DOCSLIB.ORG

Joint Hypermobility in Adults Referred to Rheumatology Clinics

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Joint Hypermobility in Adults Referred to Rheumatology Clinics Annals ofthe Rheumatic Diseases 1992; 51: 793-796 793 Joint hypermobility in adults referred to Ann Rheum Dis: first published as 10.1136/ard.51.6.793 on 1 June 1992. Downloaded from rheumatology clinics Alan J Bridges, Elaine Smith, John Reid Abstract rheumatologist for musculoskeletal problems, Joint hypermobility is a rarely recognised we evaluated 130 consecutive new patients for aetiology for focal or diffuse musculoskeletal joint hypermobility and associated clinical symptoms. To assess the occurrence and features. importance of joint hypermobility in adult patients referred to a rheumatologist, we prospectively evaluated 130 consecutive Patients and methods new patients for joint hypermobility. Twenty PATIENTS women (15%) had joint hypermobility at One hundred and thirty consecutive adult three or more locations (¢5 points on a patients (age >18 years) referred to the out- 9 point scale). Most patients with joint patient rheumatology clinic at the University hypermobility had common musculoskeletal of Missouri-Columbia for musculoskeletal problems as the reason for referral. Two problems or connective tissue disease were patients referredwith adiagnosis ofrheumatoid evaluated by ES and AJB. There were 97 arthritis were correctly reassigned a diagnosis women and 33 men with an average age of 51 of hypermobility syndrome. Three patients years (range 18-83). with systemic lupus erythematosus had diffuse joint hypermobility. There was a statistically significant association between METHODS diffuse joint hypermobility and osteoarthritis. A complete history and physical examination Most patients (65%) had first degree family was performed including an examination for members with a history of joint hypermobility. joint laxity. The criteria devised by Carter and These results show that joint hypermobility is Wilkinson'5 with a modification by Beighton common, familial, found in association with et al 8 were used to assess hypermobility (table common rheumatic disorders, and statistically 1). A mobility score was calculated by allocating associated with osteoarthritis. The findings one pointfor the ability to perform the manoeuvre http://ard.bmj.com/ support the hypothesis that joint hypermobility at each joint. Two points were allocated if predisposes to musculoskeletal disorders, hypermobility was detectable at bilateral joints. especially osteoarthritis. Truncal hypermobility received a score of 1. A mobility score greater than or equal to 5 was considered consistent with joint hypermobility. A commonly unrecognised aetiology for focal The following features were also assessed: (a) or diffuse musculoskeletal problems is the easy bruising; (b) history of joint dislocations; on September 25, 2021 by guest. Protected copyright. hypermobility syndrome. ' 2 The hypermobility (c) history of recurrent joint sprains; (d) history syndrome refers to a constellation of musculo- or physical finding of joint swelling (effusion); skeletal symptoms and clinical findings of (e) loose skin or hernias; (f) temporomandibular Department of diffuse joint laxity in an otherwise normal crepitus and pain; (g) scoliosis; (h) mitral valve Medicine, subject.' 2 When not associated with musculo- prolapse by auscultation (click-murmur with Division of skeletal problems the clinical findings are best characteristic changes on Valsalva manoeuvre) Immunology and Rheumatology, termed diffuse joint hypermobility. Although or echocardiography; (i) passive hyperextension University of the clinical features may mimic inflammatory of one or more proximal interphalangeal joints Missouri School arthritis with joint swelling and pain, the course to greater than 900; (j) passive internal rotation of Medicine, Columbia, MO, USA of joint hypermobility is not progressive, of the hips greater than 450; (k) passive dorsi- A J Bridges destructive, nor disabling.27 flexion of the ankle beyond 150; (I) flat medial E Smith In population studies joint hypermobility has arch of the foot on standing. Department of been found more often in children, with The criteria used to make the diagnoses were Biostatistics, University of diminishing occurrence as age increases.89 Missouri School Joint hypermobility was commonly noted