International Perspectives on Joint Hypermobility

Abstract

There is exponential clinical and research interest in joint hypermobility due to recognition of the complexity of identification, assessment, and its appropriate referral pathways, ultimately impacting management. This state-of-the-science review provides an international, multidisciplinary perspective on the presentation, etiology, and assessment of joint hypermobility, as it presents in those with and without a systemic condition. We synthesize the literature, propose standardizing the use of terminology and outcome measures, and suggest potential management directions. The major topics covered are (i) historical perspectives; (ii) current definitions of hypermobility, laxity, and instability; (iii) inheritance and acquisition of hypermobility; (iv) traditional and novel assessments; (v) strengths and limitations of current assessment tools; (vi) age, sex, and racial considerations; (vii) phenotypic presentations; (viii) generalized hypermobility spectrum disorder and hypermobility Ehlers-Danlos syndrome; and (ix) clinical implications and research directions. A thorough understanding of these topics will equip the reader seeking to manage individuals presenting with joint hypermobility, while mindful of its etiology. Management of generalized joint hypermobility in the context of a complex, multisystem condition will differ from that of acquired hypermobility commonly seen in performing artists, specific athletic populations, posttrauma, and so on. In addition, people with symptomatic hypermobility present predominantly with musculoskeletal symptoms and sometimes systemic symptoms including fatigue, orthostatic intolerance, and gastrointestinal or genitourinary issues. Some also display skeletal deformities, tissue and skin fragility, and structural vascular or cardiac differences, and these warrant further medical follow-up. This comprehensive review on the full spectrum of joint hypermobility will assist clinicians, coaches/ sports trainers, educators, and/or researchers in this area.

Looking back and beyond the 2017 diagnostic criteria for hypermobile Ehlers‐Danlos syndrome: A retrospective cross‐sectional study from an Italian reference center

“…HCTDs that need to be differentiated from hEDS/HSD (Colombi et al, 2015;Ritelli, Rovati, et al, 2020;Tinkle et al, 2017), and are even not unusual in the general population, such as piezogenic papules and striae distensae (Borrelli et al, 2021;Brown & Cook, 2022) (Nicholson et al, 2022;Singh et al, 2017). Some of our concerns about the limited validity of the 2017 criteria for pediatric patients were recently addressed in a paper published by the Pediatric Working Group of the International Consortium on EDS and HSD (Tofts et al, 2023).…”

“…Atrophic scarring, for example, cannot be detected in a young child who has not yet developed skin tears, dental crowding cannot be determined in a child who has not yet erupted all adult teeth, and stretch marks and recurring hernias do not usually present at a young age. Further hindering hEDS diagnosis at young age, the current criterion of a BS ≥6 might underestimate the presence of gJHM children aged >8 years in the general population (Nicholson et al, 2022; Singh et al, 2017). Some of our concerns about the limited validity of the 2017 criteria for pediatric patients were recently addressed in a paper published by the Pediatric Working Group of the International Consortium on EDS and HSD (Tofts et al, 2023).…”

Gelenkschmerzen – eine rheumatische Erkrankung?

“…Diese sind u. a. eine Übersteckbarkeit von Ellbogen und Knien um >10°und der Kleinfinger von >90°. Etwa 3% der Bevölkerung erfüllen die Kriterien eines Hypermobilitätssyndroms, das mit (nicht entzündlichen) Gelenkschmerzen einhergeht und keine rheumatische Erkrankung darstellt [8].…”

The effect of generalized joint hypermobility on functional capacity, pulmonary function, respiratory muscle strength, and chest expansion in healthy young adults

“…It is a global health problem that is seen more in women than men and causes symptoms such as pain, fatigue, discomfort, and joint instability (9). Joint hypermobility and GJH may be inherited as a normal trait with no identifiable genetic variant or also be a part of many different genetic syndromes such as Ehlers-Danlos Syndrome and other heritable disorders of connective tissue (10,11). The hypermobility of the joint changes the body biomechanics and causes compensatory mechanisms such as pain or muscle spasms in other body parts (10).…”