Joint hypermobility: what is it, symptoms, treatment, prognosis

What is joint hypermobility?

Joint hypermobility means that some or all of the joints have an unusually large range of motion. People with hypermobility are especially malleable and able to move their limbs into positions that other people find impossible.

Many people with hypermobile joints do not have any problems and do not need treatment. However, joint hypermobility can sometimes cause unpleasant symptoms such as:

• joint pain;
• backache;
• dislocation of the joints;
• soft tissue injuries such as tenosynovitis (inflammation of the protective sheath around the tendon).

If hypermobility is causing these types of symptoms, it is often referred to as hypermobility joint syndrome.

Joint hypermobility pathology is often hereditary (occurs in families).

It is believed that one of the main causes of joint hypermobility is a change in a type of protein called collagen.

Collagen is found throughout the body - for example, in the skin and in ligaments (tough bands that tie two bones together in a joint). If the collagen is weaker than it should be, the tissues in the body will be fragile. This can make the ligaments and joints especially loose and elastic. As a result, the joints may expand further than usual.

Sometimes joint hypermobility is part of a rare and more serious condition, such as:

• Osteogenesis imperfecta - a condition affecting the bones;
• Marfan syndrome - a condition affecting the blood vessels, eyes and skeleton of a person;
• Ehlers-Danlos Syndrome - a condition that causes the skin to stretch and bruise.

All of these conditions are described in more detail below in the Causes section.

How common is joint hypermobility?

It is believed that this condition may affect up to 3 in 10 people to some extent. The disease affects women more often than men because female hormones increase flexibility.

Joint hypermobility is quite common in children. Children with joint hypermobility may bend into unusual positions (often called "double joints"). In many children, joints become stiffer by the time they reach puberty. but in some people joint hypermobility and associated symptoms persist into adulthood life.

Marfan syndrome affects about 1 in 5,000 people.

Symptoms of joint hypermobility

Many people with hypermobile joints have few or no problems. Hypermobility does not necessarily mean there will be any pain or difficulty. If you have painful symptoms, you most likely have joint hypermobility syndrome.

Joint hypermobility syndrome

Joint hypermobility syndrome can cause:

• joint pain, especially after physical work or exercise - this is associated with overexertion the joint capsule (the structure surrounding the joint) and the ligaments (rigid bands that connect two bones in joint);
• muscle pain because the muscles work harder when the joints are flexible;
• backache;
• a tendency to bruises and bruises;
• pain worsening during the day and at night after rest;
• tiredness (extremely tired);
• night pain in children.

Joint hypermobility syndrome can be caused by changes in collagen (a protein in connective tissue). In this case, other concomitant diseases or symptoms may occur, since collagen is present throughout the body.

If there is joint hypermobility that is part of another condition, such as a syndrome Ehlers-Danlos (skin stretching and easy bruising), you may also have additional symptoms.

Additional symptoms

People with joint hypermobility syndrome may have other related conditions and symptoms, including:

• irritable bowel syndrome (IBS) - a disorder that affects the digestive system, causing abdominal pain, diarrhea and constipation;
• urinary incontinence A type of urinary incontinence that occurs when the pelvic floor muscles are too weak to prevent urination.
• low blood pressure (hypotension), which can lead to fainting;
• hernias - the inner part of the body, organs, protrude through the weak areas of the muscles or the walls of the surrounding tissue;
• Varicose veins - swollen and enlarged veins, usually blue or dark purple
• flat feet - the inner part of the legs (arch) does not rise above the ground when standing;
• drooping of the eyelids;
• thin or elastic skin;
• bluish tint of the white part of the eyes (sclera);
• feeling anxious or nervous.

Joint injury

If you have hypermobile joints, you may be at increased risk of injury to your joints, such as partially or completely dislocating them (when the joint is out of position). Joints, especially in the shoulder, can dislocate if overstretched. The dislocated joint can be returned to its place in the hospital.

Also, a person with hypermobility may be at an increased risk of soft tissue injuries, for example, you may experience:

• tenosynovitis - inflammation (swelling) of the protective sheath around the tendon; Tendons - Tough, elastic cords that connect muscles to bones
• bursitisInflammation of the bursa, which is a small fluid-filled sac that sits above the joints and between the tendons and bones.
• epicondylitis - a condition that affects the outside of the elbow, causing swelling and pain.

