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Kim MS, Kim JJ, Kang KH, Sin KJ, In Y. Does Generalized Joint Laxity Affect Postoperative Alignment and Clinical Outcomes Following Medial Opening-Wedge High Tibial Osteotomy? J Arthroplasty 2023; 38:662-667. [PMID: 36309143 DOI: 10.1016/j.arth.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether generalized joint laxity affects the postoperative alignment and clinical outcomes of medial opening-wedge high tibial osteotomy (MOWHTO). METHODS A total of 198 patients who underwent MOWHTO was divided into two groups according to absence or presence of generalized joint laxity. Generalized joint laxity was measured using the Beighton and Horan criteria, and a score of 4 or more out of 9 was defined as generalized joint laxity. A weight bearing line (WBL) ratio of 55% to 70% was considered an acceptable postoperative lower limb alignment range; WBL over 70% was defined as overcorrection and less than 55% as undercorrection. The WBL ratio was investigated before and 2 years after surgery, and the Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC) was evaluated for patient-reported outcomes (PRO) of MOWHTO. There were 147 (73.7%) patients in the nongeneralized joint laxity group and 51 (26.3%) in the generalized joint laxity group. Preoperatively, there was no difference between the two groups in hip-knee-ankle (HKA) angle or WBL ratio (all P > .05). RESULTS At 2 years postoperatively, the generalized joint laxity group showed significantly higher HKA angle and WBL ratio than the nongeneralized joint laxity group (all P < .05). There was a significant difference in the distribution ratio of undercorrection, normocorrection, and overcorrection patients between the two groups (P < .05). There were no differences between the two groups in preoperative and postoperative WOMAC scores (all, P > .05). CONCLUSION The generalized joint laxity significantly affected postoperative over correction of alignment following MOWHTO. However, there was no significant difference in PRO between the patients who did and did not have generalized joint laxity after MOWHTO until 2 years.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Jae Jung Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Ki Ho Kang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Kyung Jun Sin
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
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Ma Y, Wu X, Shen S, Hong W, Qin Y, Sun M, Luan Y, Zhou X, Zhang B. Relationship between Locomotive Syndrome and Musculoskeletal Pain and Generalized Joint Laxity in Young Chinese Adults. Healthcare (Basel) 2023; 11:healthcare11040532. [PMID: 36833063 PMCID: PMC9956093 DOI: 10.3390/healthcare11040532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
This study aims to investigate the prevalence of locomotive syndrome (LS) and to examine the relationship of LS with musculoskeletal symptoms (pain, generalized joint laxity (GJL)) in young Chinese adults. Our study population (n = 157; mean age of 19.8 ± 1.2 years) comprises college student residents at Tsinghua University in Beijing, China. Three screening methods were used to evaluate LS: 25-question Geriatric Locomotive Function Scale (GLFS-25), a two-step test, and a stand-up test. Musculoskeletal pain was assessed by self-report and visual analog scale (VAS), and joint body laxity was evaluated using the GJL test. The prevalence of LS was 21.7% of all participants. Musculoskeletal pain affected 77.8% of the college students with LS and was strongly associated with LS. A total of 55.0% of college students with LS had four or more site joints that were positive for GJL, and higher scores of GJL were associated with a higher prevalence rate of LS. Young Chinese college students have a relatively high prevalence of LS, and musculoskeletal pain and GJL were significantly related to LS. The present results suggest that we need early screening of musculoskeletal symptoms and LS health education in young adults to prevent the mobility limitations of LS in the future.
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Affiliation(s)
- Yixuan Ma
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Xinze Wu
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi 980-8574, Japan
| | - Shaoshuai Shen
- School of Education and Welfare, Aichi Prefectural University, 1522-3 Ibaragabasama, Nagakute, Aichi 480-1198, Japan
| | - Weihao Hong
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Ying Qin
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Mingyue Sun
- Department of Physiotherapy, Planet Rehabilitation Center, Planet Rehabilitation Technology Co., Ltd., Guangzhou 510623, China
| | - Yisheng Luan
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
| | - Xiao Zhou
- School of Physical Education, Huazhong University of Science and Technology, Wuhan 430074, China
- Correspondence: (X.Z.); (B.Z.); Tel.: +86-138-0592-5552 (X.Z.); +86-135-2205-1883 (B.Z.)
| | - Bing Zhang
- Division of Sports Science and Physical Education, Tsinghua University, Beijing 100081, China
- Correspondence: (X.Z.); (B.Z.); Tel.: +86-138-0592-5552 (X.Z.); +86-135-2205-1883 (B.Z.)
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Satis S, Tuna M. Effects of Benign Joint Hypermobility Syndrome on the Clinical Characteristics of Carpal Tunnel Syndrome in Females. J Clin Neurol 2022; 18:223-226. [PMID: 35274838 PMCID: PMC8926761 DOI: 10.3988/jcn.2022.18.2.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The study aim was to determine the effects of benign joint hypermobility syndrome (BJHS) on symptom severity and functional capacity in females with carpal tunnel syndrome (CTS) based on the findings of physical examinations. Methods One hundred female patients diagnosed with bilateral CTS in electrophysiological testing were included in this study. The participants were evaluated for BJHS using the Brighton 1998 criteria, and divided into two groups: one consisting of 56 CTS patients with BJHS, and the other comprising 44 CTS patients without BJHS. Tinel’s, Phalen’s, and reverse Phalen’s tests were applied to all patients, and the severity and functional capacity of CTS were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire. Results Symptom severity and functional capacity varied significantly between the two groups in the right hand (p=0.037 and p=0.039, respectively) and in the left hand (p=0.016 and p=0.029). The hypermobile group yielded more positive results on the right side during Tinel’s, Phalen’s, and reverse Phalen’s tests (p=0.032, p=0.032, and p=0.018, respectively). Conclusions Hypermobility in females exacerbated the symptoms of CTS and led to a further reduction of functional capacity. Therefore, hypermobility should be tested and an intense exercise program should be implemented in BJHS patients, especially in females with CTS.
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Affiliation(s)
- Serap Satis
- Department of Physical Medicine and Rehabilitation, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Mustafa Tuna
- Department of Physical Medicine and Rehabilitation, Sanliurfa Education and Research Hospital, Sanliurfa, Turkey
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Bates AV, McGregor AH, Alexander CM. Comparing sagittal plane kinematics and kinetics of gait and stair climbing between hypermobile and non-hypermobile people; a cross-sectional study. BMC Musculoskelet Disord 2021; 22:712. [PMID: 34412618 PMCID: PMC8377885 DOI: 10.1186/s12891-021-04549-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background Joint Hypermobility Syndrome (JHS) presents with a range of symptoms including widespread joint hypermobility and chronic arthralgia. The study objective was to investigate whether impairments in JHS are due to hypermobility or another factor of JHS by identifying impairments in gait and stair-climbing tasks; an activity that is demanding and so may better show differences between the cohorts. Methods Sixty-eight adults participated; 23 JHS, 23 Generalised Joint Hypermobility (GJH), and 22 Normal Flexibility (NF). Inclusion criteria for JHS participants were a positive classification using the Brighton Criteria, for GJH a Beighton Score ≥ 4, and for NF a Beighton Score < 4 with no hypermobile knees. Participants were recorded with a 10-camera Vicon system whilst they performed gait and stair-climbing. Temporal-spatial, and sagittal plane kinematic and kinetic outcome measures were calculated and input to statistical analyses by statistical parametric mapping (SPM). Results During the gait activity JHS had significantly greater stride time and significantly lower velocity than NF, and significantly greater stride time, lower velocity, and lower stride length than GJH. SPM analysis showed no significant differences between groups in gait kinematics. There were significant differences between groups for gait moments and powers; people with JHS tended to have lower moments and generate less power at the ankle, and favour power generation at the knee. A similar strategy was present in stair ascent. During stair descent people with JHS showed significantly more hip flexion than people with NF. Conclusions As there was only one significant difference between GJH and NF we conclude that impairments cannot be attributed to hypermobility alone, but rather other factor(s) of JHS. The results show that both gait and stair-climbing is impaired in JHS. Stair-climbing results indicate that JHS are using a knee-strategy and avoiding use of the ankle, which may be a factor for clinicians to consider during treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04549-2.
