom
| | - Oluwakemi Adebukola Ituen
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charles I Ezema
- Department of Medical Rehabilitation, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ituen OA, Anieto EM, Ferguson G, Duysens J, Smits-Engelsman B. Prevalence and Demographic Distribution of Hypermobility in a Random Group of School-Aged Children in Nigeria. Healthcare (Basel) 2023; 11:healthcare11081092. [PMID: 37107926 PMCID: PMC10137997 DOI: 10.3390/healthcare11081092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/08/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of hypermobility in randomly selected healthy children, without previous trauma or disease process affecting the joints and whether other demographic variables (age, sex, BMI) had an impact on Beighton scores and range of motion (RoM) in children between 6 and 10 years of age. RESULTS 286 children were included; 27.3% of them had a Beighton score ≥7/9 and 72% would be classified hypermobile if we had used a Beighton cut-off score ≥4/9. Prevalence declined with increasing age. Girls were more often hypermobile (34%) than boys (20%) and this was mainly caused by increased RoM in the knees. Positive scores of finger items of the Beighton were more common than on the other items, leading to a high prevalence of peripheral hypermobility. Localized hypermobility was only found in the fifth MCP joint. A total of 15% of the children with normal mobility reached 20 excess degrees RoM of the left and right fifth MCP. Pain was present in 12 of the 239 children but was not linked to the level of mobility. CONCLUSION Hypermobility is the rule in this pain-free population of children with GJH.
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Affiliation(s)
| | - Ebuka Miracle Anieto
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Gillian Ferguson
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
| | - Jacques Duysens
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, KU Leuven, 3001 Leuven, Belgium
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
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ARİFOĞLU KARAMAN Ç, ZEREN E, MARAL F, PARLAK M, KİRAZLI Ö, BORACI H, ZEREN M, ARİFOĞLU Y. The Effect of Hypermobility on Pain and Quality of Life in Young Adults. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2022.55707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Malek S, Reinhold EJ, Pearce GS. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol Int 2021; 41:1707-1716. [PMID: 33738549 PMCID: PMC8390395 DOI: 10.1007/s00296-021-04832-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
The Beighton Score (BS) is a set of manoeuvres in a nine-point scoring system, used as the standard method of assessment for Generalised Joint Hypermobility (GJH). It was originally developed as an epidemiological tool used in screening large populations for GJH, but later adopted as a clinical tool for diagnostic purposes. Its ability to truly reflect GJH remains controversial, as joints within the scoring system are predominantly of the upper limb and disregard many of the major joints, preventing a direct identification of GJH. Furthermore, a consistent finding in the literature whereby the BS failed to identify hypermobility in joints outside the scoring system suggests its use as an indirect indicator of GJH is also not viable. As such, the collective findings of this review demonstrate a need for a change in clinical thinking. The BS should not be used as the principle tool to differentiate between localised and generalised hypermobility, nor used alone to exclude the presence of GJH. Greater emphasis should be placed on a clinician’s judgement to identify or exclude GJH, according to its full definition.
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Affiliation(s)
- Sabeeha Malek
- Centre for Mechanochemical Cell Biology, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | | | - Gemma S Pearce
- Faculty of Health and Life Sciences, School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, CV1 5FB, UK
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Gensemer C, Burks R, Kautz S, Judge DP, Lavallee M, Norris RA. Hypermobile Ehlers-Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes. Dev Dyn 2021; 250:318-344. [PMID: 32629534 PMCID: PMC7785693 DOI: 10.1002/dvdy.220] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022] Open
Abstract
The Ehlers-Danlos syndromes (EDS) are a group of heritable, connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. There is phenotypic and genetic variation among the 13 subtypes. The initial genetic findings on EDS were related to alterations in fibrillar collagen, but the elucidation of the molecular basis of many of the subtypes revealed several genes not involved in collagen biosynthesis or structure. However, the genetic basis of the hypermobile type of EDS (hEDS) is still unknown. hEDS is the most common type of EDS and involves generalized joint hypermobility, musculoskeletal manifestations, and mild skin involvement along with the presence of several comorbid conditions. Variability in the spectrum and severity of symptoms and progression of patient phenotype likely depend on age, gender, lifestyle, and expression domains of the EDS genes during development and postnatal life. In this review, we summarize the current molecular, genetic, epidemiologic, and pathogenetic findings related to EDS with a focus on the hypermobile type.
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Affiliation(s)
- Cortney Gensemer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Randall Burks
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel P. Judge
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Mark Lavallee
- Department of Family Medicine, Wellspan Health, York, Pennsylvania
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
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Nicholson LL, McKay MJ, Baldwin JN, Burns J, Cheung W, Yip S, Chan C. Is there a relationship between sagittal cervical spine mobility and generalised joint hypermobility? A cross-sectional study of 1000 healthy Australians. Physiotherapy 2021; 112:150-157. [PMID: 34090187 DOI: 10.1016/j.physio.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The primary aim was to determine the association between sagittal cervical mobility and the presence and extent of GJH across the lifespan. Secondary aims were to determine which features explain variability in cervical range of motion (CROM) and to establish the sagittal cervical hypermobile range in both genders across the lifespan. DESIGN Cross-sectional observational study. Spearman's rho determined the relationship between presence and extent of GJH and CROM, age, gender and ethnicity. Multiple regression identified the factors explaining variability in CROM. The hypermobile CROM was identified as the upper 5% of flexion, extension and combined ranges for age and gender. SETTING University laboratory in Sydney Australia. PARTICIPANTS One thousand healthy individuals, aged 3-101 years. OUTCOME MEASURES Cervical active range of motion was assessed using an inclinometer, extent of and presence of generalised joint hypermobility were assessed using the Beighton scoring system and age- and gender-specific criteria respectively. RESULTS CROM correlated positively with GJH (Beighton score as a continuous or dichotomous age and gender specific variable) (rho=0.12-0.50; p < 0.001) and negatively with age (rho=0.54; p < 0.001). Age, gender and extent of GJH (Beighton as a continuous score) accounted for 19 to 51% of variability in CROM. Cut-offs for cervical hypermobility were calculated across the lifespan. CONCLUSIONS Increased sagittal CROM was observed in individuals identified with GJH. Extension CROM decreased with age more than flexion; the greatest loss in the second and third decades. CROM screening is warranted for patients identified with GJH and for rehabilitation goal-setting.
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Affiliation(s)
- Leslie L Nicholson
- The University of Sydney, School of Medical Sciences, Faculty of Medicine and Health, Camperdown, NSW 2006, Australia.
| | - Marnee J McKay
- The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, NSW, 2006, Australia.
| | - Jennifer N Baldwin
- The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, NSW, 2006, Australia; University of Newcastle, Priority Research Centre for Physical Activity and Nutrition, College of Health, Medicine and Wellbeing, Newcastle, Australia.
| | - Joshua Burns
- The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, NSW, 2006, Australia; Paediatric Gait Analysis Service of New South Wales, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, NSW 2145, Australia.
| | - Winky Cheung
- The Hong Kong Polytechnic University, Faculty of Health and Social Sciences, Department of Rehabilitation Sciences, 11 Yuk Choi Road, Hung Hum, Hong Kong.
| | - Sally Yip
- The Hong Kong Polytechnic University, Faculty of Health and Social Sciences, Department of Rehabilitation Sciences, 11 Yuk Choi Road, Hung Hum, Hong Kong.
| | - Cliffton Chan
- The University of Sydney, School of Medical Sciences, Faculty of Medicine and Health, Camperdown, NSW 2006, Australia.
