Physiotherapy - Joint Hypermobility
Posted: Tuesday, April 21, 2009
by Jonathan Blood Smyth
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.
The fifth finger can be pushed back beyond 90 degrees angle to the rest of the hand. One point is given for one hand exhibiting this, two points for the flexibility occurring in both little fingers.
The patient can press their thumb back to the under surface of the forearm with the wrist fully bent. Same points as for the fingers.
If the elbows can be straightened more than 10 degrees beyond straight.
The knees go back beyond straight by more than 10 degrees.
With the knees straight the patient is able to flex over frontwards and place the palms of the hands on the ground.
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.
Hypermobility occurs in approximately 4 to 7 percent of the population although if you look at athletic groups such as gymnasts or dancers there will be a higher likelihood of finding hypermobiles. Joint mobility is affected by several things which include tendon and ligament connective tissue laxity, muscle tone and the structural anatomy of joints. Our genetic heritage, hormonal regimes, gender and sporting or other training are all important in contributing to joint mobility.
Joint laxity is determined primarily by the connective tissues, the mechanical behaviour of which seems to be the pivotal features of whether joints are mobile or not. The structure and function of collagenous tissues varies with genetic differences between people and explains a lot of the variability that people exhibit in their joint mobility. Longer and weaker collagen can result from differences in its synthesis.
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.
Some sports and occupations may be unsuitable such as contact sports or jobs which involve strenuous work, momentum or joint stresses. Joint protection principles should be taught and encouragement of an appropriate exercise regime. Moderate exercise can be useful to control weight, encourage good posture and train good muscular joint support. Manual therapy techniques can be used, along with hydrotherapy, acupuncture, TENS (transcutaneous electrical nerve stimulation) and other techniques.
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.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in London, back pain, musculo-skeletal conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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