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Affiliation(s)
- Alexander Vernon Bates
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Therapies, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK.
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Physiotherapy, Imperial College Healthcare NHS Trust, London, UK
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Wessel LE, Eliasberg CD, Bowen E, Sutton KM. Shoulder and elbow pathology in the female athlete: sex-specific considerations. J Shoulder Elbow Surg 2021; 30:977-985. [PMID: 33220412 DOI: 10.1016/j.jse.2020.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
Unique biologic and biomechanical aspects of the female body make women more prone to certain orthopedic injuries. Sex differences are well understood with regard to certain orthopedic pathologies such as anterior cruciate ligament injury, hallux valgus, carpal tunnel, and carpometacarpal joint arthritis; however, sex differences are less commonly discussed with regard to shoulder and elbow pathology. The purpose of this review is to elucidate sex differences specific to sports-related shoulder and elbow injuries in the female athlete population.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Claire D Eliasberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Edward Bowen
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Karen M Sutton
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
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van Meulenbroek T, Huijnen IPJ, Simons LE, Conijn AEA, Engelbert RHH, Verbunt JA. Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain. Scand J Pain 2020; 21:22-31. [PMID: 32862151 DOI: 10.1515/sjpain-2020-0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/12/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability. CONTENT Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability. SUMMARY AND OUTLOOK It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism.In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.
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Affiliation(s)
- Thijs van Meulenbroek
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Ivan P J Huijnen
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Arnoud E A Conijn
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; and ACHIEVE, Centre for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam,The Netherlands
| | - Jeanine A Verbunt
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
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Ahlqvist K, Bjelland EK, Pingel R, Schlager A, Nilsson-Wikmar L, Kristiansson P. The Association of Self-Reported Generalized Joint Hypermobility with pelvic girdle pain during pregnancy: a retrospective cohort study. BMC Musculoskelet Disord 2020; 21:474. [PMID: 32689990 PMCID: PMC7372850 DOI: 10.1186/s12891-020-03486-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Pelvic girdle pain (PGP) is common during pregnancy but the causes remain poorly understood. Generalized joint hypermobility (GJH) is an inherited trait, with joint mobility beyond normal limits and is assumed to be related with PGP. The aim of this project was to study the association between self-reported GJH and the presence of PGP during pregnancy. Methods In this cohort study, 4884 Swedish-speaking women were consecutively recruited at their first visit for registration in the national antenatal screening programme in Sweden. We used the five-part questionnaire (5PQ) to assess GJH and pain drawings to identify PGP. Our primary outcome was the presence of PGP during the entire pregnancy and secondary outcomes were PGP in each trimesters. We tested the associations with logistic regression analysis, and adjusted for age and ethnicity. Results In all, 2455 (50.3%) women responded to both questionnaires. The prevalence of self-reported GJH was 28.7%. A higher proportion of women with GJH than women without GJH reported PGP during the entire pregnancy (47.9% vs. 41.0%), particularly in trimester 1 (31.6% vs. 22.0%). Thus, women with GJH also had higher odds of PGP during the entire pregnancy (adjusted odds ratio (aOR) 1.27: 95% CI 1.11–1.47) and in trimester 1 (aOR 1.54: 95% CI 1.20–1.96), but the associations were not statistically significant in trimester 2 (aOR 1.24: 95% CI 0.82–1.88) or trimester 3 (aOR 1.20: 95% CI 0.99–1.45). The odds of PGP in pregnancy increased with increasing numbers of positive answers to the 5PQ (p for linear trend < 0.001) for the entire pregnancy and in trimester 1 (p for linear trend < 0.001), but not in trimesters 2 or 3 (p = 0.13 and p = 0.06, respectively). Conclusions Compared to women with normal joint mobility, women with GJH had higher odds of reporting PGP during pregnancy and the odds increased with number of positive responses to the 5PQ. The associations were present in trimester 1 but did not reach statistical significance in trimester 2 and 3.
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Affiliation(s)
- Kerstin Ahlqvist
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.
| | - Elisabeth Krefting Bjelland
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Angela Schlager
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.,Academic Primary Healthcare Centre, Stockholm County Council, Huddinge, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Per Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden
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Sacks HA, Prabhakar P, Wessel LE, Hettler J, Strickland SM, Potter HG, Fufa DT. Generalized Joint Laxity in Orthopaedic Patients: Clinical Manifestations, Radiographic Correlates, and Management. J Bone Joint Surg Am 2019; 101:558-566. [PMID: 30893238 DOI: 10.2106/jbjs.18.00458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hayley A Sacks
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Pooja Prabhakar
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Lauren E Wessel
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Jessica Hettler
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Sabrina M Strickland
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Hollis G Potter
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Duretti T Fufa
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
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Palmer S, Bridgeman K, Di Pierro I, Jones R, Phillips C, Wilson M. The views of people with joint hypermobility syndrome on its impact, management and the use of patient-reported outcome measures. A thematic analysis of open-ended questionnaire responses. Musculoskeletal Care 2019; 17:183-193. [PMID: 30793827 DOI: 10.1002/msc.1387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Joint hypermobility syndrome (JHS) has been reported to have widespread impacts on people with the condition. However, our understanding of those impacts is still developing and we do not know if they can be captured effectively using patient-reported outcome measures. The aim of the present study was to explore written qualitative comments from previously administered questionnaires, to identify the impacts of JHS and any issues related to using patient-reported outcome measures to assess those impacts. METHODS Previous research administered a draft condition-specific questionnaire and Short Form-36 questionnaire to adult members of a patient organization in the UK, incorporating an open text box for further comments. Those comments were transcribed, anonymized and analysed using thematic analysis. A coding list, themes and subthemes were developed through double coding, parallel independent analysis and consensus. RESULTS A total of 393 of 614 eligible questionnaires (64%) contained qualitative comments and were analysed (mean respondent age 41 years, mean Bristol Impact of Hypermobility questionnaire score 228/360, 95% women). Three main themes were identified: (a) "Impacts of living with JHS"; (b) "Management strategies for JHS"; and (c) "Measurement and research into JHS". Participants highlighted a range of impacts of JHS, incorporating physical, social and psychological domains. Respondents described difficult journeys to diagnosis, and feeling unsupported and misunderstood by their peers and healthcare professionals. They detailed helpful strategies for managing their condition and provided useful comments on using questionnaires to assess JHS. CONCLUSIONS The study yielded valuable findings that can be used to directly inform the assessment and management of JHS.