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Glans MR, Thelin N, Humble MB, Elwin M, Bejerot S. The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison. Front Psychiatry 2021; 12:803334. [PMID: 35211037 PMCID: PMC8861852 DOI: 10.3389/fpsyt.2021.803334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/27/2021] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorder (ASD) and generalised joint hypermobility (GJH) share a number of clinical manifestations including proprioceptive impairment, motor difficulties, sensory hypersensitivity, and autonomic dysfunction. Clinical observations suggest that GJH is overrepresented in ASD. However, there are currently few systematic studies available. Knowledge about comorbidities may unfold common aetiopathological pathways underlying the association and improve the clinical management. The aim of this large, cross-sectional comparative study is to evaluate the relationship between ASD and GJH in adults. Data on joint hypermobility, symptoms associated with both hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), lifetime psychiatric diagnoses, psychiatric rating scales for ASD and attention deficit hyperactivity disorder (ADHD), and socio-demographics was collected for 199 individuals with ASD and 419 non-ASD community controls. Logistic regression models adjusting for covariates (age, sex, ethnicity) revealed a significant relationship between ASD and GJH and between ASD and symptomatic GJH, with adjusted odds ratios of 3.1 (95% CI: 1.9, 5.2; p < 0.001) and 4.9 (95% CI: 2.6, 9.0; p < 0.001), respectively. However, the high prevalence of comorbid ADHD in the study sample reduces the generalizability of the results among individuals with ASD without comorbid ADHD. Possibly, an additional ADHD phenotype is the primary driver of the association between ASD and GJH. Furthermore, GJH with additional self-reported symptoms, suggestive of HSD/hEDS, showed a stronger association with ASD than did non-specified GJH, indicating that symptomatic GJH plays a greater role in the relationship than non-specified GJH does. Therefore, the current study underscores the need of careful sample subclassifications. ASD with GJH may represent a novel subgroup of ASD in terms of aetiopathology and clinical presentation. Future research should elucidate the aetiological factors behind the association between ASD and GJH and evaluate how the comorbidity of GJH affects ASD outcomes.
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Affiliation(s)
- Martin R Glans
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Nils Thelin
- Division of Psychiatry, Linköping University Hospital, Linköping, Sweden
| | - Mats B Humble
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Marie Elwin
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet (KI), Solna, Sweden
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Bashaireh KM, Yabroudi MA, Nawasreh ZH, Al-Zyoud SM, Bashir NB, Aleshawi AJ, Allouh MZ. Racial variations in knee joint laxity: A comparative study of the Jordanian Arab and Malay populations. Knee 2020; 27:1205-1211. [PMID: 32711883 DOI: 10.1016/j.knee.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A high incidence of joint laxity has been reported among Asians compared with Western populations, but clear differences between more specific ethnic populations have not been established. This study aimed to determine the average knee laxity in the Malaysian and Jordanian populations. METHODS Jordanian and Malaysian medical students from our institution were invited to participate in the study. General demographic data and factors affecting joint laxity were obtained from each participant using a printed questionnaire. Both knees were examined using the anterior drawer test while in 90° of flexion. Knee laxity was measured by three separate independent investigators through a knee laxity tester. RESULTS One hundred and eighty-six participants (95 females) were enrolled in the study. Among them, 108 Malaysians participated. The Jordanians had significantly higher knee laxity in both knees compared with the Malaysians. The mean average right knee laxity for Jordanians was 2.98 mm vs. 2.72 mm for Malaysians (P = 0.005). Similarly, the mean average left knee laxity for Jordanians was 2.95 mm, while for Malaysians, it was 2.62 mm (P = 0.0001). Furthermore, smokers had significantly more laxity in both knees. After performing a multivariate linear regression analysis for all factors, race was the only independent factor that affected knee laxity in both knees. CONCLUSIONS Race is directly associated with knee laxity. Jordanians tend to have more laxity in knee joints compared with Malaysians. Larger multi-center and genetic studies are recommended to establish the racial differences between different ethnic groups.
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Affiliation(s)
- Khaldoon M Bashaireh
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan.
| | - Mohammad A Yabroudi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science & Technology, Irbid, Jordan
| | - Zakariya H Nawasreh
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science & Technology, Irbid, Jordan
| | | | | | | | - Mohammed Z Allouh
- Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
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Hanzlíková I, Hébert-Losier K. Do asymptomatic generalised hypermobility and knee hyperextension influence jump landing biomechanics? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1769721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ivana Hanzlíková
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, New Zealand
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Saremi H, Shahbazi F, Rahighi AH. Epidemiology of generalized ligamentous laxity in northwest of Iran: A pilot national study on 17–40 years old adults in Hamadan province. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Turan ÖD, Sabancı S, Özdemir E, Atakul T, Turan Y. Is joint hypermobility related to preterm birth? J Matern Fetal Neonatal Med 2020; 34:2212-2216. [PMID: 32312125 DOI: 10.1080/14767058.2020.1754393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM The aim of this study was to investigate whether women giving preterm birth have joint hypermobility. METHODS The study included 44 women giving preterm birth (study group) and 48 women with the history of term birth (control group). After demographic data were recorded, the presence of joint hypermobility based on the Beighton diagnostic criteria and subgroup scores were noted down. Total Beighton scores were compared between the study and control groups. RESULTS The total Beighton scores were significantly higher in the study group (p < .001). The study group had the highest hypermobility score for elbow hyperextension and the lowest hypermobility score for thumb hyperextension. CONCLUSIONS It should be kept in mind that joint hypermobility detected during follow-up of pregnancy can be related to the risk of preterm birth. Informing pregnant women with joint hypermobility about the possibility of preterm birth could be helpful.
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Affiliation(s)
- Özgür Deniz Turan
- Department of Obstetrics and Gynecology, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Serkan Sabancı
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Ezgi Özdemir
- Department of Obstetrics and Gynecology, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Tolga Atakul
- Department of Obstetrics and Gynecology, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Yasemin Turan
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydin, Turkey
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Corten L, Ferguson G, Smits-Engelsman B. Does the item 'hands on floor' add value to the Beighton score in identifying joint hypermobility? Eur J Rheumatol 2020; 7:79-83. [PMID: 32644928 DOI: 10.5152/eurjrheum.2020.19185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/29/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Different assessment tools are used to screen for joint hypermobility. One of the most commonly used tools is the Beighton score. However, the inclusion of the item "hands on floor" (HOF) has been questioned, as this maneuver is not a pure measure of the range of motion because it involves multiple joints and stretching of muscular structures. This study therefore aimed to determine the value of the HOF item to the Beighton score in children aged 6-11 years. METHODS Exploratory research involved children in Grades 1-4 attending four different primary schools in South Africa. Children with a severe medical or neurological condition were excluded from the study. Hypermobility was determined as a score ≥5/8 on the Beighton score excluding the HOF item. RESULTS A total of 460 children (median age 8.58 years [interquartile range, 7.33-9.50]) were tested, of which 34.57% were hypermobile. However, only 8.91% of all children scored positive on HOF. Although a significant association was found between HOF and the hypermobility classification (p=0.007), 86.16% of the hypermobile children could not place their hands flat on the floor. Internal consistency improved slightly when HOF was removed from the scale (α changed from 0.698 to 0.703), with a weak corrected item-total correlation (r=0.16). The specificity of the item HOF in identifying hypermobility is high (93.69%); however, the sensitivity is very low (13.84%). CONCLUSION This study does not show an additional value of the item HOF of the Beighton score in children.