in of Medicine, paediatric patients referred to a rheumatologist Columbia, MO, USA and in normal schoolchildren.' Investigations J Reid in adults have suggested that joint hypermobility Table I Criteria used to evaluate joint hypermobility. Correspondence to: Based on Carter and Wilkinson'" modified by Beighton et Dr Alan Bridges, is associated with osteoarthritis, mitral valve al 8 MA-427 Health prolapse, and chondrocalcinosis.' '3 Only one Sciences Center, Passive dorsiflexion of fifth finger beyond 90° at One Hospital Drive, report has focused on the hypermobility syn- metacarpophalangeal joint University of Missouri drome as a diagnosis in adult patients referred 2 Passive apposition of thumb to flexor aspect of forearm Hospitals and Clinics, 3 Hyperextension of elbow beyond 10° Columbia, MO 65212, USA. to a rheumatologist.'4 To assess the occurrence, 4 Hyperextension of knee beyond 10° modes of and associations of joint 5 Forward flexion of the trunk with the knees fully extended so Accepted for publication presentation, that the palms of the hands rest flat on the floor 8 October 1991 hypermobility in adult patients referred to a 794 Bridges, Smith, Reid based on the accepted criteria of the American graphy in five patients. Easy bruising (three College of Rheumatology where applicable."6 patients), temporomandibular joint dysfunction Patients with findings including dislocation (two patients), history of joint effusions (five Ann Rheum Dis: first published as 10.1136/ard.51.6.793 on 1 June 1992. Downloaded from of the lens (or positive family history), aortic patients), and recurrent sprains (three patients), regurgitation or family history of aortic rupture, were rare. Joint dislocations, loose skin, and arachnodactyly, excessive arm span, marked hernias were not noted in any patient. skin hyperextensibility, or cigarette paper scars A primary diagnosis of hypermobility were suspected to have Marfan or Ehler-Danlos syndrome was made in two young women with syndrome and not considered to have benign joint mobility scores of 9, recurrent joint hypermobility syndrome. effusions, scoliosis, and mitral valve prolapse. The two patients were referred with a diagnosis of rheumatoid arthritis. One patient also had STATISTICS temporomandibular joint dysfunction and Categorical variables (two way tables) were chronic low back pain from sacroiliac hyper- tested using x2 analysis. Continuous variables mobility that became symptomatic during her were tested using the Wilcoxon signed rank or first pregnancy. Neither patient had eye, aortic, Mann-Whitney U tests. skin, or other skeletal abnormalities suggestive of Marfan or Ehlers-Danlos syndrome. Table 2 gives the primary diagnosis for the Results main symptom of each patient with joint hyper- Joint hypermobility was found in 20 (15%) mobility. Causes for the main symptom other patients. Table 2 summarises the findings. The than joint hypermobility were found in 18/20 average age of the patients with joint hyper- patients. Osteoarthritis and fibromyalgia were mobility was 50 years (range 23-80), whereas commonly noted in the patients with joint patients without joint hypermobility had an hypermobility. When all diagnoses were taken average age of 52 years (range 18-83); (p>0.4). into consideration, osteoarthritis was found in The patients with joint hypermobility had an 12/20 (60%) patients with joint hypermobility. average mobility score of 8 whereas patients In contrast, 33/110 (30%) patients without joint without joint hypermobility had mobility scores hypermobility had osteoarthritis (X2=6 73; of -2 (average 0-4; p<0 001). All patients with p<0-01). The age of the patients with osteo- joint hypermobility were women whereas only arthritis and joint hypermobility did not differ 75% of the total number of referred patients significantly from the age of the patients with were women. Most patients (65%) with joint osteoarthritis without joint hypermobility (60 hypermobility reported a family history of joint and 66 years respectively; p>005). Fibro- hypermobility in at least one first degree myalgia was common, but its occurrence did relative. Hypermobility of the trunk was found not differ significantly between the patients in the younger patients with joint hypermobility with (30%) and without joint hypermobility (average age 37 years) but was not found in (38%) (p>0.05). No other musculoskeletal http://ard.bmj.com/ older patients with joint hypermobility (average problem occurred more often in patients with age 62 years) (p<0 005). joint hypermobility compared with patients Table 2 shows that patients who met the without joint hypermobility. criteria for joint hypermobility had other Joint hypermobility was found in three features of joint laxity. Many patients had patients with systemic lupus erythematosus hypermobility of the fingers (50%), hips (35%), (SLE) and one patient with incomplete lupus rheumatoid and ankles (50%). Eighty five per cent of the erythematosus. A patient with on September 25, 2021 by guest. Protected copyright. patients had flat feet and 35% had scoliosis. arthritis had a joint mobility score of 5. This Mitral valve prolapse was found in nine (45%) patient had a history of hypermobility of the patients. This was documented by echocardio- hands and wrists before the onset of rheumatoid
Load more

Recommended publications
  • Association of Generalized Joint Hypermobility and the Occurrence of Musculoskeletal Work-Related Injury in the First Zero to Fi
    University of North Dakota UND Scholarly Commons Physical Therapy Scholarly Projects Department of Physical Therapy 2018 Association of Generalized Joint Hypermobility and the Occurrence of Musculoskeletal Work- Related Injury in the First Zero to Five Years of Physical Therapy Practice: A Pilot Study Mikelle Fetsch University of North Dakota Ashley Naas University of North Dakota Amanda Slaikeu University of North Dakota Follow this and additional works at: https://commons.und.edu/pt-grad Part of the Physical Therapy Commons Recommended Citation Fetsch, Mikelle; Naas, Ashley; and Slaikeu, Amanda, "Association of Generalized Joint Hypermobility and the Occurrence of Musculoskeletal Work-Related Injury in the First Zero to Five Years of Physical Therapy Practice: A Pilot Study" (2018). Physical Therapy Scholarly Projects. 655. https://commons.und.edu/pt-grad/655 This Scholarly Project is brought to you for free and open access by the Department of Physical Therapy at UND Scholarly Commons. It has been accepted for inclusion in Physical Therapy Scholarly Projects by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. ASSOCIATION OF GENERALIZED JOINT HYPERMOBlLlTY AND THE OCCURRENCE OF MUSCULOSKELETAL WORK-RELATED INJURY IN THE FIRST ZERO TO FIVE YEARS OF PHYSICAL THERAPY PRACTICE: A PILOT STUDY by Mikelle Fetsch Bachelor of General Stndies with a Health Sciences Emphasis University of North Dakota, 2016 Ashley Naas Bachelor of General Studies with a Health Sciences Emphasis
    [Show full text]
  • The Ehlers–Danlos Syndromes
    PRIMER The Ehlers–Danlos syndromes Fransiska Malfait1 ✉ , Marco Castori2, Clair A. Francomano3, Cecilia Giunta4, Tomoki Kosho5 and Peter H. Byers6 Abstract | The Ehlers–Danlos syndromes (EDS) are a heterogeneous group of hereditary disorders of connective tissue, with common features including joint hypermobility, soft and hyperextensible skin, abnormal wound healing and easy bruising. Fourteen different types of EDS are recognized, of which the molecular cause is known for 13 types. These types are caused by variants in 20 different genes, the majority of which encode the fibrillar collagen types I, III and V, modifying or processing enzymes for those proteins, and enzymes that can modify glycosaminoglycan chains of proteoglycans. For the hypermobile type of EDS, the molecular underpinnings remain unknown. As connective tissue is ubiquitously distributed throughout the body, manifestations of the different types of EDS are present, to varying degrees, in virtually every organ system. This can make these disorders particularly challenging to diagnose and manage. Management consists of a care team responsible for surveillance of major and organ-specific complications (for example, arterial aneurysm and dissection), integrated physical medicine and rehabilitation. No specific medical or genetic therapies are available for any type of EDS. The Ehlers–Danlos syndromes (EDS) comprise a genet­ six EDS types, denominated by a descriptive name6. The ically heterogeneous group of heritable conditions that most recent classification, the revised EDS classification in share several clinical features, such as soft and hyper­ 2017 (Table 1) identified 13 distinct clinical EDS types that extensible skin, abnormal wound healing, easy bruising are caused by alterations in 19 genes7.
