9Hypermobility disorders in children and adolescents
Section snippets
Hypermobility in children: true pathology or normal variation?
The definition of hypermobility is inherently an arbitrary one, and methods used to categorize an individual as being hypermobile or not should seek to identify populations with increased risk of important clinical phenomena. Hypermobility as such is not a medical disorder but merely an observed phenomenon, which may be associated with musculoskeletal symptoms, or symptom complexes, and may predispose to or be associated with more serious medical disorders. The degree of ligamentous laxity has
Joint Hypermobility Syndrome (Benign JH or BJHS) versus Joint Hypermobility
In an effort to clarify the relationship between hypermobility and musculoskeletal disorders the revised (Brighton, 1998) criteria for the diagnosis of BJHS were developed.5 In essence this collection of associated history and examination features indicates that ligamentous laxity alone is not sufficient to establish the diagnosis in such symptomatic patients. The collection of major and minor criteria serves to emphasize that many patients will have a history of particular symptoms (such as
Musculoskeletal features associated with JHS
Virtually all parts of the musculoskeletal system may be affected in JHS, but particular problems or symptom complexes seem to occur at different ages. This probably represents a combination of developmental changes or differences in growth patterns at different ages and the degree of physical activity engaged in as children get older.
Dental and oral health disorders
Abnormal dentition is recognized in Ehlers Danlos syndrome and osteogenesis imperfecta. Temporomandibular joint disease has long been associated with either localized or generalized hypermobility disorders and has more recently been elaborated in young adults. It is less common for children to present with temporomandibular joint disease symptoms57, but by late adolescence symptoms of clicking and instability are not uncommon, as are acute painful episodes and locking, and these may predate
Genetics and the aetiology of hypermobility
Table 5 lists the well-described associations of defined genetic disorders with ligamentous laxity.68, 69, 70, 71, 72, 73, 74, 75, 76 Even well-described disorders such as Ehlers Danlos syndrome have remarkable genetic and phenotypic heterogeneity. Whilst some forms have single gene defects that have been identified (in collagen formation in particular), inheritance is far from straightforward. What this teaches us perhaps is that many genes affect the integrity of joint and other tissue
Key aspects of management for hypermobile children
A positive diagnosis is a key issue for embarking on management of hypermobile patients. Rather than being a diagnosis of exclusion, hypermobility can be easily recognized and understood with appropriate history-taking (including family history) and a detailed examination (see Figure 1). Hypermobility is often ‘missed’ because it is not examined for in a situation where the exclusion of inflammatory or destructive rheumatic conditions is the expectation of patient and physician alike. Many
Joint stability and muscle strength
Improving dynamic muscle control to supplement the ligamentous insufficiency should minimize trauma to joints. It is commonly recognized that children respond well to a muscle-strengthening programme, and while they may not improve their muscle bulk, they do improve strength and their neuromuscular coordination, thus making the muscles more effective.78 It is often useful, especially if the child is experiencing significant pain, to start on some static exercises in the hypermobile range before
Conclusions
Joint hypermobility is a phenomenon with many forms of potential clinical presentation in young people. Positive recognition and avoidance of unnecessary investigations and drug therapy are among the most important interventions. Most patients are well managed with simple advice and reassurance. Modification of activities may be required to redress the balance between healthy physical activities and high-impact physical pursuits. If untreated or undiagnosed, hypermobility can at times result in
References (83)
- et al.
Hypermobility of the joints in juvenile episodic arthritis/arthralgia
Journal of Pediatrics
(1985) - et al.
Joint hypermobility: prevalence and relationship with musculoskeletal pain
Anales de Pediatria (Barc)
(2004) - et al.
Hypermobility in two Dutch school populations
European Journal of Obstetrics Gynecology and Reproductive Biology
(1997) - et al.
Pulled elbow—not the effect of hypermobility of joints
Injury
(1995) - et al.
Prognosis of non-specific musculoskeletal pain in preadolescents: a prospective4-year follow-up study till adolescence
Pain
(2004) - et al.
Contributing factors to the persistence of musculoskeletal pain in preadolescents: a prospective 1-year follow-up study
Pain
(1998) - et al.
Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls
Journal of Pediatrics
(2002) - et al.
Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers–Danlos syndrome
Journal of Pediatrics
(1999) Evaluation of the child with ligamentous laxity
Clinics in Podiatric Medicine and Surgery
(1997)- et al.
Genitourinary prolapse and joint hypermobility in women
Obstetrical and Gynecological
(1995)
Lower urinary tract dysfunction in children with generalized hypermobility of joints
Journal of Urology
Infantile hypertrophic pyloric stenosis and asymptomatic joint hypermobility
Journal of Pediatrics
Osteogenesis imperfecta in childhood: impairment and disability. A prospective study with 4-year follow-up
Archives of Physical Medicine and Rehabilitation
Physiotherapy for children with hypermobility syndrome
Physiotherapy
The hypermobility syndrome. Musculoskeletal complaints associated with generalized joint hypermobility
Annals of the Rheumatic Diseases
Generalized hypermobility of joints: arthrochalasis multiplex congenita
Archives of Disease in Childhood
Articular hypermobility simulating chronic rheumatic disease
Archives of Disease in Childhood
The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS)
Journal of Rheumatology
The hypermobility syndrome
Pediatrics
Arthritis/arthralgia and hypermobility of the joints in schoolchildren
Journal of Rheumatology
Musculoskeletal pain in primary pediatric care: analysis of 1000 consecutive general pediatric clinic visits
Pediatrics
Analysis of joint mobility patterns among preschool children
Sao Paulo Medical Journal
Articular hypermobility in Icelandic 12-year-olds
Rheumatology
Validation of Beighton score and prevalence of connective tissue signs in 773 Dutch children
Journal of Rheumatology
Benign hypermobility syndrome in Greek schoolchildren
European Journal of Pediatrics
Hypermobility among Egyptian children: prevalence and features
Journal of Rheumatology
Prevalence of articular hypermobility in schoolchildren: a one-district study in Barcelona
Rheumatology (Oxford)
Articular hypermobility in school children in Sao Paulo, Brazil
Journal of Rheumatology
Hypermobility: features and differential incidence between the sexes
Arthritis and Rheumatism
Persistent joint laxity and congenital dislocation of the hip
Journal of Bone and Joint Surgery (British)
Generalized joint hypermobility and black admixture in school children of Bahia, Brazil
American Journal of Physical Anthropology
Dominant inheritance in familial generalised articular hypermobility
Journal of Bone and Joint Surgery British
Joint hypermobility syndrome in childhood. A not so benign multisystem disorder?
Rheumatology (Oxford)
Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder?
Pediatrics
Functional ability and physical and psychosocial well-being of hypermobile schoolchildren
Clinical and Experimental Rheumatology
Joint hypermobility is not a contributing factor to musculoskeletal pain in pre-adolescents
Journal of Rheumatology
Femoral neck anteversion: values, development, measurement, common problems
Collegium Antropologicum
Traumatic hip dislocation in childhood
Journal of Pediatric Orthopedics
Early surgical correction of residual hip dysplasia: the San Diego children's hospital approach
Acta Orthopaedica Belgica
Prognosis of motor development and joint hypermobility
Archives of Disease in Childhood
Joint mobility and motor development
Archives of Disease in Childhood
Cited by (111)
Ligamentous laxity in children with achondroplasia: Prevalence, joint involvement, and implications for early intervention strategies
2024, European Journal of Medical GeneticsAn investigation of body awareness, fatigue, physical fitness, and musculoskeletal problems in young adults with hypermobility spectrum disorder
2022, Musculoskeletal Science and PracticeCitation Excerpt :These may be age, gender, race, muscle tone, joint shape, ethnicity, injury, and the presence of medical disorders or syndromes that cause joint tissue laxity. Also, familial and environmental factors are thought to play a role (Bird, 2007; Juul-Kristensen, Schmedling, Rombaut, Lund and Engelbert, 2017; Murray, 2006). The prevalence of joint hypermobility in the adult population has been reported to be between 10% and 30% (Scheper et al., 2014).
Osteochondral Fracture Fixation With Fragment Preserving Suture Technique
2020, Arthroscopy TechniquesMultiligamentous laxity
2019, Pediatric Hand TherapyHypermobility and increased risk of ankle injury in dancers
2020, Revue du PodologueConservative management of hand impairment in children and adolescents with heritable disorders of connective tissue: A scoping review
2024, Physical and Occupational Therapy in Pediatrics