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Hypermobility (joints)

hypermobility (joints), hypermobility joints in children
Hypermobility, also known as double-jointedness, describes joints that stretch farther than normal For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or perform other contortionist "tricks" It can affect one or more joints throughout the body

Hypermobile joints are common and occur in about 10 to 25% of the population2 It is usually not associated with any symptoms3 but a minority of people develop other conditions caused by their unstable joints; in such cases, it is known as joints hypermobility syndrome JHS4

Joint hypermobility syndrome is sometimes interchangeably called Ehlers–Danlos syndrome hypermobile type As no genetic test can identify or separate either conditions and because of the similarity of the diagnosis criteria and recommended treatments, many experts recommend they should be recognized as the same condition until further research is carried out56


  • 1 Signs and symptoms
    • 11 Associated conditions
  • 2 Causes
    • 21 Syndromes
  • 3 Diagnosis
    • 31 Brighton criteria
      • 311 Major criteria
      • 312 Minor criteria
    • 32 Beighton score
  • 4 Treatments
    • 41 Physical therapy
    • 42 Medication
    • 43 Lifestyle modification
    • 44 Other treatments
  • 5 Epidemiology
  • 6 See also
  • 7 References
  • 8 External links

Signs and symptomsedit

People with Joint Hypermobility Syndrome may develop other conditions caused by their unstable joints47 These conditions include:

  • Joint instability causing frequent sprains, tendinitis, or bursitis when doing activities that would not affect others
  • Joint pain
  • Early-onset osteoarthritis as early as during teen years
  • Subluxations or dislocations, especially in the shoulder Severe limits to ability to push, pull, grasp, finger, reach, etc, is considered a disability by the US Social Security Administration8
  • Knee pain
  • Fatigue, even after short periods of exercise
  • Back pain, prolapsed discs or spondylolisthesis
  • Joints that make clicking noises also a symptom of osteoarthritis
  • Susceptibility to whiplash
  • Temporomandibular Joint Syndrome also known as TMJ
  • Increased nerve compression disorders eg carpal tunnel syndrome
  • The ability of finger locking
  • Poor response to anaesthetic or pain medication
  • "Growing pains" as described in children in late afternoon or night

Associated conditionsedit

Those with hypermobile joints are more likely to have fibromyalgia, mitral valve prolapse, and anxiety disorders such as panic disorder2


Hypermobility generally results from one or more of the following:

  • Abnormally shaped ends of one or more bones at a joint
  • A Type 1 collagen or other connective tissue defect as found in Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Marfan syndrome resulting in weakened ligaments/ligamentous laxity, muscles and tendons This same defect also results in weakened bones, which may result in osteoporosis and fractures
  • Abnormal joint proprioception an impaired ability to locate body parts in space and/or monitor an extended joint

These abnormalities cause abnormal joint stress, meaning that the joints can wear out, leading to osteoarthritis

The condition tends to run in families, suggesting a genetic basis for at least some forms of hypermobility The term double jointed is often used to describe hypermobility; however, the name is a misnomer and should not be taken literally, as hypermobile joints are not doubled/extra in any sense

Most people have hypermobility with no other symptoms Approximately 5% of the healthy population have one or more hypermobile joints However, people with "joint hypermobility syndrome" are subject to many difficulties For example, their joints may be easily injured, be more prone to complete dislocation due to the weakly stabilized joint and they may develop problems from muscle fatigue as muscles must work harder to compensate for weakness in the ligaments that support the joints Hypermobility syndrome can lead to chronic pain or even disability in severe cases Musical instrumentalists with hypermobile fingers may have difficulties when fingers collapse into the finger locking position Or, conversely, they may display superior abilities due to their increased range of motion for fingering, such as in playing a violin or cello

Hypermobility may be symptomatic of a serious medical condition, such as Stickler Syndrome, Ehlers-Danlos syndrome,9 Marfan syndrome,9 Loeys-Dietz syndrome, rheumatoid arthritis, osteogenesis imperfecta,9 lupus, polio, Down syndrome,9 morquio syndrome, cleidocranial dysostosis or myotonia congenita

Hypermobility has been associated with chronic fatigue syndrome and fibromyalgia Hypermobility causes physical trauma in the form of joint dislocations, joint subluxations, joint instability, sprains, etc These conditions often, in turn, cause physical and/or emotional trauma and are possible triggers for conditions such as fibromyalgia10

Women with hypermobility may experience particular difficulties when pregnant During pregnancy, the body releases certain hormones that alter ligament physiology, easing the stretching needed to accommodate fetal growth as well as the birthing process The combination of hypermobility and pregnancy-related pelvic girdle during pregnancy can be debilitating The pregnant woman with hypermobile joints will often be in significant pain as muscles and joints adapt to the pregnancy Pain often inhibits such women from standing or walking during pregnancy The pregnant patient may be forced to use a bedpan and/or a wheelchair during pregnancy and may experience permanent disability

