Pediatric Generalized Joint Hypermobility With and Without Musculoskeletal Complaints: A Localized or Systemic Disorder?

Engelbert, Raoul; Bank, Ruud A.; Sakkers, R. J. B.; Helders, Paul J. M.; Beemer, Frits A.; Uiterwaal, Cuno S.P.M.

doi:10.1542/peds.111.3.e248

Cited by 94 publications

(84 citation statements)

References 31 publications

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“…Our results agree also with Engelbert et al, 2003 [21], when he said that, Children with generalized joint hypermobility without musculoskeletal complaints had significantly higher total range of joint motion, and lower total muscle strength as compared with the reference group when they use hand-held myometer in the assessment. However, some of their findings may point towards another explanation, that these children are less active than normal children which also concluded by Dolan AL, 1998 [22].…”

Section: Discussionsupporting

confidence: 92%

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

Allam¹,

Elsayyad²,

Abdelgawad³

2017

IJPR

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Purpose: the current study intended to investigate the effect of hypermobility on the hamstring's muscular torque, quadriceps' muscular torque and H/Q ratio.Materials and Methods: thirty normal male children aged from seven to eleven years and thirty age-matched male children with GJH were tested using isokinetic dynamometer. Eccentric-concentric and concentric eccentric moods were used for hamstring and quadriceps respectively at angular velocity of 60°/s.Results: the results exposed that there was significant decrease in both peak muscular torques and H/Q ratio in children with GJH when they were compared with normal children [P < .05]. Conclusion:it can be concluded that joint hypermobility decreases muscular torque and H/Q ratio. This may be due to proprioceptive deficits associated with hypermobility and abnormal muscular activation pattern. Further studies are needed to verify the definite cause of decreased muscular torque and H/Q ratio.

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Section: Discussionsupporting

confidence: 92%

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

Allam¹,

Elsayyad²,

Abdelgawad³

2017

IJPR

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“…dancers) and symptomatic forms of GJH (e.g. EDS-HT, hypermobility syndrome) [19][20][21] In these studies, muscle weakness was found to be associated with pain [22] and fatigue. [21] However, whether these factors moderate the association between muscle strength and activity limitations is unknown.…”

Section: Introductionmentioning

confidence: 94%

“…[33] The HAQ disability index ranges from 0 to 3, where scores of 0 -1 represent mild to moderate disability, 1-2 moderate to severe disability, and 2-3 severe to very severe disability. [33] Musculoskeletal function Muscle strength in both extremities was measured bilaterally in a standardized way [19] with a hand-held dynamometer (Citec, Groningen, The Netherlands). Measurements were consecutively performed three times and the highest value was registered.…”

Section: Activity Limitationsmentioning

confidence: 99%

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

Scheper

Rombaut

Vries

et al. 2016

Disability and Rehabilitation

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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 ¼ 0.67, p ¼ <0.001), 6MWT (r ¼ 0.58, p ¼ <0.001) and HAQ (r ¼ 0.63, p¼ <0.001). Proprioception was associated with 30CRT (r ¼ 0.55, p < 0.001), 6MWT (r ¼ 0.40, p ¼ <0.05) and HAQ (r ¼ 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. ä IMPLICATIONS FOR REHABILITATIONReducing 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. ARTICLE HISTORY

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“…However, the risk of having (ankle) injuries due to larger sway for the GJH group must be studied in future longitudinal studies. J Orthop Sports Phys Ther 2017;47 (10) …”

Section: U T Conclusion: For Ballet Dancers and Teamgymmentioning

confidence: 99%

“…Additional reasons for sustaining an injury may be decreased muscle strength and consequent decreased muscular stability, as confirmed in some studies of 8-to-10-year-old children with symptomatic GJH 10 and in the general adolescent athlete, 3 but not in studies of children with nonsymptomatic GJH. 22 However, motor performance has never been studied in elite-level adolescent athletes with GJH.…”

mentioning

confidence: 96%

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries

Schmidt¹,

Pedersen²,

Junge

et al. 2017

J Orthop Sports Phys Ther

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U t STUDY DESIGN:Cross-sectional. U t BACKGROUND:Generalized joint hypermobility (GJH) may increase pain and likelihood of injuries and also decrease function and health-related quality of life (HRQoL) in elite-level adolescent athletes. U t OBJECTIVE:To assess the prevalence of GJH in elite-level adolescent athletes, and to study the association of GJH with pain, function, HRQoL, and musculoskeletal injuries. U t METHODS:A total of 132 elite-level adolescent athletes (36 adolescent boys, 96 adolescent girls; mean ± SD age, 14.0 ± 0.9 years), including ballet dancers (n = 22), TeamGym gymnasts (n = 57), and team handball players (n = 53), participated in the study. Generalized joint hypermobility was classified by Beighton score as GJH4 (4/9 or greater), GJH5 (5/9 or greater), and GJH6 (6/9 or greater). Function of the lower extremity, musculoskeletal injuries, and HRQoL were assessed with self-reported questionnaires, and part of physical performance was assessed by 4 postural-sway tests and 2 single-legged hop-for-distance tests. U t RESULTS:Overall prevalence rates for GJH4, GJH5, and GJH6 were 27.3%, 15.9%, and 6.8%,

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Pediatric Generalized Joint Hypermobility With and Without Musculoskeletal Complaints: A Localized or Systemic Disorder?

Cited by 94 publications

References 31 publications

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

Comparison Between Muscular Torque and H/Q Ratio in Normal Children and Children With Generalized Joint Hypermobility

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries

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