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Affiliation(s)
- Lieselotte Corten
- Department of Physiotherapy, School of Health Sciences, University of Brighton, Eastbourne, United Kingdom.,Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Gillian Ferguson
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bouwien Smits-Engelsman
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
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13
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Judging heel height: A new test for proprioception while standing reveals that young hypermobile children perform better than controls. Gait Posture 2020; 75:8-13. [PMID: 31586753 DOI: 10.1016/j.gaitpost.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with Generalized Joint Hypermobility (GJH) have been reported to have poorer proprioception than children with normal mobility. However, they were usually tested under unloaded conditions and in an age-group in which pain starts to play a role. RESEARCH QUESTION In contrast, some young children with GJH perform well in motor tasks, suggesting they may have good proprioceptive abilities if assessed more ecologically. METHODS Children with GJH (Beighton score of ≥ 5; mean age 8.34 years) were compared to children with a Beighton score of 4 or less. A proprioception test was performed using wedges of different heights to evaluate the ability to judge heel height. A pair of wedges of various heights, was placed under the children's feet at random and they were required to report the higher leg while standing RESULTS: Independent t-test showed that children with GJH performed better (p < 0.01) than controls, suggesting better proprioceptive abilities when assessed under loaded conditions SIGNIFICANCE: Children with GJH do not have inferior proprioception when tested under loaded conditions. The least one can say is that one should be careful in postulating that measuring passive position sense in one particular joint is necessarily the best estimation of proprioception. Body position during standing can be estimated on the basis of knowledge of joint positions (of the ankle in particular in the present test) but also of other information (loading of foot mechanoreceptors for example). In conclusion, the new test may be more suited to evaluate proprioception than the conventional tests, which rely on passive joint position estimation during sitting.
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To M, Strutton PH, Alexander CM. Central fatigue is greater than peripheral fatigue in people with joint hypermobility syndrome. J Electromyogr Kinesiol 2019; 48:197-204. [PMID: 31442925 DOI: 10.1016/j.jelekin.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 07/08/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue. METHODS Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. RESULTS JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p < 0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p < 0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p < 0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p < 0.01). CONCLUSION JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.
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Affiliation(s)
- May To
- Physiotherapy Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Paul H Strutton
- Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK
| | - Caroline M Alexander
- Physiotherapy Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK.
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15
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Rejeb A, Fourchet F, Materne O, Johnson A, Horobeanu C, Farooq A, Witvrouw E, Whiteley R. Beighton scoring of joint laxity and injury incidence in Middle Eastern male youth athletes: a cohort study. BMJ Open Sport Exerc Med 2019; 5:e000482. [PMID: 30899548 PMCID: PMC6407572 DOI: 10.1136/bmjsem-2018-000482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2018] [Indexed: 11/15/2022] Open
Abstract
Objectives To examine the association between generalised joint laxity (GJL) and injury rates in Middle Eastern male youth athletes. Design Prospective observational study consisting of GJL screen and injury audit (season 2009/2010). Setting Aspire Sports Academy Doha, Qatar. Participants A total of 226 adolescent male athletes (mean age: 14.2 years; SD: 1.7; range: 10–18) involved in 15 sporting activities were grouped into contact and non-contact sports. All available athletes were included in this study. Outcome measures A seasonal injury audit, athletes’ anthropometric characteristics, for example, weight, height and body mass index and screen for GJL to determine Beighton Score (BS). Results The 226 athletes sustained 596 injuries and 75% reported at least one injury over a seasonal injury audit. Players in contact sports were injured more often than players in non-contact sports (more frequent injuries than injury-free time in contact sports; 127 days (95% CI 93 to 160) vs 176 days in non-contact sports (95% CI 118 to 234) (p<0.001). Survival analysis showed that gradient BS was not associated with injury HR=1.004 (95% CI 0.95 to 1.06) in the overall cohort. However, BS was associated with a greater injury risk in contact sports (HR: 1.29; 95% CI 1.05 to 1.59; p=0.015). Conclusion Greater GJL, defined by gradient BS, plus involvement in contact sports together influence injury risk in youth athletes. Preseason documentation of GJL scoring should be considered specifically for contact sports as injury pre-emptive measure.
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Affiliation(s)
- Abdallah Rejeb
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | - Olivier Materne
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Amanda Johnson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Zweig A, Schindler V, Becker AS, van Maren A, Pohl D. Higher prevalence of joint hypermobility in constipation predominant irritable bowel syndrome. Neurogastroenterol Motil 2018; 30:e13353. [PMID: 29687534 DOI: 10.1111/nmo.13353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) is characterized by excessive connective tissue laxity manifest as joint hypermobility (JH) together with musculoskeletal symptoms. Previous studies have shown an association between JH/JHS and gastrointestinal symptoms, including irritable bowel syndrome (IBS), although its association with specific IBS subtypes is incompletely understood. We aimed to determine the prevalence of JH according to the subtypes of IBS, in particular IBS-C and IBS-D. METHODS Data of 228 consecutive IBS patients were analyzed. IBS was subtyped into constipation and diarrhea predominant IBS (IBS-C and IBS-D), IBS with mixed bowel habits (IBS-M) and unsubtyped IBS (IBS-U). JH was defined as a Beighton Score ≥4/9 points and JHS diagnosed according to revised Brighton Criteria. Data of IBS patients were analyzed for psychological comorbidities assessed by Hospital Anxiety and Depression Scale (HADS) and Visceral Sensitivity Index (VSI). KEY RESULTS Of 228 IBS patients, 64 (28.1%) suffered from IBS-C, 89 (39.0%) from IBS-D, 48 (21.1%) from IBS-M, and 27 (11.8%) from IBS-U. JH was diagnosed in 95 patients (41.7%). The prevalence of JH was significantly higher in IBS-C than IBS-D (57.8% vs 34.8%, P = .031). There was no significant difference in VSI and HADS according to JH or IBS subtype. CONCLUSIONS AND INTERFERENCES The prevalence of JH was significantly higher in IBS-C compared to IBS-D. Abnormalities in the connective tissue biomechanics in those with JH may contribute to a degree of colonic inertia which could result in constipation in JH-positive IBS patients. Further work is needed to determine the colonic biomechanics in patients with JH.