Causes of joint hypermobility

There are four factors that can contribute to joint hypermobility:

1. the shape of the ends of the bones;
2. collagen structure (a type of protein found in some types of tissue);
3. muscle tone;
4. a sense of position and movement of the joints.

These are explained in more detail below.

Bone ends shape

A joint is the connection of two bones. The shape of the bones determines how far you can move your limbs. For example, limbs will be more flexible if the socket in which the bone moves, such as the shoulder or hip bone, is shallow. A shallow socket will increase the range of motion of the joint.

Collagen structure

Collagen is a type of protein found throughout the body, such as the skin and ligaments. Ligaments are tough bands of connective tissue (fibers that support other tissues and organs in the body) that bind two bones together at a joint. They strengthen the joint and restrict movement in certain directions.

If the structure of collagen changes, it may not be as strong and the tissues containing collagen will be fragile. This can lead to loose or easily stretched ligaments. All joints may be affected, especially the knees and thumbs.

Changes in collagen structure can be caused by changes in genes. Genes are single units of genetic material that a person inherits from their parents. They contain genetic instructions that tell the body how to work. If the genetic instructions in the genes change, it can change the structure of collagen.

There can be several genes that affect collagen, and changes in these genes can cause hypermobility of the joints.

Hormones also appear to play a role in joint hypermobility, as the female hormone estrogen increases flexibility, probably by acting on collagen. Women may find that their joints are more flexible before menstruation and less after menopause (when women stop menstruating). This is why women are more flexible than men.

Muscle tone

Children with joint hypermobility may have a degree of hypotension (low muscle tone). It is more common in children with autism spectrum disorders (developmental disorders) and chromosomal abnormalities such as Down syndrome. Down syndrome affects physical development and causes learning difficulties.

Sensation of movement of joints

You should feel the position and movement of the joints. For example, even if you close your eyes, you should know if the arm is bent or straight. The medical term for this meaning is proprioception.

However, if you have an unusual sense of joint movement, you won't be able to feel when the joint is too stretched, so you will have a wider range of motion.

Other diseases

Joint hypermobility can be part of a more serious underlying condition. These are often hereditary diseases that parents pass on to their children.

Osteogenesis imperfecta

Osteogenesis imperfecta is a rare condition sometimes called brittle bone disease because it causes brittle bones. This condition can also affect the teeth, causing hearing loss and blue discoloration of the sclera (the white part of the eyes). The most severe forms of osteogenesis imperfecta can affect 1 in 25,000 people.

Marfan syndrome

Marfan syndrome - a condition that affects the connective tissues of the body. They provide support and structure to other tissues and organs. Marfan syndrome can affect:

• blood vessels, causing damage to the heart;
• skeleton, causing lengthening, thinness of the limbs;
• the eye, causing the clear lens at the front of the eye to move into an abnormal position (lens displacement).

About 1 in 5,000 people have Marfan syndrome.

Ehlers-Danlos Syndrome

Estimated, Ehlers-Danlos syndrome affects 1 to 2 people in every 10,000 people.

Like Marfan syndrome, Ehlers-Danlos syndrome also affects connective tissue, although different types of syndrome cause slightly different symptoms. Ehlers-Danlos syndrome can cause:

• bruising;
• skin elasticity;
• poor wound healing, this leads to scars;
• blue sclera (white part of the eyes).

Diagnostics

If your doctor thinks you might have joint hypermobility, the Beyton test is often used as a quick test to assess the range of motion in some joints.

However, it cannot be used to confirm the diagnosis, as it is important to examine all joints.

A therapist may also order blood tests and x-rays to rule out other conditions associated with joint pain, such as rheumatoid arthritis.

If you have other symptoms in addition to hypermobile joints, your therapist may further evaluate your conditions using the Brighton criteria, which can help determine if you have hypermobility syndrome (SGS).

Joint hypermobility treatment

If you have joint hypermobility that does not cause any symptoms, treatment is not required. However, you may need treatment if you have joint hypermobility syndrome and it causes symptoms such as joint pain.

Depending on the symptoms, the condition can be treated by a number of healthcare professionals, including:

• physician;
• rheumatologist - specialist in diseases affecting muscles and joints;
• physiotherapist - a specialist in the treatment of various diseases using physical methods such as massage, ultrasound, etc. manipulations;
• occupational therapist - a healthcare professional who is trained to identify potential problem areas in the patient's daily life, such as dressing, and develop practical solutions;
• orthopedist - a specialist in the treatment of deformities and dysfunctions of the musculoskeletal system.