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Affiliation(s)
- Shea Palmer
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Keely Bridgeman
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Isabelle Di Pierro
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Rosanna Jones
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Caitlin Phillips
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Megan Wilson
- Department of Allied Health Professions, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
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Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, López-López D, Rodríguez-Sanz D, Romero-Morales C, Calvo-Lobo C. Effect of generalized ligamentous hyperlaxity related of quality of life in the foot: a case controlled study. ACTA ACUST UNITED AC 2019; 64:819-823. [PMID: 30673003 DOI: 10.1590/1806-9282.64.09.819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/13/2018] [Indexed: 11/22/2022]
Abstract
Generalized ligamentous hyperlaxity (GLH) has been shown to predispose an individual to a number of orthopaedic conditions. Little is known about how GLH affects people' foot health-related quality of life. This study analyses a sample of people with GLH and people without GLH with normalised reference values of the scores collected with regard to using the Foot Health Status Questionnaire (FSHQ). A total of 100 respondents with mean age of 22.69 ± 3.78 years old, who attended a health centre were classified as GLH (n = 50) or non-GLH (n = 50). The GLH was determined of the patients with and without GLH using assessment with Beighton tool and the scores on the FHSQ were compared. The control group recorded higher scores in the First Section for foot pain, foot function and general foot health, and lower scores in footwear. In the Second Section, they obtained higher scores in social capacity and lower scores in physical activity, vigour and general health. Differences between the two groups were evaluated through a t-test for independent samples, showing statistical significance (P<0.001). This study has detected measurable differences of association between GLH (Beighton score ≥4) with impaired quality of life related to foot health.
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Affiliation(s)
- Patricia Palomo-López
- . University Center of Plasencia. Universidad de Extremadura, Plasencia, Extremadura, Spain
| | | | | | - Daniel López-López
- . Research, Health and Podiatry Unit. Department of Health Sciences. Faculty of Nursing and Podiatry. Universidade da Coruña, Ferrol, Spain
| | - David Rodríguez-Sanz
- . Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid, Madrid, Spain.,. Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, Madrid, Madrid, Spain
| | - Carlos Romero-Morales
- . Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, Madrid, Madrid, Spain
| | - César Calvo-Lobo
- . Department, Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain
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11
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The Relationship between Shoe Fitting and Foot Health of Persons with Down Syndrome: A Case Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050983. [PMID: 29757962 PMCID: PMC5982022 DOI: 10.3390/ijerph15050983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 12/01/2022]
Abstract
Background: Down syndrome is the most common chromosomal abnormality and a cause of intellectual disability. It is also associated with orthopaedic and musculoskeletal problems of the locomotive apparatus, especially of the feet. These problems are believed to have a harmful effect on health, social functioning, and mobility. In addition, these persons generally don’t have access to podiatric health services, even when their foot problems are well known, because of limited access to healthcare facilities. The goal of our research was to evaluate and compare the foot health status of study participants with and without Down syndrome and to determine whether inadequate footwear is being used with normalized reference values. Methods: A total of 105 participants with and without Down syndrome, with a mean age of 35.71 (SD = 12.93) years, were enrolled in the study. They self-reported demographic data and their clinical characteristic data were recorded. Measurements of their foot and shoe fitting were taken at all stages of the research process. Ninety-two percent of the participants with Down syndrome had foot problems. Results: Only 12 (24%) participants with Down syndrome used bilateral shoes that met the requirements of their feet compared to their controls (50 participants, 90.9% for the right foot; 46 participants, 83.6% for the left foot). Participants with Down syndrome presented statistically significant differences with respect to controls and wore incorrectly sized shoe. Conclusions: Evaluation of foot length and width may prevent development of foot deformities, as well as to improve general health.
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Engelbert RHH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JV. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:158-167. [PMID: 28306230 DOI: 10.1002/ajmg.c.31545] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.
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Physical and Psychosocial Characteristics of Current Child Dancers and Nondancers With Systemic Joint Hypermobility: A Descriptive Analysis. J Orthop Sports Phys Ther 2017; 47:782-791. [PMID: 28870141 DOI: 10.2519/jospt.2017.7331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional study. Background The effect of current participation in dance training on joint pain and instability, fatigue, and quality of life is unknown. Objectives To examine differences in joint pain, instability, gross motor skills, nonmusculoskeletal systemic manifestations, health-related quality of life (HRQoL), and fatigue between children with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type (JHS/EDS-HT) who currently undertake formal dance training and those who do not. Methods Children with JHS/EDS-HT and 1 parent completed reports providing data on demographic variables, symptoms, organized activity participation, HRQoL, and fatigue. Physical and functional measures included extent of hypermobility, aerobic fitness, balance, and muscle endurance. Results Of the 102 participating children, 22 currently undertook dance classes, averaging 3.3 h/wk. While the dancers reported a number of painful joints similar to that reported by nondancers (mean ± SD, 5.5 ± 3.7 versus 6.4 ± 3.9 joints, respectively; P = .36), they reported significantly lower pain levels on a 0-to-10 scale (3.8 ± 3.3 versus 5.6 ± 3.4, P = .04) and found pain to be less problematic, affecting less of their body. They reported fewer unstable joints (1.0 ± 1.0 versus 2.0 ± 1.8 joints, P = .001), despite being more hypermobile (Beighton score, 7.3 ± 1.4 versus 6.6 ± 1.6 on a 9-point scale, P = .047; Lower Limb Assessment Score, 9.2 ± 2.0 versus 8.1 ± 1.9 on a 12-point scale, P = .02). The dancers had significantly better HRQoL in the subdomain of school functioning (P = .004) and reported less fatigue (P = .024). Conclusion Children with JHS/EDS-HT who are currently undertaking formal dance training have fewer joint pain and instability symptoms, less fatigue, and better HRQoL; however, the cross-sectional nature of the study means that causation cannot be determined. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2017;47(10):782-791. Epub 4 Sep 2017. doi:10.2519/jospt.2017.7331.
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Fikree A, Aziz Q, Sifrim D. Mechanisms underlying reflux symptoms and dysphagia in patients with joint hypermobility syndrome, with and without postural tachycardia syndrome. Neurogastroenterol Motil 2017; 29. [PMID: 28191707 DOI: 10.1111/nmo.13029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/19/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The joint hypermobility syndrome (JHS) is a common non-inflammatory connective tissue disorder which frequently co-exists with postural tachycardia syndrome (PoTS), a form of orthostatic intolerance. Gastrointestinal symptoms and dysmotility have been reported in PoTS. Dysphagia and reflux are common symptoms in JHS, yet no studies have examined the physiological mechanism for these, subdivided by PoTS status. METHODS Thirty patients (28 female, ages: 18-62) with JHS and symptoms of reflux (n=28) ± dysphagia (n=25), underwent high-resolution manometry and 24 hour pH-impedance monitoring after questionnaire-based symptom assessment. Esophageal physiology parameters were examined in JHS, subdivided by PoTS status. RESULTS Fifty-three percent of JHS patients with reflux symptoms had pathological acid reflux, 21% had reflux hypersensitivity, and 25% had functional heartburn. Acid exposure was more likely to be increased in the recumbent than upright position (64% vs 43%). The prevalence of hypotensive lower esophageal sphincter (33%) and hiatus hernia (33%) was low. Forty percent of patients with dysphagia had minor disorders of motility, 60% had functional dysphagia. Eighteen (60%) patients had coexistent PoTS-they had significantly higher dysphagia (21 vs 11.5, P=.04) and reflux scores (24.5 vs 16.5, P=.05), and double the prevalence of pathological acid reflux (64% vs 36%, P=.1) and esophageal dysmotility (50% vs 25%, P=.2) though this was not significant. CONCLUSIONS AND INFERENCES A large proportion of JHS patients with esophageal symptoms have true reflux-related symptoms or mild esophageal hypomotility, and this is more likely if they have PoTS.