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Affiliation(s)
- A Zweig
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - V Schindler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - A S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - A van Maren
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - D Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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Tingle A, Bennett O, Wallis A, Palmer S. The links between Generalized Joint Laxity and the incidence, prevalence and severity of limb injuries related to physical exercise: a systematic literature review. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1481626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alexander Tingle
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Oliver Bennett
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Amy Wallis
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Shea Palmer
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Palmer S, Cramp F, Clark E, Lewis R, Brookes S, Hollingworth W, Welton N, Thom H, Terry R, Rimes KA, Horwood J. The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome. Health Technol Assess 2018; 20:1-264. [PMID: 27365226 DOI: 10.3310/hta20470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) is a heritable disorder associated with laxity and pain in multiple joints. Physiotherapy is the mainstay of treatment, but there is little research investigating its clinical effectiveness. OBJECTIVES To develop a comprehensive physiotherapy intervention for adults with JHS; to pilot the intervention; and to conduct a pilot randomised controlled trial (RCT) to determine the feasibility of conducting a future definitive RCT. DESIGN Patients' and health professionals' perspectives on physiotherapy for JHS were explored in focus groups (stage 1). A working group of patient research partners, clinicians and researchers used this information to develop the physiotherapy intervention. This was piloted and refined on the basis of patients' and physiotherapists' feedback (stage 2). A parallel two-arm pilot RCT compared 'advice' with 'advice and physiotherapy' (stage 3). Random allocation was via an automated randomisation service, devised specifically for the study. Owing to the nature of the interventions, it was not possible to blind clinicians or patients to treatment allocation. SETTING Stage 1 - focus groups were conducted in four UK locations. Stages 2 and 3 - piloting of the intervention and the pilot RCT were conducted in two UK secondary care NHS trusts. PARTICIPANTS Stage 1 - patient focus group participants (n = 25, three men) were aged > 18 years, had a JHS diagnosis and had received physiotherapy within the preceding 12 months. The health professional focus group participants (n = 16, three men; 14 physiotherapists, two podiatrists) had experience of managing JHS. Stage 2 - patient participants (n = 8) were aged > 18 years, had a JHS diagnosis and no other musculoskeletal conditions causing pain. Stage 3 - patient participants for the pilot RCT (n = 29) were as for stage 2 but the lower age limit was 16 years. INTERVENTION For the pilot RCT (stage 3) the advice intervention was a one-off session, supplemented by advice booklets. All participants could ask questions specific to their circumstances and receive tailored advice. Participants were randomly allocated to 'advice' (no further advice or physiotherapy) or 'advice and physiotherapy' (an additional six 30-minute sessions over 4 months). The physiotherapy intervention was supported by a patient handbook and was delivered on a one-to-one patient-therapist basis. It aimed to increase patients' physical activity through developing knowledge, understanding and skills to better manage their condition. MAIN OUTCOME MEASURES Data from patient and health professional focus groups formed the main outcome from stage 1. Patient and physiotherapist interview data also formed a major component of stages 2 and 3. The primary outcome in stage 3 related to the feasibility of a future definitive RCT [number of referrals, recruitment and retention rates, and an estimate of the value of information (VOI) of a future RCT]. Secondary outcomes included clinical measures (physical function, pain, global status, self-reported joint count, quality of life, exercise self-efficacy and adverse events) and resource use (to estimate cost-effectiveness). Outcomes were recorded at baseline, 4 months and 7 months. RESULTS Stage 1 - JHS is complex and unpredictable. Physiotherapists should take a long-term holistic approach rather than treating acutely painful joints in isolation. Stage 2 - a user-informed physiotherapy intervention was developed and evaluated positively. Stage 3 - recruitment to the pilot RCT was challenging, primarily because of a perceived lack of equipoise between advice and physiotherapy. The qualitative evaluation provided very clear guidance to inform a future RCT, including enhancement of the advice intervention. Some patients reported that the advice intervention was useful and the physiotherapy intervention was again evaluated very positively. The rate of return of questionnaires was low in the advice group but reasonable in the physiotherapy group. The physiotherapy intervention showed evidence of promise in terms of primary and secondary clinical outcomes. The advice arm experienced more adverse events. The VOI analysis indicated the potential for high value from a future RCT. Such a trial should form the basis of future research efforts. CONCLUSION A future definitive RCT of physiotherapy for JHS seems feasible, although the advice intervention should be made more robust to address perceived equipoise and subsequent attrition. TRIAL REGISTRATION Current Controlled Trials ISRCTN29874209. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Shea Palmer
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Fiona Cramp
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Emma Clark
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | | | - Sara Brookes
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | | | - Nicky Welton
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Howard Thom
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Rohini Terry
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
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Frequency of Benign Joint Hypermobility Syndrome in Patients Undergoing Inguinal Hernia Repair: A Prospective Study. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00100.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this prospective study is to investigate the frequency and associated clinical findings of benign joint hypermobility syndrome (BJHS) in adult patients who were diagnosed with inguinal hernia. Benign joint hypermobility syndrome (BJHS) is defined as a clinical condition consisting of musculoskeletal symptoms such as arthralgia, pain, recurrent soft tissue disorders, joint dislocation, as well as increased normal range of motion. We hypothesized that the frequency of BHJS may increase in the patients who underwent surgery for groin hernias due to the hypermobility in connective tissue. We evaluated 66 patients in terms of BHJS prospectively in a 6-month period. The patients were divided into 2 groups. The first group consisted of 33 patients who underwent inguinal hernia repair surgery. The second group also included 33 healthy volunteers who did not have inguinal hernia operation. General joint hypermobility (GJH) was assessed using Beighton hypermobility scoring criteria, and BJHS was scored by Brighton scoring criteria. The data were assessed statistically. BJHS was diagnosed in 22 (66%) patients with inguinal hernia and in 4 (12%) healthy volunteers, respectively. Prevalence of BJHS and Beighton scores in patients with inguinal hernia were significantly higher (P < 0.05). GJH was found in 20 (60%) of the inguinal hernia patients (Beighton score ≥ 4; P < 0.05). BJHS should be considered when evaluating patients with inguinal hernia. We believe that further studies are needed in big cohorts to verify the relationship between inguinal hernia in adults and BJHS.
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20
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Xu HX, Lee KB. Modified Broström Procedure for Chronic Lateral Ankle Instability in Patients With Generalized Joint Laxity. Am J Sports Med 2016; 44:3152-3157. [PMID: 27496909 DOI: 10.1177/0363546516657816] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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 laxity (GJL) has been considered a risk factor for late failure of ligament reconstruction in the knee; however, it is not known whether GJL is the cause of recurrent instability after the modified Broström procedure for chronic lateral ankle instability. PURPOSE To compare the clinical results of the modified Broström procedure for chronic lateral ankle instability in patients with or without GJL. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 100 patients (100 ankles) who underwent the modified Broström procedure were divided into 2 groups, with or without GJL, according to the Beighton criteria. Age and body mass index were matched between the 2 groups. The mean follow-up duration was 43.3 months in the laxity group (44 ankles; Beighton score ≥5) and 42.9 months in the nonlaxity group (56 ankles). RESULTS The mean preoperative Karlsson and American Orthopaedic Foot and Ankle Society (AOFAS) scores were a respective 53.2 and 60.9 in the laxity group and 53.9 and 62.6 in the nonlaxity group, and these scores improved to 87.4 and 89.5, respectively, in the laxity group and to 94.1 and 94.8, respectively, in the nonlaxity group at final follow-up. The mean preoperative talar tilt angle and anterior talar translation were a respective 12.5° and 8.8 mm in the laxity group and 10.8° and 8.5 mm in the nonlaxity group, and these values improved to 7.3° and 6.0 mm, respectively, in the laxity group and to 5.2° and 5.0 mm, respectively, in the nonlaxity group at final follow-up. Failure rates were 11.4% (5 patients) in the laxity group and 1.8% (1 patient) in the nonlaxity group. Significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, talar tilt angle, anterior talar translation, and failure rate at final follow-up (P < .05). CONCLUSION Patients with GJL showed inferior outcomes and a higher failure rate compared with patients without GJL. Therefore, GJL appears to be a risk factor associated with recurrent instability after the modified Broström procedure.
