Benign joint hypermobility syndrome: a hospital-based study from northern India
Amit KumarS. WadhwaPragyan AcharyaSandeep SethSudarshan KhokharRV SinghK BaliS RawallS SinghaniaNishita Singh
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Keywords:
Joint hypermobility
Hypermobility (travel)
Study Design: Cross-sectional and matchedpairs study. Background and Purpose: The prevalence of joint hypermobility varies according to gender, age, and ethnicity. Studies indicate joint hypermobility is more common in females than males and may be linked to an increase risk of joint injury. Purpose: The purpose of this study was to describe the prevalence of joint hypermobility in a healthy, young adult female sample, and to observe the relationship between hypermobility and reported musculoskeletal injuries. Methods: One hundred and one young adult females participated in this study. Each subject completed questionnaires regarding their general health, physical activity level, and musculoskeletal injuries. The subjects were designated as hypermobile after being tested for joint hypermobility utilizing the Beighton hypermobility scale. Subjects with joint hypermobility were age and activity matched with subjects with normal joint mobility. Results: The frequency of joint hypermobility in this study of young adult women was 15.8%. A small, significant positive correlation was found between raw hypermobility score and musculoskeletal injury score based on self-report. There was a significant difference in the injury score based on hypermobility status after controlling for age and activity level. Subjects designated as hypermobile scored higher on the injury questionnaire than subjects without hypermobility. Conclusion: Sixteen percent of this sample of healthy, young, adult females tested positively for joint hypermobility. Subjects with joint hypermobility reported more musculoskeletal injuries than those without hypermobility. Additional research is needed to determine what influences injury rates in the person with hypermobility, and what interventions are most beneficial to prevent further injury.
Joint hypermobility
Hypermobility (travel)
Joint instability
Musculoskeletal injury
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Background
Existing research examining those with Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome (Hypermobility Type) (EDS-HT) has predominately focused on factors such as pain, range of movement and physical function. However psychosocial factors have received much less attention.Objectives
This study sought to 1. Identify the psychosocial impact of JHS/EDS-HT by examining participants' lived experiences, and; 2. Identify characteristics of effective coping with JHS/EDS-HT, using qualitative methods.Methods
Adults with JHS/EDS-HT took part in semi-structured telephone interviews to discuss their own lived experiences and the impact of the condition on their lives. All met the Hakim and Grahame (2003) five-item criteria for clinically significant joint hypermobility, and had a self-confirmed diagnosis of JHS/EDS-HT. The transcripts were coded using NVivo 10 and analysed using inductive thematic analysis.Results
17 participants (14 women, 3 men) took part (age range 22–70, mean 38 years). The sample was purposively selected from across the UK to broadly represent different genders, ages and ethnicities. Inductive thematic analysis indicated five main themes: Healthcare limitations: All participants reported a lack of awareness of JHS/EDS-HT among healthcare professionals, and diagnosis typically took several years. Examples were given where local anaesthetics had either partly or completely failed, leaving patients aware of severe pain during surgical or dental procedures. A restricted life: Participants experienced a range of symptoms including joint pain and instability, fatigue, gastrointestinal issues, frequent dislocations and subluxations. Due to difficulty completing daily activities, some relied on their partners or family for support, but this led to feelings of guilt and shame. Social stigma: The invisible nature of their condition led to participants facing criticism and confrontations with others as they 'looked fine'. Fears of being judged led some to hide their symptoms. Many felt frustrated and angry that due to fatigue or injury they could not keep up with friends, family or colleagues. Fear of the unknown: Not knowing when the next injury was going to occur, and how JHS/EDS-HT would affect them over time made participants especially fearful of declines in their physical ability. Many cited of a lack of reliable information about their condition, other than in published books or research journals. Psychological support to better cope with the enduring impact of JHS/EDS-HT on their lives was lacking. Ways of coping: Several coping approaches were identified by participants, including acceptance of their condition, building social networks, finding out more about JHS/EDS-HT and adapting their activities. Physiotherapists were instrumental in supporting participants to exercise regularly.Conclusions
The results of this qualitative study highlight the significant psychosocial impact of JHS/EDS-HT on participants' lives. Further research should consider potential interventions to improve information provision, address psychological support and increase awareness of JHS/EDS-HT among healthcare professionals.Reference
[1] Hakim A, Grahame R. A simple questionnaire to detect hypermobility: An adjunct to the assessment of patients with diffuse musculoskeletal pain. International Journal of Clinical Practice2003;57(3):163–166.Disclosure of Interest
None declaredHypermobility (travel)
Joint hypermobility
Ehlers–Danlos syndrome
Joint instability
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Joint hypermobility syndrome (JHS) is a hereditary disorder of connective tissue recently considered the one and the same as the Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT). The JHS/EDS-HT is mainly characterized by joint hypermobility, chronic pain and a variable skin involvement. Clinical manifestations expressed by patients are multiple and varied. The rehabilitative approach may play a fundamental role in the understanding and management of symptoms and clinical manifestation. Aim of this study is to make a literature revision of all the aspects of this not so rare disease.