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Affiliation(s)
- A Fikree
- Wingate Institute of Neurogastroenterology, Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Q Aziz
- Wingate Institute of Neurogastroenterology, Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - D Sifrim
- Wingate Institute of Neurogastroenterology, Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Stettler M, Luder G, Schmid S, Mueller Mebes C, Stutz U, Ziswiler HR, Radlinger L. Passive anterior tibial translation in women with and without joint hypermobility: an exploratory study. Int J Rheum Dis 2016; 21:1756-1762. [PMID: 27456472 DOI: 10.1111/1756-185x.12917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Generalized joint hypermobility (GJH) is a frequent entity, which is still not fully understood. Symptoms associated with GJH are musculoskeletal disorders, decreased balance, impaired proprioception and chronic pain. The purpose of this study was to compare the passive anterior tibial translation (TT) in terms of distance and corresponding force between normomobile (NM) and hypermobile (HM) as well as between NM, symptomatic (HM-s) and asymptomatic (HM-as) hypermobile women. METHODS A total of 195 women, 67 NM and 128 HM, whereof 56 were further classified as HM-s and 47 as HM-as, participated in this study. Passive TT was measured using an adapted Rolimeter. A manual traction force was applied and the distance of the translation measured. For the analysis, maximal translation (TTmax) and the respective force as well as the distance at 40N (TTF40) and 80N (TTF80) traction force were determined. The NM and HM groups were compared using independent samples t-tests, whereas the NM, HM-s and HM-as groups were compared using one-way analyses of variance with Tukey post hoc tests (significance level P ≤ 0.05). RESULTS Comparisons revealed higher values for the variables TTmax, TTF40 and TTF80 in the HM compared to the NM group. In addition, TTmax and TTF80 were found to be higher in the HM-s compared to the NM group. CONCLUSIONS HM women showed significantly higher TT distances, which were even more accentuated in those having symptoms. The findings point toward less passive stability of the knee joint and thus maybe a need of higher muscle activation in order to stabilize the joint.
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Affiliation(s)
- Matthias Stettler
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Gere Luder
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland.,Inselspital, Department of Physiotherapy, Bern University Hospital, Bern, Switzerland
| | - Stefan Schmid
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | | | - Ursula Stutz
- Inselspital, Department of Physiotherapy, Bern University Hospital, Bern, Switzerland
| | | | - Lorenz Radlinger
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
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Scheper M, Rombaut L, de Vries J, De Wandele I, van der Esch M, Visser B, Malfait F, Calders P, Engelbert R. The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers-Danlos syndrome: the impact of proprioception. Disabil Rehabil 2016; 39:1391-1397. [PMID: 27339264 DOI: 10.1080/09638288.2016.1196396] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The patients diagnosed with Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients. METHODS Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders. RESULTS Muscle strength was associated with 30CRT (r = 0.67, p = <0.001), 6MWT (r = 0.58, p = <0.001) and HAQ (r = 0.63, p= <0.001). Proprioception was associated with 30CRT (r = 0.55, p < 0.001), 6MWT (r = 0.40, p = <0.05) and HAQ (r = 0.46, p < 0.05). Muscle strength was found to be associated with activity limitations, however, proprioceptive inacuity confounded this association. CONCLUSIONS Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT. Implications for rehabilitation Reducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients. Although muscle strength is the most dominant factor that is associated with activity limitations, this association is confounded by proprioception. In contrast to common belief proprioception was not directly associated with activity limitations but confounded this association. Controlling muscle strength on the bases of proprioceptive input may be more important for reducing activity limitations than just enhancing sheer muscle strength.
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Affiliation(s)
- Mark Scheper
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,b Department of Rehabilitation , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | - Lies Rombaut
- c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Ghent , Belgium
| | - Janneke de Vries
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,b Department of Rehabilitation , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | - Inge De Wandele
- c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Ghent , Belgium
| | - Martin van der Esch
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,d Reade, Amsterdam Rehabilitation Research Centre , Amsterdam , The Netherlands
| | - Bart Visser
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands
| | | | - Patrick Calders
- c Department of Rehabilitation Sciences and Physiotherapy , Ghent University , Ghent , Belgium
| | - Raoul Engelbert
- a Faculty of Health, ACHIEVE , Center for Applied Research, University of Applied Sciences Amsterdam , Amsterdam , The Netherlands.,b Department of Rehabilitation , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
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Phatarakijnirund V, Mumm S, McAlister WH, Novack DV, Wenkert D, Clements KL, Whyte MP. Congenital insensitivity to pain: Fracturing without apparent skeletal pathobiology caused by an autosomal dominant, second mutation in SCN11A encoding voltage-gated sodium channel 1.9. Bone 2016; 84:289-298. [PMID: 26746779 PMCID: PMC4755825 DOI: 10.1016/j.bone.2015.11.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/19/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Abstract
Congenital insensitivity to pain (CIP) comprises the rare heritable disorders without peripheral neuropathy that feature inability to feel pain. Fracturing and joint destruction are common complications, but lack detailed studies of mineral and skeletal homeostasis and bone histology. In 2013, discovery of a heterozygous gain-of-function mutation in SCN11A encoding voltage-gated sodium channel 1.9 (Nav1.9) established a distinctive CIP in three unrelated patients who suffered multiple painless fractures, self-inflicted mutilation, chronic diarrhea, and hyperhidrosis. Here, we studied a mother and two children with CIP by physical examination, biochemical testing, radiological imaging including DXA, iliac crest histology, and mutation analysis. She suffered fractures primarily of her lower extremities beginning at age two years, and had Charcot deformity of both ankles and joint hypermobility. Nerve conduction velocity together with electromyography were normal. Her children had recurrent major fractures beginning in early childhood, joint hypermobility, and chronic diarrhea. She had an excoriated external nare, and both children had hypertrophic scars from scratching. Skin collagen studies were normal. Radiographs revealed fractures and deformities. However, lumbar spine and total hip BMD Z-scores, biochemical parameters of mineral and skeletal homeostasis, and iliac crest histology of the mother (after in vivo tetracycline labeling) were normal. Genomic DNA from the children revealed a unique heterozygous missense mutation in exon 23 (c.3904C>T, p.Leu1302Phe) of SCN11A that is absent in SNP databases and alters an evolutionarily conserved amino acid. This autosomal dominant CIP reflects the second gain-of-function mutation of SCN11A. Perhaps joint hypermobility is an unreported feature. How mutation of Nav1.9 causes fracturing remains unexplained. Lack of injury awareness is typically offered as the reason, and was supported by our unremarkable biochemical, radiological, and histological findings indicating no skeletal pathobiology. However, low-trauma fracturing in these patients suggests an uncharacterized defect in bone quality.