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Affiliation(s)
- He-Xing Xu
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
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21
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Gürer G, Bozbas GT, Tuncer T, Unubol AI, Ucar UG, Memetoglu OI. Frequency of joint hypermobility in Turkish patients with knee osteoarthritis: a cross sectional multicenter study. Int J Rheum Dis 2016; 21:1787-1792. [DOI: 10.1111/1756-185x.12883] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gülcan Gürer
- Division of Rheumatology; Department of Physical Medicine and Rehabilitation; Adnan Menderes University School of Medicine; Aydin Turkey
| | - Gulnur Tasci Bozbas
- Division of Rheumatology; Department of Physical Medicine and Rehabilitation; Adnan Menderes University School of Medicine; Aydin Turkey
| | - Tiraje Tuncer
- Department of Physical Medicine and Rehabilitation; Akdeniz University School of Medicine; Antalya Turkey
| | - Ayse Iyiyapici Unubol
- Division of Rheumatology; Department of Physical Medicine and Rehabilitation; Adnan Menderes University School of Medicine; Aydin Turkey
| | - Ulku Gurbuz Ucar
- Department of Physical Medicine and Rehabilitation; Akdeniz University School of Medicine; Antalya Turkey
| | - Ozge Illeez Memetoglu
- Department of Physical Medicine and Rehabilitation; Akdeniz University School of Medicine; Antalya Turkey
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To M, Simmonds J, Alexander C. Where do People with Joint Hypermobility Syndrome Present in Secondary Care? The Prevalence in a General Hospital and the Challenges of Classification. Musculoskeletal Care 2016; 15:3-9. [PMID: 27238954 DOI: 10.1002/msc.1147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- May To
- Department of Therapies, Charing Cross Hospital, London, UK
| | - Jane Simmonds
- The hypermobility unit at Hospital of St. John and St Elizabeth, London, UK and the Institute of Child Health, University College London, London, UK
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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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24
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Javadi Parvaneh V, Shiari R. Proposed modifications to Beighton criteria for the diagnosis of joint hypermobility in children. INDIAN JOURNAL OF RHEUMATOLOGY 2016. [DOI: 10.1016/j.injr.2016.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Palmer S, Terry R, Rimes K, Clark C, Simmonds J, Horwood J. Physiotherapy management of joint hypermobility syndrome – a focus group study of patient and health professional perspectives. Physiotherapy 2016; 102:93-102. [DOI: 10.1016/j.physio.2015.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/21/2015] [Indexed: 11/26/2022]
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Folci M, Capsoni F. Arthralgias, fatigue, paresthesias and visceral pain: can joint hypermobility solve the puzzle? A case report. BMC Musculoskelet Disord 2016; 17:58. [PMID: 26846674 PMCID: PMC4743317 DOI: 10.1186/s12891-016-0905-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background Joint hypermobility syndrome describes a disorder in which musculoskeletal pain occurs in a generalized joint hypermobility substrate. The clinical picture comprises variable manifestations which involve mainly but not exclusively the musculoskeletal system, and evolve over the person’s lifetime. Case presentation Describing the case of a 20-year-old female with generalized arthro-myalgias, persistent fatigue and troublesome visceral pain, we illustrate how a frequently ignored clinical sign such as joint hypermobility can be the keystone to clarify different simultaneous symptoms. All of the patient’s physical complaints had been investigated separately during her previous medical examinations, and several tests repeatedly gave negative results. The patient received different diagnoses that describe only part of her problems, such as irritable bowel syndrome for visceral pain, fibromyalgia for arthralgias or depression for fatigue. These approaches gave rise to pharmacological or physical treatments which did not improve her quality of life in any way and in some instances worsened the situation. Pronounced joint hypermobility which led the patient to flex her joints excessively, causing subluxations in several districts, was the only sign overlooked. Conclusion Exploring the patient’s articular features in her clinical context led us to diagnose joint hypermobility syndrome, a complex and often ignored condition. The case highlights the utility of a multidisciplinary approach and coordinated interventions to define and manage this clinical entity.
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Affiliation(s)
- Marco Folci
- Allergy, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy. .,University of Milan, Milan, Italy.
| | - Franco Capsoni
- Allergy, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy. .,University of Milan, Milan, Italy.
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Al-Jarallah K, Shehab D, Al-Jaser MT, Al-Azemi KM, Wais FF, Al-Saleh AM, Al-Ajmi AS, Al-Omairah HA, Abraham M, Sharma PN. Prevalence of joint hypermobility in Kuwait. Int J Rheum Dis 2014; 20:935-940. [PMID: 25529052 DOI: 10.1111/1756-185x.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To determine the prevalence of joint hypermobility (JH) among young Kuwaiti adults. METHODS This was a cross-sectional study of 390 randomly selected healthy undergraduate university students, aged 18-29 years from the Health Sciences Centre, Kuwait University, Safat, Kuwait. Beighton score at four peripheral sites bilaterally (knees, elbows, thumbs and fifth fingers) and forward flexion of the trunk were used to evaluate joint hypermobility. Any student who met four out of the nine criteria was considered hypermobile. Joint pain was documented in all subjects through personal interview. RESULTS A total of 390 subjects (male : female ratio 1.0 : 0.9) were assessed. Of those, 87 (22.3%) were found to have JH: 60 (29.4%) males and 27 (14.5%) females, showing a significantly higher male predominance (P < 0.001). Beighton score was inversely correlated with age (ρ = -0.15, P = 0.003). A higher incidence of finger signs was noted in comparison to elbow-knee hyperextension and hands-to-floor. Knee joint, back, neck and shoulder pains, in descending order, were the commonest type of joint complaints, although not statistically significant (P > 0.05) in subjects with and without joint hypermobility. It was also observed that the left side, at all the sites, was slightly more hypermobile in comparison to the right side in hypermobile subjects. CONCLUSIONS The prevalence of joint hypermobility is not uncommon among young Kuwaiti adults, and was comparable to the data published in other Asian-Pacific regions. General practitioners should therefore be familiar with the condition and its clinical associations, while assessing musculoskeletal complaints.
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Affiliation(s)
- Khaled Al-Jarallah
- Department of Medicine, Kuwait University, Safat, Kuwait.,Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Diaa Shehab
- Department of Medicine, Kuwait University, Safat, Kuwait.,Faculty of Medicine, Kuwait University, Safat, Kuwait
| | | | | | - Fatma F Wais
- Faculty of Medicine, Kuwait University, Safat, Kuwait
| | | | | | | | - Mini Abraham
- Department of Medicine, Kuwait University, Safat, Kuwait.,Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Prem N Sharma
- Faculty of Medicine, Kuwait University, Safat, Kuwait
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29
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Strunk RG, Pfefer MT, Dube D. Multimodal chiropractic care of pain and disability for a patient diagnosed with benign joint hypermobility syndrome: a case report. J Chiropr Med 2014; 13:35-42. [PMID: 24711783 DOI: 10.1016/j.jcm.2014.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe multimodal chiropractic care of a female patient diagnosed with benign joint hypermobility syndrome (BJHS) and a history of chronic spine pain. CLINICAL FEATURES A 23-year-old white female presented for chiropractic care with chronic low back pain, neck pain, and headaches. The patient was diagnosed with BJHS, including joint hypermobility of her thumbs, elbows, right knee, and lumbopelvic region. A 6-year history of low back pain and varicose veins in her posterior thighs and knees were additional significant diagnostic findings of BJHS. INTERVENTIONS AND OUTCOMES The treatment consisted of spinal and extremity manipulation, Graston technique, and postisometric relaxation combined with sensory motor stimulation and scapular stabilization exercises. The patient was seen 15 times over an 18-week period. After 18 weeks of care, the Revised Oswestry Low Back Questionnaire and Headache Disability Index demonstrated clinically important improvements with her low back pain and headache; but little change was noted in her neck pain as measured by the Neck Disability Index. CONCLUSION This patient with BJHS who had decreased disability and spine pain improved after a course of multimodal chiropractic care.
