Hyper Mobility of the Joints
The mobility of our joints, the ability of them to move for greater or lesser amounts from fully bent to fully extended, is very variable. Some people are very stiff jointed while others are very mobile, with familial tendencies being important, so our joint mobility can be closely related to our parents. Many diagnostic names have been attached to conditions where hypermobility is important, including joint laxity, double jointed, loose jointed, ligamentous laxity and benign joint hypermobility syndrome.
Hypermobility is a clinical diagnosis and cannot be confirmed by laboratory tests, relying on clinical examination by a physiotherapist or a doctor. There have been many efforts to develop a diagnostic testing scale and one of them is the Beighton scale, described here:
It is possible to pull the fifth finger up and beyond 90 degrees to the back of the hand. If this is possible then a score of one is given for that, with two if both fingers show the mobility.
Pressing the thumb back against the underneath of the forearm with a bent wrist gives a score of one again, with two for both.
If the elbows can be straightened more than 10 degrees beyond straight.
The knees go back beyond straight by more than 10 degrees.
The ability to lean forward with the knees fully straight and place the palms flat on the floor. One point for this.
The highest score in this test is nine if the patient can show hypermobility of all the non spinal joints and can exhibit the final spinal mobility part. Scoring six out of nine in this test is generally accepted to be an indicator of hypermobility.
The general population shows an incidence of four to seven percent of hypermobility, although specialised groups such as dancers and gymnasts may have much higher incidences. The reasons for joint laxity appear to be affected by several aspects including muscle tone, joint structure and laxity of connective tissues such as tendons and ligaments, with athletic or other training, hormones, gender and genetics all playing a part.
The mechanical properties of the connective tissues which make up joints appear to be the most important aspect of joint mobility. Collagen is the tissue which makes up significant amounts of our bodies, being found in skin, discs, tendons, ligaments and other tissues. Variations in the structure and function of collagen are the explanation for variations in joint laxity. Genetic variations in the synthesis of collagen can allow for weakened or lengthened soft tissues.
Significant variation exists in the degree of hypermobility amongst with some suffering no real or minor symptoms, others experiencing chronic pain and disability. Hypermobile people exhibit a number of symptoms which include a higher likelihood of dislocation of joints and trauma to joints, joint effusions, joint pains, osteo-arthritis and loss of a degree of proprioception. Some patients can find it difficult to keep typical day to day activities going without pain.
A specialist doctor should perform the initial assessment and testing of the patient for a secure and accurate diagnosis, with a physical and treatment assessment by an experienced physiotherapist. The presenting symptoms and potential management of hypermobility can be so varied that careful attention is needed. Patient education is a key priority to identify the overall benign form of the condition and identify the consequences and potential treatments. Joint protection should be taught for stressful activities.
People with hypermobile joints should consider carefully whether they participate in activities, jobs or sports involving repetitive heavy work, speed or stresses on the joints. An exercise regime can be taught within the principles of joint protection. Developing good muscular joint support, maintaining postural control and keeping weight down can be controlled by a moderate exercise programme. Acupuncture, hydrotherapy, TENS, mobilisation techniques and other treatments can be used.
Medications can be used to control pain but this should be prescribed by a medical practitioner as there are side effects to all drugs. In severe cases where joints are badly compromised or arthritic then surgery such as joint fusion or joint replacement may be considered. Joint laxity occurs in several other conditions including EDS or Ehlers-Danloss Syndrome. EDS 3 is the type of the syndrome often called benign joint hypermobility.