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Affiliation(s)
- Voraluck Phatarakijnirund
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - William H McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Deborah V Novack
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Deborah Wenkert
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA.
| | - Karen L Clements
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA.
| | - Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
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Association between joint hypermobility and pelvic organ prolapse in women: a systematic review and meta-analysis. Int Urogynecol J 2015; 27:1469-78. [PMID: 26658756 DOI: 10.1007/s00192-015-2896-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/15/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Abnormalities of common collagen proteins have been noted in individuals affected by POP and JHM, suggesting a common aetiology. We assessed strength, consistency and potential for bias in pooled associations of the relationship between JHM and POP. METHODS We searched MEDLINE, EMBASE and CINAHL, as well as International Continence Society (ICS) and International Urogynaecologic Association (IUGA) annual meeting abstracts, including reference lists, without language restrictions. We included case-control and cohort studies and applied strict criteria for choosing eligible studies. Methodologically trained reviewers independently screened abstracts and full texts to confirm eligibility. We extracted data on study and patient characteristics, clinical assessment tools, and methodology. We assessed comparability and representativeness of source populations, confidence in the assessment of JHM and POP and adjustment for confounding and missing data. Meta-analysis was performed using a random effects model. RESULTS We retrieved 39 full texts, of which 14 were used in the meta-analysis. Overall pooled odds ratio (OR) was 2.37 [95 % confidence interval (CI) 1.54-3.64, I(2) = 77.0 %]. We identified no significant factors in meta-regression, and there was no evidence of publication bias; six studies were at high risk of bias with frequent differences in sampling frames, limited validity for clinical assessments and failure to match for important prognostic variables. CONCLUSIONS We found a strong association between POP and JHM, with an effect size that is clinically relevant. Our findings are limited by high heterogeneity and the potential for residual confounding factors. JHM is an important early indicator for POP risk, and future longitudinal studies should explore the shared aetiology.
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Scheper MC, de Vries JE, Verbunt J, Engelbert RHH. Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): it is a challenge. J Pain Res 2015; 8:591-601. [PMID: 26316810 PMCID: PMC4548768 DOI: 10.2147/jpr.s64251] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers-Danlos syndrome. However, within the Ehlers-Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers-Danlos syndrome hypermobility type (EDS-HT). Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1) and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2). In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3). Despite recent scientific advances, many obstacles for clinical care and research still remain. To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available. Future research and clinical care should revise and create consensus on the diagnostic criteria for HMS/EDS-HT (Solution 1), account for clinical heterogeneity by the classification of subtypes within the HMS/EDS-HT spectrum (Solution 2), and create a clinical core set (Solution 3).
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Affiliation(s)
- Mark C Scheper
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Janneke E de Vries
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Adelante, Center of expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Raoul HH Engelbert
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Over LM. Maxillofacial prosthetic rehabilitation for esophageal and laryngeal laxity due to the hypermobility syndrome: A clinical report. J Prosthet Dent 2015; 113:656-9. [PMID: 25794916 DOI: 10.1016/j.prosdent.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/12/2022]
Abstract
Laryngeal and esophageal laxity resulting from a connective tissue disease can lead to severe pain and functional impairment. This clinical report describes a patient with such significant neck pain that it prevented her from speaking; it also caused pain with deglutition. Maxillofacial prosthetic rehabilitation with an external laryngeal and esophageal support significantly reduced the patient's pain and restored normal speaking and deglutition functions. This clinical report describes the design and fabrication of a support to stabilize the patient's laryngeal and esophageal structures to her midline.
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Affiliation(s)
- Larry Michael Over
- Adjunct Professor, Department of Restorative Dentistry, Oregon Health and Sciences University, Portland, Ore; and Private practice, Eugene, Ore.
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Han WJ, Kim HB, Lee GW, Choi JH, Jo WJ, Lee SM. Generalized Joint Laxity is Associated with Primary Occurrence and Treatment Outcome of Lumbar Disc Herniation. Korean J Fam Med 2015; 36:141-5. [PMID: 26019764 PMCID: PMC4445054 DOI: 10.4082/kjfm.2015.36.3.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 05/16/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We investigated relationships between generalized joint laxity and primary lumbar disc herniation occurrence and compared clinical outcomes after conservative treatment in lumbar disc herniation patients with and without generalized joint laxity. METHODS The study group included 128 men, and the control group included 276 men matched for age and body mass index with the study group. The primary outcome measure was the presence or absence of generalized joint laxity using the Beighton scale. Clinical outcomes measured by the visual analog scale and the Oswestry disability index 2 years after conservative treatment were the secondary outcome measure. RESULTS Generalized joint laxity prevalence was 13.2% in the study group and 5.1% in the control group, a significant difference (P=0.01). Spearman correlation analysis revealed that weight (r=0.162, P=0.03), body mass index (r=0.131, P=0.03), and generalized joint laxity (r=0.372, P<0.01) significantly correlated with lumbar disc herniation occurrence. In multivariate regression analysis, generalized joint laxity was the only significant lumbar disc herniation predictor (P=0.002; 95% confidence interval, 1.08 to 5.26). Generalized joint laxity in lumbar disc herniation patients was associated with worse clinical outcomes after conservative treatment measured by visual analog scale scores for lower extremity pain (P=0.02), lower back pain (P=0.03), and Oswestry disability index scores (P=0.03). CONCLUSION Generalized joint laxity might be associated with lumbar disc herniation occurrence and might also be a negative predictor of worse clinical outcomes after conservative treatment.
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Affiliation(s)
- Woo Jin Han
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Hong-Bae Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Gun Woo Lee
- Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangju, Korea
| | - Jung Heum Choi
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Won Jin Jo
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Sun-Mi Lee
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
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Luder G, Schmid S, Stettler M, Mueller Mebes C, Stutz U, Ziswiler HR, Radlinger L. Stair climbing – An insight and comparison between women with and without joint hypermobility: A descriptive study. J Electromyogr Kinesiol 2015; 25:161-7. [DOI: 10.1016/j.jelekin.2014.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022] Open
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Lee GW, Lee SM, Suh BG. The impact of generalized joint laxity on the occurrence and disease course of primary lumbar disc herniation. Spine J 2015; 15:65-70. [PMID: 25011096 DOI: 10.1016/j.spinee.2014.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/17/2014] [Accepted: 06/30/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Generalized joint laxity (GJL) has been associated with spine-related disorders such as low back pain, accelerated disc degeneration, and recurrence after discectomy surgery for primary lumbar disc herniation (p-LDH). Generalized joint laxity might be a causative factor of p-LDH, but this relationship is poorly understood. In addition, the impact of GJL on outcomes after the treatment for p-LDH has not been reported. PURPOSE To explore relationship between GJL and p-LDH and to compare clinical and radiological outcomes post-therapy in p-LDH patients with or without GJL. STUDY DESIGN A retrospective comparative study. PATIENT SAMPLE The study group included 203 males, and the control group included 362 males who were matched for age, race, and body mass index with the study group. OUTCOME MEASURES The primary outcome was the presence or absence of GJL according to the Beighton scale. The secondary outcome measures included the clinical outcome according to a visual analog scale and the Oswestry disability index and the radiological outcome. METHODS We compared baseline data between groups, and we evaluated the impact of GJL on outcomes after different types of several treatment for LDH. RESULTS The prevalence of GJL was significantly higher in the study group (10.8%) than in the matched control group (4.4%) (p=.003). In multivariate logistic regression analysis, GJL was the only significant predictor (p=.012). For all treatment methods, patients with GJL had worse clinical outcomes than did patients without GJL. In the patients treated with lumbar discectomy surgery, the differential Cobb value at the last follow-up was higher in the GJL patients than in the non-GJL patients (p=.001). CONCLUSIONS Generalized joint laxity was closely related to p-LDH and may be a causative factor. In addition, patients with GJL had worse clinical and radiological outcomes than patients without GJL. Consequently, GJL should be evaluated preoperatively, and this information should be communicated to p-LDH patients with GJL.