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Affiliation(s)
- Richard G Strunk
- Assistant Professor, Research Clinician Cleveland Chiropractic College, Overland Park, KS
| | - Mark T Pfefer
- Professor, Research Director Cleveland Chiropractic College, Research, Overland Park, KS
| | - Derrick Dube
- Student, Cleveland Chiropractic College, Overland Park, KS
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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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Shahid M, Mahroof S, Wu F, Bourne K, Jose R, Titley G. Are Asian hands more flexible than their Caucasian counterparts? HAND THERAPY 2013. [DOI: 10.1177/1758998313496400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Though there is a general perception that Asian hands have an increased range of movements in all their joints, there is very little written in the literature on this topic. Our unit caters to a multiethnic population and it has been our experience that the outcomes after hand surgery are generally better in Asian hands. This study was aimed at comparing the range of movements between two cohorts of volunteers: Asians and Caucasians. Methods Data were collected on their ethnicity, gender, age, handedness and any medical conditions. The Beighton score was measured for all subjects and range of movements was measured using a standard goniometer. Totally, 114 subjects were enrolled into the study, which included 53 men (46%). Results There were 59 Caucasians and 55 Asians. The range of movements of wrist and hand was greater in Asians and the difference was statistically significant ( p < 0.05). Men in general had greater range of movement of the fingers whereas women had greater range of movement of the thumb. There was no difference between Asian men and women with regard to wrist movements. However, Caucasian women had greater wrists movements than Caucasian males. The average Beighton score was the highest in Asian women (7), followed by Asian men (6). Caucasian men and women had an average Beighton Score of 2. Discussion Normative data for different ethnic groups are important for hand therapy as they can guide rehabilitation protocols. Our study demonstrates that a difference in hand flexibility between British Asians and their Caucasian counterparts exists.
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Affiliation(s)
- Mohammad Shahid
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | | | - Feiran Wu
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Kathryn Bourne
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Rajive Jose
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Garth Titley
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
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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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Dermal ultrastructure in low Beighton score members of 17 families with hypermobile-type Ehlers-Danlos syndrome. J Biomed Biotechnol 2012; 2012:878107. [PMID: 23091361 PMCID: PMC3471064 DOI: 10.1155/2012/878107] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022] Open
Abstract
The distinction between the Ehlers-Danlos syndrome hypermobile type (EDSH) and the benign joint hypermobility syndrome (BJHS) is unclear. The aim of the present study was to compare skin ultrastructural abnormalities of EDSH and BJHS among different families. Skin of 23 EDSH, 27 BJHS, and 41 asymptomatic subjects from 17 families was examined using transmission electron microscopy. Similar ultrastructural abnormalities were found irrespective of the Beighton score. Flower-like collagen fibrils represented the key change and elastic fibers were altered as well. Beighton score is a clinical parameter rating joint mobility that appeared unrelated to quantitative and qualitative collagen ultrastructural alterations in the skin. Some EDSH family members fit with BJHS diagnosis. BJHS possibly represents a mild variant of EDSH.
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Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr 2011; 158:119-23, 123.e1-4. [PMID: 20850761 DOI: 10.1016/j.jpeds.2010.07.021] [Citation(s) in RCA: 216] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 06/15/2010] [Accepted: 07/13/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the validity of the Beighton score as a generalized measure of hypermobility and to measure the prevalence of hypermobility and pain in a random population of school age children. STUDY DESIGN Prospective study of 551 children attending various Dutch elementary schools participated; 47% were males (258) and 53% (293) females, age range was 6 to 12 years. Children's joints and movements were assessed according to the Beighton score by qualified physiotherapists and by use of goniometry measuring 16 passive ranges of motion of joints on both sides of the body. RESULTS More than 35% of children scored more than 5/9 on the Beighton score. Children who scored high on the Beighton score also showed increased range of motion in the other joints measured. Moreover 12.3% of children had symptoms of joint pain, and 9.1% complained of pain after exercise or sports. Importantly, this percentage was independent of the Beighton score. There were no significant differences in Beighton score for sex in this population. CONCLUSION The Beighton score, when goniometry is used, is a valid instrument to measure generalized joint mobility in school-age children 6 to 12 years. No extra items are needed to improve the scale.
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Affiliation(s)
- Bouwien Smits-Engelsman
- Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Avans, University for Professionals, Breda, The Netherlands.
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Castori M, Camerota F, Celletti C, Grammatico P, Padua L. Ehlers-Danlos syndrome hypermobility type and the excess of affected females: Possible mechanisms and perspectives. Am J Med Genet A 2010; 152A:2406-8. [DOI: 10.1002/ajmg.a.33585] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kim SJ, Kumar P, Kim SH. Anterior cruciate ligament reconstruction in patients with generalized joint laxity. Clin Orthop Surg 2010; 2:130-9. [PMID: 20808583 PMCID: PMC2915391 DOI: 10.4055/cios.2010.2.3.130] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/16/2009] [Indexed: 01/15/2023] Open
Abstract
Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.
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Affiliation(s)
- Sung-Jae Kim
- Yonsei University Arthroscopy & Joint Research Institute and Department of Orthopedic Surgery, Yonsei University Health System, Seoul, Korea
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Pacey V, Nicholson LL, Adams RD, Munn J, Munns CF. Generalized joint hypermobility and risk of lower limb joint injury during sport: a systematic review with meta-analysis. Am J Sports Med 2010; 38:1487-97. [PMID: 20601606 DOI: 10.1177/0363546510364838] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Generalized joint hypermobility is a highly prevalent condition commonly associated with joint injuries. The current literature has conflicting reports of the risk of joint injury in hypermobile sporting participants compared with their nonhypermobile peers. Systematic reviews have not been conclusive and no meta-analysis has been performed. PURPOSE This review was undertaken to determine whether individuals with generalized joint hypermobility have an increased risk of lower limb joint injury when undertaking sporting activities. STUDY DESIGN Systematic review with meta-analysis. METHODS Studies were identified through a search without language restrictions of PubMed, CINAHL, Embase, and SportDiscus databases from the earliest date through February 2009 with subsequent handsearching of reference lists. Inclusion criteria for studies were determined before searching and all included studies underwent methodological quality assessment by 2 independent reviewers. Meta-analyses for joint injury of the lower limb, knee, and ankle were performed using a random effects model. The difference in injury proportions between hypermobility categories was tested with the z statistic. RESULTS Of 4841 identified studies, 18 met all inclusion criteria with methodological quality ranging from 1 of 6 to 5 of 6. A variety of tests of hypermobility and varied cutoff points to define the presence of generalized joint hypermobility were used, so the authors determined a standardized cutoff to indicate generalized joint hypermobility. Using this criterion, a significantly increased risk of knee joint injury for hypermobile and extremely hypermobile participants compared with their nonhypermobile peers was demonstrated (P < .001), whereas no increased risk was found for ankle joint injury. For knee joint injury, a combined odds ratio of 4.69 (95% confidence interval, 1.33-16.52; P = .02) was calculated, indicating a significantly increased risk for hypermobile participants playing contact sports. CONCLUSION Sport participants with generalized joint hypermobility have an increased risk of knee joint injury during contact activities but have no altered risk of ankle joint injury.