Symptoms of hypermobility include a dull but intense pain around the knee and ankle joints and the soles of the feet The pain and discomfort affecting these body parts can be alleviated by using custom orthoses


Hypermobile metacarpo-phalangeal joints Hyperextension thumb

Hypermobility syndrome is generally considered to comprise hypermobility together with other symptoms, such as myalgia and arthralgia It is relatively common among children and affects more females than males

Current thinking suggests four causative factors:

  • The shape of the ends of the bones—Some joints normally have a large range of movement, such as the shoulder and hip Both are ball and socket joints If a shallow rather than a deep socket is inherited, a relatively large range of movement will be possible If the socket is particularly shallow, then the joint may dislocate easily
  • Protein deficiency or hormone problems—Ligaments are made up of several types of protein fibre These proteins include elastin, which gives elasticity and which may be altered in some people Female sex hormones alter collagen proteins Women are generally more supple just before a period and even more so in the latter stages of pregnancy, because of a hormone called relaxin that allows the pelvis to expand so the head of the baby can pass Joint mobility differs by race, which may reflect differences in collagen protein structure People from the Indian sub-continent, for example, often have more supple hands than Caucasians11
  • Muscle tone—The tone of muscles is controlled by the nervous system, and influences range of movement Special techniques can change muscle tone and increase flexibility Yoga, for example, can help to relax muscles and make the joints more supple Please note that Yoga is not recommended by most medical professionals for people with Joint Hypermobility Syndrome due to likelihood of damage to the joints Gymnasts and athletes can sometimes acquire hypermobility in some joints through activity
  • Proprioception—Compromised ability to detect exact joint/body position with closed eyes, may lead to overstretching and hypermobile joints12

Hypermobility can also be caused by connective tissue disorders, such as Ehlers-Danlos Syndrome EDS and Marfan syndrome Joint hypermobility is a common symptom for both EDS has numerous sub-types; most include hypermobility in some degree When hypermobility is the main symptom, then EDS/hypermobility type is likely People with EDS-HT suffer frequent joint dislocations and subluxations partial/incomplete dislocations, with or without trauma, sometimes spontaneously Commonly, hypermobility is dismissed by medical professionals as nonsignificant13


Joint hypermobility syndrome shares symptoms with other conditions such as Marfan syndrome, Ehlers-Danlos Syndrome, and osteogenesis imperfecta Experts in connective tissue disorders formally agreed that severe forms of Hypermobility Syndrome and mild forms of Ehlers-Danlos Syndrome Hypermobility Type are the same disordercitation needed

Generalized hypermobility is a common feature in all these hereditary connective tissue disorders and many features overlap, but often features are present that enable differentiating these disorders14 The inheritance pattern of Ehlers-Danlos syndrome varies by type The arthrochalasia, classic, hypermobility and vascular forms usually have an autosomal dominant pattern of inheritance Autosomal dominant inheritance occurs when one copy of a gene in each cell is sufficient to cause a disorder In some cases, an affected person inherits the mutation from one affected parent Other cases result from new sporadic gene mutations Such cases can occur in people with no history of the disorder in their family

The dermatosparaxis and kyphoscoliosis types of EDS and some cases of the classic and hypermobility forms, are inherited in an autosomal recessive pattern In autosomal recessive inheritance, two copies of the gene in each cell are altered Most often, both parents of an individual with an autosomal recessive disorder are carriers of one copy of the altered gene but do not show signs and symptoms of the disorder

Brighton criteriaedit

As of July 2000, hypermobility was diagnosed using the Brighton criteria15 The Brighton criteria do not replace the Beighton score but instead use the previous score in conjunction with other symptoms and criteria HMS is diagnosed in the presence of either two major criteria, one major and two minor criteria, or four minor criteria The criteria are:

Major criteriaedit

  • A Beighton score of 4/9 or more either current or historic
  • Arthralgia for more than three months in four or more joints

Minor criteriaedit

  • A Beighton score of 1, 2 or 3/9 0, 1, 2 or 3 if aged 50+
  • Arthralgia > 3 months in one to three joints or back pain > 3 months, spondylosis, spondylolysis/spondylolisthesis
  • Dislocation/subluxation in more than one joint, or in one joint on more than one occasion
  • Soft tissue rheumatism > 3 lesions eg epicondylitis, tenosynovitis, bursitis
  • Marfanoid habitus tall, slim, span/height ratio >103, upper: lower segment ratio less than 089, arachnodactyly; positive Steinberg thumb / Walker wrist signs
  • Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring
  • Eye signs: drooping eyelids, myopia or antimongoloid slant Palpebral slant
  • Varicose veins or hernia or uterine/rectal prolapse

Beighton scoreedit

The Beighton score is an edited version of the Carter/Wilkinson scoring system which was used for many years as an indicator of widespread hyper-mobility Medical professionals varied in their interpretations of the results; some accepting as low as 1/9 and some 4/9 as a diagnosis of HMS Therefore, it was incorporated, with clearer guidelines, into the Brighton Criteria The Beighton score is measured by adding 1 point for each of the following:

  • Placing flat hands on the floor with straight legs
  • Left knee bending backward
  • Right knee bending backward
  • Left elbow bending backward
  • Right elbow bending backward
  • Left thumb touching the forearm
  • Right thumb touching the forearm
  • Left little finger bending backward past 90 degrees
  • Right little finger bending backward past 90 degrees


Physical therapyedit

It is important that hypermobile individuals remain fit - even more so than the average individual - to prevent recurrent injuries Regular exercise and exercise that is supervised by a physician and physical therapist can reduce symptoms because strong muscles increase dynamic joint stability Low-impact exercise such as closed chain kinetic exercises are usually recommended as they are less likely to cause injury when compared to high-impact exercise or contact sports

Heat and cold treatment can help temporarily to relieve the pain of aching joints and muscles but does not address the underlying problems


Medication is not the primary treatment for hypermobility, but can be used as an adjuct treatment for related joint pain NSAIDS are the primary medications of choice Narcotics are not recommended for primary or long term treatment and are reserved for short term use after acute injury

Lifestyle modificationedit

For some people with hypermobility, lifestyle changes decrease symptom severity In general activity that increases pain is to be avoided For example:

  • Typing can reduce pain from writing
  • Voice control software or a more ergonomic keyboard can reduce pain from typing
  • Bent knees or sitting can reduce pain from standing
  • Unwanted symptoms are frequently produced by some forms of yoga and weightlifting
  • Use of low impact elliptical training machines can replace high-impact running
  • Pain-free swimming may require a kickboard or extra care to avoid hyperextending elbow and other joints
  • Weakened ligaments and muscles contribute to poor posture, which may contribute to other medical conditions
  • Isometric exercise avoids hyperextension and contributes to strength

Other treatmentsedit

  • Bracing can be helpful for temporarily protecting unstable joints


Hypermobile joints occur in about 10 to 25% of the population2

See alsoedit

  • Ligamentous laxity


  1. ^ Federman CA, Dumesic DA, Boone WR, Shapiro SS "Relative efficiency of therapeutic donor insemination using a luteinizing hormone monitor" Fertil Steril 54: 489–92 PMID 2204553 
  2. ^ a b c Garcia-Campayo, J; Asso, E; Alda, M February 2011 "Joint hypermobility and anxiety: the state of the art" Current psychiatry reports 13 1: 18–25 PMID 20963520 doi:101007/s11920-010-0164-0 
  3. ^ "Joint hypermobility | Arthritis Research UK" wwwarthritisresearchukorg Retrieved 2016-12-02 
  4. ^ a b "Joint hypermobility - NHS Choices" NHS choices Retrieved 2016-12-02 
  5. ^ "Hypermobility Syndromes Association  » JHS v EDS Hypermobility- Same Thing" hypermobilityorg Retrieved 2016-11-24 
  6. ^ "Ehlers Danlos UK - JHS vs EDS" wwwehlers-danlosorg Retrieved 2016-11-24 
  7. ^ "Clinician’s Guide to JHS" HMSA Retrieved 2016-12-02 
  8. ^ "100 Musculoskeletal System-Adult" Ssagov 2013-05-31 Retrieved 2014-03-06 
  9. ^ a b c d Simpson, MR September 2006 "Benign joint hypermobility syndrome: evaluation, diagnosis, and management" The Journal of the American Osteopathic Association 106 9: 531–536 PMID 17079522 Archived from the original on 2013-03-02 
  10. ^ "Fibromyalgia: Possible Causes and Risk Factors" Webmdcom 2008-05-21 Retrieved 2014-03-06 
  11. ^ Keer, Rosemary; Rodney Grahame 2003 Hypermobility syndrome : recognition and management for physiotherapists Edinburgh: Butterworth-Heinemann p 71 ISBN 0-7506-5390-6 Asian Indians were found by Wordsworth et al 1987 to be significantly more mobile than English Caucasians 
  12. ^ "Joint hypermobility" Arthritis Research UK Archived from the original on 2009-04-08 
  13. ^ Levy, Howard 2004 “The Ehlers Danlos Syndrome, Hypermobility Type” University of Washington: NIH Retrieved from
  14. ^ Zweers MC, Kucharekova M, Schalkwijk J March 2005 "Tenascin-X: a candidate gene for benign joint hypermobility syndrome and hypermobility type Ehlers-Danlos syndrome" Ann Rheum Dis 64 3: 504–5 PMC 1755395  PMID 15708907 doi:101136/ard2004026559 
  15. ^ Grahame R The revised Brighton 1998 criteria for the diagnosis of benign joint hypermobility syndrome BJHS J Rheumatol 2000;27:1777–1779

External linksedit

hypermobility (joints), hypermobility joints hands, hypermobility joints in children, hypermobility joints syndrome

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Hypermobility (joints)

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