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Affiliation(s)
- Gun Woo Lee
- Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yongam-ri, 49-1, Eunhyeon-myeon, Yangju-si, Gyeonggi-do 482-863, Republic of Korea.
| | - Sun-Mi Lee
- Department of Family Medicine, Myongji Hospital, Kwandong University College of Medicine, 55 Hwasu-ro, 14 beon-gil, Deokyang-gu, Goyang, Gyeonggi, 412-826, Republic of Korea
| | - Bo-Gun Suh
- Department of Orthopaedic Surgery, Pohang Semyeng Christianty Hospital, Dae-do dong 94-5, Namgu, Pohang, Kyeongbuk, 790-822, Republic of Korea
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Kovacic K, Chelimsky TC, Sood MR, Simpson P, Nugent M, Chelimsky G. Joint hypermobility: a common association with complex functional gastrointestinal disorders. J Pediatr 2014; 165:973-8. [PMID: 25151198 DOI: 10.1016/j.jpeds.2014.07.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/12/2014] [Accepted: 07/08/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the prevalence of joint hypermobility (JH) and comorbid conditions in children and young adults referred to a tertiary care neurogastroenterology and autonomic disorders clinic for functional gastrointestinal complaints. STUDY DESIGN This was a retrospective chart review of 66 new patients aged 5-24 years who fulfilled at least 1 pediatric Rome III criteria for a functional gastrointestinal disorder (FGID) and had a recorded Beighton score (n = 45) or fibromyalgia tender point score (n = 45) based on physician examination. Comorbid symptoms were collected and autonomic testing was performed for evaluation of postural tachycardia syndrome (POTS). RESULTS The median patient age was 15 years (range, 5-24 years), 48 (73%) were females, and 56% had JH, a significantly higher rate compared with population studies of healthy adolescents (P < .001; OR, 10.03; 95% CI, 5.26-19.13). POTS was diagnosed in 34% of patients and did not correlate significantly with hypermobility. Comorbid conditions were common, including sleep disturbances (77%), chronic fatigue (93%), dizziness (94%), migraines (94%), chronic nausea (93%), and fibromyalgia (24%). CONCLUSION JH and other comorbid symptoms, including fibromyalgia, occur commonly in children and young adults with complex FGIDs. POTS is prevalent in FGIDs but is not associated with hypermobility. We recommend screening patients with complex FGIDs for JH, fibromyalgia, and comorbid symptoms such as sleep disturbances, migraines, and autonomic dysfunction.
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Affiliation(s)
- Katja Kovacic
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | | | - Manu R Sood
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Melodee Nugent
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Gisela Chelimsky
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
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Schmid S, Luder G, Mueller Mebes C, Stettler M, Stutz U, Ziswiler HR, Radlinger L. Neuromechanical gait adaptations in women with joint hypermobility--an exploratory study. Clin Biomech (Bristol, Avon) 2014; 28:1020-5. [PMID: 24120181 DOI: 10.1016/j.clinbiomech.2013.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Joint hypermobility is known to be associated with joint and muscle pain, joint instability and osteoarthritis. Previous work suggested that those individuals present an altered neuromuscular behavior during activities such as level walking. Therefore, the aim of this study was to explore the differences in ground reaction forces, temporal parameters and muscle activation patterns during gait between normomobile and hypermobile women, including symptomatic and asymptomatic hypermobile individuals. METHODS A total of 195 women were included in this cross-sectional study, including 67 normomobile (mean 24.8 [SD 5.4] years) and 128 hypermobile (mean 25.8 [SD 5.4] years), of which 56 were further classified as symptomatic and 47 as asymptomatic. The remaining 25 subjects could not be further classified. Ground reaction forces and muscle activation from six leg muscles were measured while the subjects walked at a self-selected speed on an instrumented walkway. Temporal parameters were derived from ground reaction forces and a foot accelerometer. The normomobile and hypermobile groups were compared using independent samples t-tests, whereas the normomobile, symptomatic and asymptomatic hypermobile groups were compared using one-way ANOVAs with Tukey post-hoc tests (significance level=0.05). FINDINGS Swing phase duration was higher among hypermobile (P=0.005) and symptomatic hypermobile (P=0.018) compared to normomobile women. The vastus medialis (P=0.049) and lateralis (P=0.030) and medial gastrocnemius (P=0.011) muscles showed higher mean activation levels during stance in the hypermobile compared to the normomobile group. INTERPRETATION Hypermobile women might alter their gait pattern in order to stabilize their knee joint.
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Affiliation(s)
- Stefan Schmid
- Bern University of Applied Sciences, Health Division, Discipline of Physiotherapy, Bern, Switzerland.
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Pantoja Zarza L, Díez Morrondo C, Alexis D. Hyperlax Ehlers-Danlos syndrome: benign hypermobility? REUMATOLOGIA CLINICA 2014; 10:189-190. [PMID: 24055257 DOI: 10.1016/j.reuma.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/14/2013] [Accepted: 06/07/2013] [Indexed: 06/02/2023]
Affiliation(s)
| | | | - Duckens Alexis
- Servicio de Medicina Interna, Hospital El Bierzo, Ponferrada, León, España
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Medeiros HBDO, Araújo DSMSD, Araújo CGSD. Age-related mobility loss is joint-specific: an analysis from 6,000 Flexitest results. AGE (DORDRECHT, NETHERLANDS) 2013; 35:2399-407. [PMID: 23529505 PMCID: PMC3824991 DOI: 10.1007/s11357-013-9525-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/08/2013] [Indexed: 06/02/2023]
Abstract
Although aging is commonly linked to a reduction in joint range of motion, it is unclear if all body joints behave similarly. To address this issue, the main purpose of this study was to compare age-related loss of mobility of seven body joints. A total of 6,000 participants (3,835 men and 2,165 women) aged 5 to 92 years took part in this study. The maximal passive range of motion of 20 movements was evaluated by Flexitest, and each movement was scored from 0 to 4. Composite scores were obtained for each of seven joints and for overall flexibility (Flexindex (FLX)) by adding individual movement scores. Confirming previous findings, FLX systematically decreased with aging (p < .001), with female participants being more flexible for all ages (p < 0.001) and having a more gradual, 0.6% vs. 0.8%/year, age reduction (p < .001). Starting at 30 and 40 years, respectively, for male and female participants, the relative contribution of each composite joint score to FLX dramatically changed. Shoulder contribution to FLX male's score went from 13.9% at 28 years of age to only 5.2% at 85 years of age. In general, proportionally, shoulder and trunk became less flexible, while elbow and knee mobility was preserved to a greater extent. Our findings indicated that age-related loss of mobility is rather joint-specific, which could be related to distinct routine usage patterns of the major body joints along life.