    [Show full text]
  • The Impact of Hypermobility Spectrum Disorders on Musculoskeletal Tissue Stiffness: an Exploration Using Strain Elastography
    Clinical Rheumatology (2019) 38:85–95 https://doi.org/10.1007/s10067-018-4193-0 ORIGINAL ARTICLE The impact of hypermobility spectrum disorders on musculoskeletal tissue stiffness: an exploration using strain elastography Najla Alsiri1 & Saud Al-Obaidi2 & Akram Asbeutah2 & Mariam Almandeel1 & Shea Palmer3 Received: 24 January 2018 /Revised: 13 June 2018 /Accepted: 26 June 2018 /Published online: 3 July 2018 # International League of Associations for Rheumatology (ILAR) 2018 Abstract Hypermobility spectrum disorders (HSDs) are conditions associated with chronic joint pain and laxity. HSD’s diagnostic approach is highly subjective, its validity is not well studied, and it does not consider many of the most commonly affected joints. Strain elastography (SEL) reflects musculoskeletal elasticity with sonographic images. The study explored the impact of HSD on musculoskeletal elasticity using SEL. A cross-sectional design compared 21 participants with HSD against 22 controls. SEL was used to assess the elasticity of the deltoid, biceps brachii, brachioradialis, rectus femoris, and gastrocnemius muscles, and the patellar and Achilles tendon. SEL images were analyzed using strain index, strain ratio, and color pixels. Mean strain index (standard deviation) was significantly reduced in the HSD group compared to the control group in the brachioradialis muscle 0.43 (0.10) vs. 0.59 (0.24), patellar 0.30 (0.10) vs. 0.44 (0.11), and Achilles tendons 0.24 (0.06) vs. 0.49 (0.13). Brachioradialis muscle and patellar tendon’s strain ratios were significantly lower in the HSD group compared to the control group, 6.02 (2.11) vs. 8.68 (2.67) and 5.18 (1.67) vs.
    [Show full text]
  • Hypermobility Spectrum Disorder (HSD)
    Hypermobility Spectrum Disorder (HSD) Dr Alan Hakim MA FRCP Consultant Rheumatologist & Acute Physician Clinical Lead, Hypermobility Unit, The Wellington Hospital, London UK For The Ehlers-Danlos Society: Director of Education Member, Medical & Scientific Board Member, Steering Committee, The Internal Collaborative on EDS Member, PCORI EDS Co-morbidity Coalition Content • Bridging the gap between hypermobility in the well population, and hEDS • A spectrum of illness rather than a single definition – Regional vs general hypermobility – Associations / co-morbidities • Clinical Practical 3 For colleagues not familiar with the 2017 classification and terminology, the Joint Hypermobility Syndrome (JHS) diagnostic criteria covered a wide group of patients some of whom had signs and symptoms that might equally be described as the Hypermobile variant of Ehlers-Danlos syndrome (EDS-HM). As such some confusion arose over the use of JHS/EDS-HM co-terminology. 4 The 2017 international criteria for the Hypermobile variant of EDS (hEDS) were developed to address this, give clarity as to the diagnosis of hEDS, and also allow opportunity for more focused basic science and clinical research including assessment of treatment outcomes. 5 The term JHS has been dropped. Those individuals with hypermobility-related problems that do not have hEDS; or any other Heritable Disorder of Connective Tissue; or other syndromic or secondary myopathic, neuropathic, or traumatic cause for hypermobility / joint instability are now given the diagnosis of Hypermobility Spectrum Disorder (HSD). 6 There is a ‘spectrum’ of presentations laying between asymptomatic hypermobility and the diagnosis of hEDS. This does not infer any greater severity at one end of the spectrum compared to the other.