Hypermobility (travel)
Joint hypermobility
Ehlers–Danlos syndrome
Joint instability
Connective Tissue Disorder
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The incidence of joint hypermobility and benign joint hypermobility syndrome may differ greatly in different publications.This may be caused by the differences between the tests and the criteria used in the diagnosis of joint hypermobility.The lack of consensus on the cut-off value of the Beighton score, which is one of the most commonly used diagnostic
Joint hypermobility
Hypermobility (travel)
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Joint hypermobility is considered to be both an advantage and a disadvantage. However, the degree of hypermobility in members of particular occupations requiring intense physical activity and the nature of the association between symptoms referable to specific joints and their hypermobility are unknown.
Hypermobility (travel)
Joint hypermobility
Disadvantage
Joint instability
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Background The term benign hypermobility syndrome is applied to those children with musculoskeletal pain associated with generalized hypermobility of the joints without any associated congenital syndrome or abnormality of connective tissue, such as Marfan's or Ehlers-Danlos syndrome. The aim of this study was to determine the prevalence of joint hypermobility among school students and to define the characteristics of patients with joint hypermobility.
Joint hypermobility
Hypermobility (travel)
Ehlers–Danlos syndrome
Abnormality
Joint instability
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Hypermobility (travel)
Joint hypermobility
Ehlers–Danlos syndrome
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Joint mobility was examined on 1.136 schoolchildren of both sexes at the ages of 11 and 14 years. At the same time, they were asked if they had a history of bone fractures and about their weekly consumption of liver. The results were that 13% of the boys and 21% of the girls had hypermobility of their joints. A description is made of a short test to detect hypermobility. It was found that liver consumption and hypermobility are related, also that only in boys hypermobility is contrarily related with the history of fractures.
Hypermobility (travel)
Joint hypermobility
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Joint mobility was examined on 1.136 schoolchildren of both sexes at the ages of 11 and 14 years. At the same time, they were asked if they had a history of bone fractures and about their weekly consumption of liver. The results were that 13% of the boys and 21% of the girls had hypermobility of their joints. A description is made of a short test to detect hypermobility. It was found that liver consumption and hypermobility are related, also that only in boys hypermobility is contrarily related with the history of fractures.
Hypermobility (travel)
Joint hypermobility
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The objectives of this study were to register clinicians performance and opinion of importance of clinical tests for generalized joint hypermobility (GJH), Ehlers–Danlos syndrome, hypermobility type (EDS‐HT) and joint hypermobility syndrome (JHS), and to reach a consensus among clinicians on criteria for diagnosing GJH, EDS‐HT and JHS. A panel of clinicians answered questions about how to perform and interpret clinical tests and rated test importance on an 11‐box scale. The questionnaire was developed on the basis of information from focus groups and the literature. Cronbach's α was used as a measure of internal consistency/consensus among the panelists. The results showed Cronbach's α on importance score of items for diagnosing GJH, EDS‐HT and JHS was 0.61, 0.79, and 0.44, respectively. Panelist‐group correlation for the three conditions varied substantially (−0.46 to 0.89, 0.03 to 0.68, and −0.07 to 0.68) indicating heterogeneity among the panelists. There was agreement on which tests to use, but performance of the tests (i.e., the specific maneuvers) varied considerably inclusive use of tests with unknown reliability. Furthermore, agreement on the diagnostic criteria varied. We conclude that the level of consensus for the importance of various items for diagnosing GJH, EDS‐HT and JHS, was below the required limit (Cronbach's α >0.90) for clinical decision‐making and diagnosing. Consensus on tests and criteria through a Delphi process could not be reached. Better descriptions of, and reliability studies on, test maneuvers and criteria sets for these conditions are needed. Subsequent intensive training and implementation of these tests and criteria, nationally as well as internationally should be established. © 2014 Wiley Periodicals, Inc.
Joint hypermobility
Hypermobility (travel)
Ehlers–Danlos syndrome
Joint instability
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