Hypermobility

 

Musculoskeletal hypermobility can be an asset (i.e. not a disease or condition) for example in facilitating dancing aptitude or athletic excellence and its development) but it can be associated with problems including pains, fatigue, cardiovascular autonomic dysfunction (POTS), bowel dysfunction and internal organ prolapse (e.g. uterine, bowel, bladder). 

However, the diagnosis of hypermobility needs to be made very carefully where the above features are present. Very often there are other explanations for symptoms and the hypermobility is coincidental - thus not to blame for the symptoms.

Unfortunately, some doctors, physios and other practitioners may have the ability and skills to know about hypermobility but do not know about the alternative problems that can cause similar symptoms to those caused by severe hypermobility. Seeing a Rheumatologist then is important as they know about a wide range of potential problems. Remember all ‘specialists’ should remember to be clear about what they know but also what they don’t know.

The Beighton scale (see on the right of this page) was devised initially to assess hypermobility,and validated in caucasian adults. It is still used as part of clinical assessment. However, its not appropriate to apply the scale in children, and it should be remembered that both age and ethnicity affect the scoring. It is quite a blunt clinical tool. 

In hypermobility subtype Ehlers Danlos Syndrome (h-EDS) and Hypermobility Spectrum Disorder (HSD) joint stabilizing exercises with particular reference to core stability, posture and proprioception are beneficial, to avoid overuse injuries. A global approach to joint stability and function, as opposed to just treating regional symptoms,is usually effective. Finding an experienced physiotherapist to whom an affected person with h-EDS or HSD can return to when needed is important!

Pregnancy is often a concern. Unlike in EDS, h-EDS and HSD are not associated with any major vascular hazard during pregnancy and labour. However, people with h-EDS and HSD should talk to their obstetrician early in their pregnancies about risks.

Links

The diagnosis of hypermobility-type Ehlers-Danlos (h-EDS) and hypermobility Spectrum Disorder (HSD) has been recently redefined. See: https://www.ehlers-danlos.com/2017-eds-international-classification/ 

Patient led organization: http://hypermobility.org/


Information on postural tachycardia syndrome for patients: 
http://www.potsuk.org/

 

Beighton hypermobility rating

Person has the ability to:

1. Extend the fifth finger 90° or more

  • Right 1

  • Left 1

2. Pull the thumb back/down onto the same-side forearm  

  • Right 1

  • Left 1

3. Hyperextend the elbow 10°

  • Right 1

  • Left 1

4. Hyperextend the knee 10°

  • Right 1

  • Left 1

5. Place hands flat on the floor without bending the knees

  • 1

Possible maximum score

  • 9