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Affiliation(s)
- Verity Pacey
- Sports Physiotherapy Physiotherapy Department, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
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Scher DL, Owens BD, Sturdivant RX, Wolf JM. Incidence of joint hypermobility syndrome in a military population: impact of gender and race. Clin Orthop Relat Res 2010; 468:1790-5. [PMID: 19960283 PMCID: PMC2882018 DOI: 10.1007/s11999-009-1182-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Joint hypermobility syndrome is defined by abnormal laxity in multiple joints in association with symptomatic joint pain. Previous studies in small populations suggest a predominance of female gender and nonwhite race among those diagnosed with hypermobility syndrome. QUESTIONS/PURPOSES We investigated the epidemiology of joint hypermobility in a large military population, presuming this syndrome would be less prevalent in this specialized population but that demographic analysis would reveal risk factors for this rare condition. METHODS We queried the Defense Medical Epidemiology Database by race, gender, military service, and age for the years 1998 to 2007 using the International Classification of Diseases, 9th Revision code 728.5 (hypermobility syndrome). RESULTS We identified 790 individuals coded for joint hypermobility syndrome among a population at risk of 13,779,234 person-years for a raw incidence rate of 0.06 per 1000 person-years. Females had a higher incidence rate for joint hypermobility syndrome compared with males. Racial stratification showed service members of white race had higher rates of joint hypermobility syndrome compared with service members categorized as black and "other." CONCLUSIONS In a large, established military database it appears joint hypermobility syndrome is a rare condition within the young, active population we studied and female gender is the most important risk factor. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Danielle L. Scher
- Orthopaedic Surgery Service, Department of Surgery, William Beaumont Army Medical Center, El Paso, TX USA
| | - Brett D. Owens
- Orthopaedic Surgery Service, Department of Surgery, William Beaumont Army Medical Center, El Paso, TX USA
| | - Rodney X. Sturdivant
- Department of Mathematical Sciences, Center for Data Analysis and Statistics, US Military Academy, West Point, NY USA
| | - Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery, University of Colorado-Denver, 12631 E 17th Avenue, Room 4602, Aurora, CO 80045 USA
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Zarate N, Farmer AD, Grahame R, Mohammed SD, Knowles CH, Scott SM, Aziz Q. Unexplained gastrointestinal symptoms and joint hypermobility: is connective tissue the missing link? Neurogastroenterol Motil 2010; 22:252-e78. [PMID: 19840271 DOI: 10.1111/j.1365-2982.2009.01421.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unexplained gastrointestinal (GI) symptoms and joint hypermobility (JHM) are common in the general population, the latter described as benign joint hypermobility syndrome (BJHS) when associated with musculo-skeletal symptoms. Despite overlapping clinical features, the prevalence of JHM or BJHS in patients with functional gastrointestinal disorders has not been examined. METHODS The incidence of JHM was evaluated in 129 new unselected tertiary referrals (97 female, age range 16-78 years) to a neurogastroenterology clinic using a validated 5-point questionnaire. A rheumatologist further evaluated 25 patients with JHM to determine the presence of BJHS. Groups with or without JHM were compared for presentation, symptoms and outcomes of relevant functional GI tests. KEY RESULTS Sixty-three (49%) patients had evidence of generalized JHM. An unknown aetiology for GI symptoms was significantly more frequent in patients with JHM than in those without (P < 0.0001). The rheumatologist confirmed the clinical impression of JHM in 23 of 25 patients, 17 (68%) of whom were diagnosed with BJHS. Patients with co-existent BJHS and GI symptoms experienced abdominal pain (81%), bloating (57%), nausea (57%), reflux symptoms (48%), vomiting (43%), constipation (38%) and diarrhoea (14%). Twelve of 17 patients presenting with upper GI symptoms had delayed gastric emptying. One case is described in detail. CONCLUSIONS & INFERENCES In a preliminary retrospective study, we have found a high incidence of JHM in patients referred to tertiary neurogastroenterology care with unexplained GI symptoms and in a proportion of these a diagnosis of BJHS is made. Symptoms and functional tests suggest GI dysmotility in a number of these patients. The possibility that a proportion of patients with unexplained GI symptoms and JHM may share a common pathophysiological disorder of connective tissue warrants further investigation.
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Affiliation(s)
- N Zarate
- Neurogastroenterology Group, Centre for Digestive Diseases, Blizzard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
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Prevalence of joint hypermobility and patterns of articular manifestations in patients with inflammatory bowel disease. Gastroenterol Res Pract 2010; 2009:924138. [PMID: 20169104 PMCID: PMC2821781 DOI: 10.1155/2009/924138] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/11/2009] [Accepted: 12/10/2009] [Indexed: 11/17/2022] Open
Abstract
Objective. The objective is the investigation of Joint Hypermobility (JH) and the Hypermobility Syndrome (HMS) in patients with inflammatory bowel disease (IBD).
Methods. We examined 83 patients with IBD and 67 healthy individuals for the presence of JH. Patients were excluded if they were under 18 or over 50 years of age and if they had other conditions which affect joint mobility. The x2 and the Fisher exact test were used appropriately between study groups. Odds ratios (ORs) for the risk of JH and HMS in IBD groups were calculated. Results. A total of 150 individuals (83 IBD patients and 67 healthy controls) participated in the study. 69 IBD patients, 41 with Crohn's Disease (CD) and 28 with ulcerative colitis (UC), were finally eligible. JH was detected in 29 CD patients (70.7%), in 10 UC patients (35.7%), and in 17 healthy control subjects (25.4%). Significant difference was detected on JH in CD patients as compared to UC patients (P = .0063) and controls (P < .0001). The estimated OR for JH was 7.108 (95% CI: 2.98–16.95) in CD and 1.634 (95% CI: 0.63–4.22) in UC patients. HMS was detected in 5 (12.2%) CD and in 1 (3.57%) UC patients. The OR for HMS in CD was 3.75 (95% CI: 0.41–34.007), while 7 (17.1%) CD patients had overlapping symptoms for both HMS and early spondylarthropathy. Conclusions. JH and the HMS are common in CD patients, thus articular manifestations should be carefully interpreted. This implies an involvement of collagen varieties in the pathogenesis of IBD.
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Corben T, Lewis JS, Petty NJ. Contribution of lumbar spine and hip movement during the palms to floor test in individuals with diagnosed hypermobility syndrome. Physiother Theory Pract 2009; 24:1-12. [DOI: 10.1080/09593980701686708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Holman AJ. Assessing patients with fibromyalgia from a rheumatologist’s perspective: a three-step methodology for differential diagnosis. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Motor performance in children with generalized hypermobility: the influence of muscle strength and exercise capacity. Pediatr Phys Ther 2009; 21:194-200. [PMID: 19440129 DOI: 10.1097/pep.0b013e3181a3ac5f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to investigate whether muscle strength and functional exercise capacity (FEC) influence motor performance in children with generalized joint hypermobility. METHODS Forty-one children (mean age: 8.1 years) with symptomatic generalized hypermobility were included. Motor performance was assessed using the Körperkoordinationstest für Kinder (KTK) and the Movement Assessment Battery for Children. Muscle strength and FEC were measured with a handheld dynamometer and the 6-minute walk test. RESULTS Only muscle strength was significantly positively associated with motor performance on the KTK. FEC was significantly decreased. Children's scores on the KTK were significantly lower (p < 0.001) compared with scores on the Movement Assessment Battery for Children. CONCLUSIONS The KTK is a more sensitive tool for detecting motor problems in children with generalized joint hypermobility, but is not associated with FEC. Along with the KTK, the 6-minute walk test can be used to independently assess and evaluate FEC.