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Affiliation(s)
| | | | - Claudio Gil Soares de Araújo
- />Graduate Program in Exercise and Sport Sciences, Gama Filho University, Rio de Janeiro / RJ, Brazil
- />Exercise Medicine Clinic - Clinimex, Rua Siqueira Campos, 93/101, 22031-070 Rio de Janeiro / RJ, Brazil
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Abstract
STUDY DESIGN Cross-sectional study of preselected cohort of patients with neck pain. OBJECTIVE To determine the association between joint laxity and lumbar disc degeneration in young adults. SUMMARY OF BACKGROUND DATA Joint laxity is known to be closely related with orthopedic injuries and disease; however, studies about the relationship between spinal disorder and joint laxity are lacking. METHODS Patients aged 30 to 40 years, seen at the outpatient clinic of our hospital for the evaluation of neck pain, who had magnetic resonance imaging of the cervical spine with routine inclusion of T2-weighted sagittal plane of the whole spine were included in the study. The Beighton and Horan criteria was used for the assessment of joint laxity. Logistic regression analysis was performed to estimate the odds ratio for lumbar disc degeneration in patients with joint laxity, and other variables including age, sex, body mass index, physical workload, neck pain (visual analogue scale score), and related disability (neck disability index score), and sagittal alignment. RESULTS A total of 101 patients were enrolled in the study: 34 patients with joint laxity and 67 patients without joint laxity. There were no differences in age, body mass index, physical workload, neck pain (visual analogue scale score), and neck disability index score between the 2 groups, but there was a significant difference in sex ratio (P < 0.001). Patients with joint laxity showed increased lumbar lordosis (P = 0.004) and increased sacral slope (P = 0.003) but without significant difference in pelvic incidence (P = 0.084). In univariate analysis, presence of joint laxity (Beighton score ≥4) as well as positive results of thumb (P = 0.016) and elbow (P = 0.047) tests were significantly associated with decreased risk for lumbar disc degeneration. Presence of joint laxity remained significant after multivariate adjustment for sex and lumbar lordosis (odds ratio = 0.373, P = 0.040). CONCLUSION Increased joint laxity was closely associated with lower prevalence of lumbar disc degeneration in young adults, and the increased lumbar lordosis associated with joint laxity might explain the decreased risk of lumbar disc degeneration. LEVEL OF EVIDENCE 2.
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McKeon KE, London DA, Osei DA, Gelberman RH, Goldfarb CA, Boyer MI, Calfee RP. Ligamentous hyperlaxity and dorsal wrist ganglions. J Hand Surg Am 2013; 38:2138-43. [PMID: 24206976 PMCID: PMC3989881 DOI: 10.1016/j.jhsa.2013.08.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/19/2013] [Accepted: 08/19/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine whether symptomatic dorsal wrist ganglions are associated with generalized ligamentous hyperlaxity. METHODS Ninety-six patients (61 females) presenting to hand surgeons for a symptomatic dorsal wrist ganglions were prospectively enrolled in this case-control investigation. Beighton scores were calculated to quantify generalized ligamentous laxity in each patient, and a scaphoid shift test (scapholunate capsuloligamentous laxity evaluation) was performed. A positive scaphoid shift test was defined by both pain and a palpable clunk. Ninety-six individuals without ganglions were then enrolled to form an age and sex frequency-matched control cohort. The control group was similarly assessed for Beighton score and scaphoid shift test. Binary logistical regression was performed to assess the association of ganglions with generalized ligamentous hyperlaxity (Beighton score ≥ 4) while accounting for effects of age and sex. RESULTS Patients with symptomatic dorsal wrist ganglions demonstrated significantly increased rates of generalized ligamentous hyperlaxity. Among those with ganglions, 27 of 96 (28%) patients exhibited generalized ligamentous hyperlaxity, compared with 12 of the 96 (13%) age- and sex-matched individuals in the control group. Patients with symptomatic dorsal wrist ganglions were also significantly more likely to demonstrate localized scapholunate hyperlaxity with a positive scaphoid shift test (25% positive scaphoid shift test with ganglions vs 1% in controls). In logistical modeling, patients with dorsal wrist ganglions had 2.9 (95% confidence interval [CI] 1.3-6.2) times greater odds of generalized ligamentous hyperlaxity compared with patients without a dorsal wrist ganglion after accounting for patient age and sex. CONCLUSIONS Symptomatic dorsal wrist ganglions were associated with both generalized ligamentous hyperlaxity and a positive scaphoid shift test. Although an association between wrist ganglions and ligamentous hyperlaxity does not prove causation, the possibility of the same underlying pathological entity causing both can be envisioned (ie, abnormal formation or organization of dense regular connective tissue). TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Mulvey MR, Macfarlane GJ, Beasley M, Symmons DPM, Lovell K, Keeley P, Woby S, McBeth J. Modest Association of Joint Hypermobility With Disabling and Limiting Musculoskeletal Pain: Results From a Large-Scale General Population-Based Survey. Arthritis Care Res (Hoboken) 2013; 65:1325-33. [DOI: 10.1002/acr.21979] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/29/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | | | | | | | - Steve Woby
- The Pennine Acute Hospitals NHS Trust; Manchester UK
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Tobias JH, Deere K, Palmer S, Clark EM, Clinch J. Joint Hypermobility Is a Risk Factor for Musculoskeletal Pain During Adolescence: Findings of a Prospective Cohort Study. ACTA ACUST UNITED AC 2013; 65:1107-15. [DOI: 10.1002/art.37836] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/13/2012] [Indexed: 12/23/2022]
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Jackson SC, Odiaman L, Card RT, van der Bom JG, Poon MC. Suspected collagen disorders in the bleeding disorder clinic: A case-control study. Haemophilia 2012; 19:246-50. [DOI: 10.1111/hae.12020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - L. Odiaman
- Division of Hematology and Hematologic Malignancies, Department of Medicine; University of Calgary; Calgary; Alberta; Canada
| | - R. T. Card
- Division of Hematology and Hematologic Malignancies, Department of Medicine; University of Calgary; Calgary; Alberta; Canada
| | - J. G. van der Bom
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden; the Netherlands
| | - M-C. Poon
- Division of Hematology and Hematologic Malignancies, Department of Medicine; University of Calgary; Calgary; Alberta; Canada
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Scheper MC, de Vries JE, de Vos R, Verbunt J, Nollet F, Engelbert RHH. Generalized joint hypermobility in professional dancers: a sign of talent or vulnerability? Rheumatology (Oxford) 2012; 52:651-8. [DOI: 10.1093/rheumatology/kes220] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Smith TO, Donell ST, Chester R, Clark A, Stephenson R. What activities do patients with patellar instability perceive makes their patella unstable? Knee 2011; 18:333-9. [PMID: 20719519 DOI: 10.1016/j.knee.2010.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/07/2010] [Accepted: 07/13/2010] [Indexed: 02/02/2023]
Abstract
Patellar instability is a disabling musculoskeletal condition. Whilst previous texts have suggested that twisting activities may cause patients to experience instability symptoms, no studies have assessed which activities are related to the patient's perceived instability. The purpose of this study was to determine which activities and with what frequency patients with patellar instability symptoms, perceive their patella to be unstable. Ninety patients referred because of recurrent patellar instability were asked to assess the frequency with which they perceived patellar instability for 19 everyday and sporting activities. The results indicated that sporting and multi-directional twisting activities were more frequently related to patellar instability symptoms, compared to lower energy, uni-planar activities. Females and those without a family history of patellar instability reported more frequent patellar instability symptoms, compared to males, or those with a family history of this disorder. Further study is now recommended to determine whether these results reflect that of patients with milder subluxation disorders, and whether factors such as hypermobility have an impact on perceived patellar instability for this patient group.