    [Show full text]
  • Hypermobility Syndrome
    EDS and TOMORROW • NO financial disclosures • Currently at Cincinnati Children’s Hospital • As of 9/1/12, will be at Lutheran General Hospital in Chicago • Also serve on the Board of Directors of the Ehlers-Danlos National Foundation (all Directors are volunteers) • Ehlers-Danlos syndrome(s) • A group of inherited (genetic) disorders of connective tissue • Named after Edvard Ehlers of Denmark and Henri- Alexandre Danlos of France Villefranche 1997 Berlin 1988 Classical Type Gravis (Type I) Mitis (Type II) Hypermobile Type Hypermobile (Type III) Vascular Type Arterial-ecchymotic (Type IV) Kyphoscoliosis Type Ocular-Scoliotic (Type VI) Arthrochalasia Type Arthrochalasia (Type VIIA, B) Dermatosporaxis Type Dermatosporaxis (Type VIIC ) 2012? • X-Linked EDS (EDS Type V) • Periodontitis type (EDS Type VIII) • Familial Hypermobility Syndrome (EDS Type XI) • Benign Joint Hypermobility Syndrome • Hypermobility Syndrome • Progeroid EDS • Marfanoid habitus with joint laxity • Unspecified Forms • Brittle cornea syndrome • PRDM5 • ZNF469 • Spondylocheiro dysplastic • Musculocontractural/adducted thumb clubfoot/Kosho • D4ST1 deficient EDS • Tenascin-X deficiency EDS Type Genetic Defect Inheritance Classical Type V collagen (60%) Dominant Other? Hypermobile Largely unknown Dominant Vascular Type III collagen Dominant Kyphoscoliosis Lysyl hydroxylase (PLOD1) Recessive Arthrochalasia Type I collagen Dominant Dermatosporaxis ADAMTS2 Recessive Joint Hypermobility 1. Passive dorsiflexion of 5th digit to or beyond 90° 2. Passive flexion of thumbs to the forearm 3. Hyperextension of the elbows beyond 10° 1. >10° in females 2. >0° in males 4. Hyperextension of the knees beyond 10° 1. Some knee laxity is normal 2. Sometimes difficult to understand posture- forward flexion of the hips usually helps 5. Forward flexion of the trunk with knees fully extended, palms resting on floor 1.
    [Show full text]
  • 5 Common Causes of Shoulder Pain
    5 Common Causes of Shoulder Pain Leslie B. Vidal, M.D. Orthopedic Associates, LLC 303-321-6600 Rotator Cuff Syndrome: Inflammation of rotator cuff tendons and subacromial bursitis, can proceed rotator cuff tear. History: Insidious onset of anterior and lateral shoulder pain, worse with reaching overhead and behind (putting dishes away in upper cabinet, reaching into the back seat of car). Patients often report positional night pain. Symptoms may be partially alleviated with NSAIDs and ice. Exam: Pain at the extremes of shoulder range of motion, no significant loss of motion. Strength is intact although may be slightly guarded due to pain. Impingement tests positive. Treatment: NSAIDs, Physical Therapy for scapular stabilizing exercises and rotator cuff strengthening. When to refer: If no improvement with 6 weeks of NSAIDs and PT, consider MRI to rule out rotator cuff tear. Consider referral to shoulder surgeon for ultrasound guided subacromial cortisone injection. Surgery can be considered for refractory cases. If there is significant loss of motion (see adhesive capsulitis) or weakness (may have rotator cuff tear), consider immediate referral as NSAIDs and PT may not be as effective in these cases. A history of trauma resulting in shoulder weakness should lead to a prompt referral to a shoulder surgeon, as this may represent an acute RCT. Instability: Subluxation or dislocation of the glenohumeral joint. Can be acute and traumatic and unidirectional; or recurrent, atraumatic and multidirectional. History: Patient may report a traumatic injury to the shoulder resulting in a dislocation requiring a reduction maneuver; or a more nonspecific history of shoulder pain and sense of instability that the patient is able to self-reduce.