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Mays S. Septal aperture of the humerus in a mediaeval human skeletal population. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2008; 136:432-40. [PMID: 18350584 DOI: 10.1002/ajpa.20826] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Humeral septal aperture is studied in a large Mediaeval skeletal series from England. The aims are to investigate associations between septal aperture and sex, age, side and humeral robusticity; and to evaluate any associations with relative projection of ulna coronoid and olecranon processes. In this way, it is hoped to shed light on age at occurrence and the causation of the trait. Results showed a paucity of cases in juveniles. In adults, the trait was more common in left bones and in females. No association was found with humeral robusticity or humero-ulnar conformation. Detailed morphological study of humeral septa of individuals with and without apertures suggested that septal aperture forms via resorption from the anterior surface of the septum. In this group, apertures appear generally to form in early adult life. It is suggested that in the study group septal aperture generally arises from impingement on the humeral septum by the coronoid and olecranon processes, chiefly the former. It is tentatively suggested that frequency of septal aperture may be an index of joint hypermobility in earlier populations.
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Affiliation(s)
- Simon Mays
- Ancient Monuments Laboratory, English Heritage Centre for Archaeology, Fort Cumberland, Eastney, Portsmouth PO4 9LD, UK.
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Ercolani M, Galvani M, Franchini C, Baracchini F, Chattat R. Benign Joint Hypermobility Syndrome: Psychological Features and Psychopathological Symptoms in a Sample Pain-Free at Evaluation. Percept Mot Skills 2008; 107:246-56. [DOI: 10.2466/pms.107.1.246-256] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
30 subjects with BJHS (Hypermobile) ( M age = 32.3 yr., SD = 10.4) and two control groups, 25 healthy subjects (Healthy) ( M age = 33.9 yr., SD = 93) and 30 fibromyalgic patients (Fibromyalgic) ( M age = 32.2 yr., SD = 9.4), were given the Symptom Checklist-90-R, the Illness Behavior Questionnaire, the Female Functional Symptoms Frequency (FFF) and the Male Functional Symptoms Frequency (MFF), derived from the DSM-III–R, evaluating functional somatic disturbances and their intensity, and the Symptom Questionnaire. The mean scores for the Hypermobile group showed significant psychological distress and increased frequency and intensity of somatic symptoms. Scores on Anxiety and Somatic Symptoms, General Hypochondriasis, Disease Conviction, Affective Disturbance, Denial, and Irritability were significantly higher in the Hypermobile than in the Healthy group. Elevated scores were found for the Fibromyalgic group on the Illness Behavior Questionnaire subscales for Psychological vs Somatic Focus, Disease Affirmation, and Discriminating Factors when compared with the Hypermobile group. Considerable emotional symptoms were detected which should not be underestimated by physicians when establishing an integrated biopsychosocial therapy.
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Reilly DJ, Chase JW, Hutson JM, Clarke MC, Gibb S, Stillman B, Southwell BR. Connective tissue disorder--a new subgroup of boys with slow transit constipation? J Pediatr Surg 2008; 43:1111-4. [PMID: 18558192 DOI: 10.1016/j.jpedsurg.2008.02.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 02/09/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE Slow transit constipation (STC) is a form of chronic constipation, with delayed colonic passage of stool. Possible etiologies include reduced neurotransmitter levels, reduced interstitial cells of Cajal density, or a disorder of connective tissue (CT) synthesis. A common CT disorder is generalized joint hypermobility (GJH). This study aimed to investigate whether there was a greater prevalence of GJH among patients with STC than controls. METHODS Children (aged 7-17) diagnosed with STC by radio/nuclear transit study were recruited from outpatient clinics. Controls (no history of constipation) were recruited from outpatient clinics and a scout jamboree. Hypermobility was assessed using the Beighton score (4 or more = hypermobile). This project received ethical approval by the human research ethics committee. RESULTS Thirty-nine STC subjects and 41 controls were measured. Of 39 STC subjects, 15 (38%) were hypermobile, compared to 8 (20%) of 41 controls (P = .06). Analyzed by gender, 10 (38%) of 26 STC males and 1 (4%) of 23 control males were hypermobile (P < .01). CONCLUSIONS These results show that GJH is higher in STC children, particularly males, suggesting that a disorder of CT synthesis plays a role in the etiology of STC. Further research is required to ascertain the nature of any relationship and how this knowledge may aid our understanding and treatment of STC.
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Affiliation(s)
- Daniel J Reilly
- School of Medicine, University of Melbourne, Melbourne, Victoria 3052, Australia
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48
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ERCOLANI MAURO. BENIGN JOINT HYPERMOBILITY SYNDROME: PSYCHOLOGICAL FEATURES AND PSYCHOPATHOLOGICAL SYMPTOMS IN A SAMPLE PAIN-FREE AT EVALUATION. Percept Mot Skills 2008. [DOI: 10.2466/pms.107.5.246-256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Simmonds JV, Keer RJ. Hypermobility and the hypermobility syndrome. ACTA ACUST UNITED AC 2007; 12:298-309. [PMID: 17643337 DOI: 10.1016/j.math.2007.05.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 03/06/2007] [Accepted: 05/12/2007] [Indexed: 11/30/2022]
Abstract
Hypermobile joints by definition display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility, when associated with symptoms is termed the joint hypermobility syndrome or hypermobility syndrome (JHS). JHS is an under recognised and poorly managed multi-systemic, hereditary connective tissue disorder, often resulting in a great deal of pain and suffering. The condition is more prevalent in females, with symptoms frequently commencing in childhood and continuing on into adult life. This paper provides an overview of JHS and suggested clinical guidelines for both the identification and management of the condition, based on research evidence and clinical experience. The Brighton Criteria and a simple 5-point questionnaire developed by Hakim and Grahame, are both valid tools that can be used clinically and for research to identify the condition. Management of JHS frequently includes; education and lifestyle advice, behaviour modification, manual therapy, taping and bracing, electrotherapy, exercise prescription, functional rehabilitation and collaborative working with a range of medical, health and fitness professionals. Progress is often slow and hampered by physical and emotional setbacks. However with a carefully considered management strategy, amelioration of symptoms and independent functional fitness can be achieved.
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Affiliation(s)
- Jane V Simmonds
- University of Hertfordshire, School of Health and Emergency Professions, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK.
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Hakim AJ, Sahota A. Joint hypermobility and skin elasticity: the hereditary disorders of connective tissue. Clin Dermatol 2006; 24:521-33. [PMID: 17113970 DOI: 10.1016/j.clindermatol.2006.07.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The hereditary disorders of connective tissues (HDCTs) encompass a spectrum of conditions linked pathophysiologically by abnormalities of collagen, fibrillin, and matrix proteins. The clinical picture ranges from morbidity because of musculoskeletal, skin, ocular and visceral pathologies to mortality from acute vascular collapse. For many of the conditions, there is a considerable overlap in clinical features, although severity varies; appreciating the subtle differences in presentation is vital to the clinician in determining the diagnosis. Though conditions associated with severe vascular pathology are rare, other hereditary disorders of connective tissues such as the joint hypermobility syndrome and Stickler's disease are common and probably underrecognized. Abnormal skin elasticity and scaring, joint hypermobility, and chronic arthralgia are important clues that should trigger the clinician to search for underlying hereditary disorders of connective tissues. In this article, we discuss the spectrum of clinical findings, management, and genetic screening of the more common hereditary disorders of connective tissues, highlighting their diagnostic criteria and their differences.
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Affiliation(s)
- Alan J Hakim
- Department of Rheumatology, Whipps Cross University Hospital, Leytonstone, London, UK.
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