Physical therapy and exercise

Physiotherapy can be used by people with hypermobile joints for a number of reasons. For example, physical therapy can be used to:

• reducing pain;
• improving muscle strength and fitness;
• improving posture;
• improving the sense of position and movement of the body (proprioception);
• correcting movement of individual joints.

There are a number of physical therapy methods that can be used. For example, an exercise program may be offered that includes strength and balance training, specific stretching techniques, and stimulation tips.

The work involves balancing periods of activity with periods of rest. This means not overdoing it or going beyond your capabilities, because if you do, it can slow down your recovery.

One recent study of physiotherapy in children with joint hypermobility syndrome found that an overall program of improving muscle strength and fitness was as effective as a program aimed at specific joints. Both groups of children in the study were able to significantly reduce pain.

Occupational therapy

Occupational therapy aims to promote the health and well-being of people through their daily activities. If you have hypermobility joints, a professional doctor can help you adjust your home and lifestyle to your condition.

An occupational therapist will help you find a solution to tasks at home or work, reducing the stress on your joints.

Using the methods suggested by the occupational therapist, you will restore and improve your independence. For example, a doctor may suggest installing handrails on the bed to help get up and out of bed;

Orthopedics

Flat feet (flat feet), where the inside of the foot (arches) are flattened, is often associated with hypermobility. This is because the arches of the legs collapse under the weight of the body because the ligaments (tough bands of connective tissue) on the lower legs are weakened too much.

Changing the position of your feet by wearing an insole can reduce knee and ankle pain.

Pain relievers

Another aspect of the treatment of joint hypermobility syndrome is the use of drugs to treat pain.

Over-the-counter pain relievers such as paracetamol. You may also be prescribed medication that contains both paracetamol and codeine, which is a powerful pain reliever.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofencan be used to relieve any joint swelling.

Pain relievers and NSAIDs are also available as gels or sprays that can be applied directly to painful joints.

Check the information that came with the medicine to make sure it is right for you. For example, ibuprofen should be used with caution in people with:

• asthma;
• kidney disease;
• problems with liver.

Some people with joint hypermobility may benefit from referral to a pain specialist, such as a pain clinic.

Surgery

Surgery is not recommended for hypermobility of joints because the joint tissue does not heal well and can lead to osteoarthritis (arthritis that affects the cartilage in the joint). An exception is the case of rupture (splitting) of the tendons, which must be surgically repaired. Tendons are tough, rubbery cords that connect muscles to bones.

Complications of joint hypermobility

People can have a number of complications with hypermobile joints. These are discussed briefly below.

Osteoarthritis

People with joint hypermobility may have a slightly increased risk of developing osteoarthritis. It is a condition that affects the joints and causes:

• mild inflammation (swelling) of tissues in and around the joints;
• cartilage damage, a strong, smooth surface that aligns bones and allows joints to move easily and without friction;
• the formation of bony processes that develop around the edge of the joints.

Sports injuries

One review of a number of studies has shown that people with joint hypermobility are at an increased risk of knee injuries from contact sports. This includes sports such as football, basketball, and hockey. However, the risk of ankle injury was not increased.

Pelvic organ prolapse

Women with joint hypermobility or conditions such as Marfan syndrome or Ehlers-Danlos syndrome may be at increased risk pelvic organ prolapse. In this case, the organs inside the pelvis slide out of their normal position. For example, the uterus may slip into the vagina.

If you have joint hypermobility or one of these conditions, the connective tissues in the body that provide support and structure to other tissues and organs are weaker than usual. They are more likely to be unable to support internal organs and you may have organ prolapse.

Forecast

Joint hypermobility syndrome can be very difficult to live with because it can cause fatigue and long-term pain. People may also find it takes time to get a correct diagnosis due to the wide range of symptoms that hypermobility syndrome can cause.

Once diagnosed, however, joint hypermobility syndrome can be treated with a mixture of exercise and physical therapy (where physical methods are used to speed healing). An exercise program to improve fitness and muscle strength can also be effective in reducing pain.

The nature of joint hypermobility syndrome means that you are at increased risk for injury, such as dislocation and soft tissue injury. Therefore, managing joint hypermobility can include treating short-term injuries as they occur, as well as following a long-term treatment plan to address daily symptoms.

Prophylaxis

Because joint hypermobility is inherited, it cannot be prevented. However, when joint hypermobility syndrome causes symptoms, they can be prevented by avoiding injury and applying appropriate treatments.