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Affiliation(s)
- Toby O Smith
- Faculty of Health, University of East Anglia, Norwich NR4 7TJ, UK.
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Checa A. Severe cartilage damage of the knee joint in two young women with hypermobility. Rheumatol Int 2011; 32:3661-4. [PMID: 21881992 DOI: 10.1007/s00296-011-2071-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 08/21/2011] [Indexed: 10/17/2022]
Abstract
The purpose of this pictorial assay is to show the arthroscopic findings of two patients with hypermobility syndrome and patellofemoral malalignment. Severe chondral damage and recurrent bleeding were common findings in these patients. One patient also had a meniscal impingement syndrome. A dynamic assessment of the patellofemoral joint as well as the evaluation of the lateral and medial retinaculum was performed by arthroscopy. Pictures of damaged area on the articular cartilage were obtained through a 5-mm arthroscope using standard portals. A lack of the patellae retinaculum involvement was proved arthroscopically in both cases. Mechanical complaints and recurrent effusion, even without history of trauma, should alert physicians who manage patients with hypermobility. In patients with joint hypermobility, the damage of the cartilage is real and often a therapeutic challenge.
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Affiliation(s)
- Angel Checa
- Division of Rheumatology, Drexel University College of Medicine, 219 N Broad Street, 9th Floor, Philadelphia, PA 19107, USA.
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van Eerde AM, Verhoeven VJM, de Jong TPVM, van de Putte EM, Giltay JC, Engelbert RHH. Is joint hypermobility associated with vesico-ureteral reflux? An assessment of 50 patients. BJU Int 2011; 109:1243-8. [PMID: 21883843 DOI: 10.1111/j.1464-410x.2011.10469.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether there is an increased prevalence of joint hypermobility in patients with vesico-ureteric reflux (VUR). MATERIALS AND METHODS We studied 50 patients with primary VUR and matched controls drawn from a reference population. Joint mobility was assessed using the Bulbena hypermobility score. RESULTS We identified significantly more patients with VUR with generalized joint hypermobility than controls (24% vs 6.7%, P= 0.007). CONCLUSION Our findings confirm our clinical observation of an increased rate of joint hypermobility in patients with VUR. We speculate that an altered composition of the connective tissue may contribute to the severity of the (pre-existing) VUR phenotype.
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Affiliation(s)
- Albertien M van Eerde
- Departments of Medical Genetics, University Medical Centre Utrecht, The Netherlands.
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Abstract
Excessive joint laxity, or hypermobility, is a common finding of clinical importance in the management of musculoskeletal conditions. Hypermobility is common in young patients and in general is associated with an increased incidence of musculoskeletal injury. Hypermobility has been implicated in ankle sprains, anterior cruciate ligament injury, shoulder instability, and osteoarthritis of the hand. Patients with hypermobility and musculoskeletal injuries often seek care for diffuse musculoskeletal pain and injuries with no specific inciting event. Orthopaedic surgeons and other healthcare providers should be aware of the underlying relationship between hypermobility and musculoskeletal injury to avoid unnecessary diagnostic tests and inappropriate management. Prolonged therapy and general conditioning are typically required, with special emphasis on improving strength and proprioception to address symptoms and prevent future injury. Orthopaedic surgeons must recognize the implications of joint mobility syndromes in the management and rehabilitation of several musculoskeletal injuries and orthopaedic disorders.
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Wolf JM, Schreier S, Tomsick S, Williams A, Petersen B. Radiographic laxity of the trapeziometacarpal joint is correlated with generalized joint hypermobility. J Hand Surg Am 2011; 36:1165-9. [PMID: 21550184 DOI: 10.1016/j.jhsa.2011.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/09/2011] [Accepted: 03/10/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Increased joint laxity has been associated with the risk of ligament injury and development of osteoarthritis in large joints such as the knee, but this has not been investigated in depth in the hand. We hypothesized that generalized joint laxity would correlate with radiographic measures of trapeziometacarpal (TM) joint subluxation, as measured in carpometacarpal stress view radiographs. METHODS We recruited volunteer subjects of all ages and examined them for generalized laxity using the Beighton-Horan index. A total of 163 subjects, 81 men and 82 women, with an average age of 48 years (range, 20-83 y), were examined. Each subject underwent a stress view radiograph of both TM joints using a previously described technique. Different examiners independently measured radial subluxation of the thumb metacarpal over the trapezium and the articular width of the thumb metacarpal and averaged them. The ratio of the radial subluxation to the articular width was calculated as a measure of radiographic TM laxity. RESULTS The average Beighton score was 2 (range, 0-9). A total of 40 subjects had Beighton scores greater than 4. The mean stress view ratio was 0.31 (range, 0.06-0.58). When we calculated the Pearson correlation coefficient to assess the relationship between the stress view ratio and the Beighton score, a statistically significant correlation was demonstrated. CONCLUSIONS In normal volunteers generalized joint laxity is positively correlated with increased mobility of the TM joint, as demonstrated on carpometacarpal stress view radiographs. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic I.
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Affiliation(s)
- Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery, University of Colorado-Denver, and the Division of Nursing/Research, Denver Veterans Administration Medical Center, Denver, CO, USA.
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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: 119] [Impact Index Per Article: 8.5] [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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Chase JW, Stillman BC, Gibb SM, Clarke MCC, Robertson VJ, Catto-Smith AG, Hutson JM, Southwell BR. Trunk strength and mobility changes in children with slow transit constipation. J Gastroenterol Hepatol 2009; 24:1876-84. [PMID: 19686406 DOI: 10.1111/j.1440-1746.2009.05940.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM It appears that there are no published reports on childhood slow transit constipation (STC) that have considered the state of the musculoskeletal components of the trunk in these children. The present study aimed to determine whether children with STC have different trunk musculoskeletal characteristics that might be related to their defecation difficulties, compared to controls. METHODS With the aid of computer-analyzed photographs and clinical testing, 41 children with STC and 41 age-matched controls were examined for Marfanoid features, sitting posture, spinal joint mobility and trunk muscle strength. The latter was assessed by measuring maximum voluntary abdominal bulging and retraction in sitting, and active trunk extension in prone-lying. Levels of general exercise and sedentary activities were evaluated by questionnaire. RESULTS STC subjects were more slumped in relaxed sitting (P < or = 0.001), less able to bulge (P < or = 0.03) and less able to actively extend the trunk (P = 0.02) compared to controls. All subjects sat more erect during abdominal bulging (P < or = 0.03). CONCLUSION The results show that STC children have reduced trunk control and posture, which indicates that clinicians should include training of trunk muscles and correction of sitting posture. There was no evidence that children with STC exercised less than the controls.
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Affiliation(s)
- Janet W Chase
- Murdoch Children's Research Institute, The University of Melbourne, Melbourne, Australia.
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The influence of ligamentous laxity and gender: implications for hand surgeons. J Hand Surg Am 2009; 34:161-3. [PMID: 19121743 DOI: 10.1016/j.jhsa.2008.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 09/09/2008] [Indexed: 02/02/2023]
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Grahame R. Hypermobility: an important but often neglected area within rheumatology. ACTA ACUST UNITED AC 2008; 4:522-4. [DOI: 10.1038/ncprheum0907] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 08/08/2008] [Indexed: 11/09/2022]
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