    [Show full text]
  • The Correlation Between Hypermobility Syndrome and the Incidence of Musculoskeletal Injuries in Male Club Rugby Players
    The Correlation Between Hypermobility Syndrome and the Incidence of Musculoskeletal Injuries in Male Club Rugby Players Joseph Ryan Bautista, DO, Jeremy Hanson, DO, Clifford Stark, DO Primary Care Sports Medicine Fellowship Northwell Health at Plainview Hospital Introduction ■ Hypermobility is a risk factor for musculoskeletal injury ■ Numerous research has been conducted, primarily on Ehlers- Danlos Syndrome (EDS) patients, with little research done on non- EDS patients ■ The purpose of this study is to determine if any correlation exists between hypermobility and musculoskeletal injuries, with male club rugby players serving as the subjects of this study ■ Our hypothesis is that there is a positive correlation between the level of hypermobility and the incidence of musculoskeletal injuries sustained by male club rugby players Methods / Study Design ■ Northwell IRB exemption was obtained ■ Single center retrospective analysis ■ 55 male club rugby players were screened for hypermobility via Beighton scores at their pre-participation physical evaluations prior to the Fall 2019 season – Inclusion criteria: players active for at least 80% of games (N=50) – Exclusion criteria: players inactive for greater than 20% of games (Not as a result of MSK injury, N=5) N = 55 total rugby players Met Inclusion Excluded: Criteria: N = 5 N = 50 Figure 1: Number of players meeting inclusion / exclusion criteria ■ All in-season musculoskeletal injuries sustained were recorded by their training staff Figure 2: The Beighton Score scoring system Results ■ N = 50 ■ All male subjects ■ Mean age of 27.31 years old ■ Age range of 19-34 years old ■ Ethnic Backgrounds – 52% Caucasian – 24% African American – 16% Hispanic – 8% Asian / Pacific Islander ■ Sept.
    [Show full text]
  • Association of Generalized Joint Hypermobility and Occurrence of Musculoskeletal Injury in Physical and Occupational Therapy
    University of North Dakota UND Scholarly Commons Physical Therapy Scholarly Projects Department of Physical Therapy 2015 Association of Generalized Joint Hypermobility and Occurrence of Musculoskeletal Injury in Physical and Occupational Therapy Students Patricia Bisek University of North Dakota Hannah Owen University of North Dakota Maleeka Rozeboom University of North Dakota Leah Tunseth University of North Dakota Follow this and additional works at: https://commons.und.edu/pt-grad Part of the Physical Therapy Commons Recommended Citation Bisek, Patricia; Owen, Hannah; Rozeboom, Maleeka; and Tunseth, Leah, "Association of Generalized Joint Hypermobility and Occurrence of Musculoskeletal Injury in Physical and Occupational Therapy Students" (2015). Physical Therapy Scholarly Projects. 606. https://commons.und.edu/pt-grad/606 This Scholarly Project is brought to you for free and open access by the Department of Physical Therapy at UND Scholarly Commons. It has been accepted for inclusion in Physical Therapy Scholarly Projects by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. ASSOCIATION OF GENERALIZED JOINT HYPERMOBILITY AND OCCURRENCE OF MUSCULOSKELETAL INJURY IN PHYSICAL AND OCCUPATIONAL THERAPY STUDENTS by Patricia Bisek Bachelor of Arts in Exercise Science Concordia College, 2012 Hannah Owen Bachelor of Arts in Biology with Emphasis in Health and Medical Sciences Minnesota State University Moorhead, 2011 Maleeka Rozeboom Leah Tunseth A Scholarly Project Submitted
    [Show full text]
  • “I Think I May Have EDS” (Ehlers Danlos Syndrome)
    “I think I may have EDS” (Ehlers Danlos Syndrome) If you think you may have Ehlers Danlos Syndrome (EDS), you have a predicament: hardly any doctors know how to diagnose it, let alone treat it. This article aims to help you with information and strategies to help with that predicament, and get better medical care. The EDS predicament Many people think they have EDS – or rather, one of them, since there are several Ehlers Danlos Syndromes. Some of these people have medical problems that resemble those of a relative who has been diagnosed with an EDS, so they wonder if they have one too. Or, they’ve been surfing the web to learn more about some ailment, and they find it can be part of an EDS, and then they read more, and it all seems to fit them. Or, they see a doctor who notices they have some loose joints and wonders aloud about EDS. If you ask, say, an orthopedist or a rheumatologist whether you have an EDS, and if so what to do about it, you are likely to get a version of one of the following responses: “It’s just a name, don’t worry about it.” “It’s inherited, so there’s nothing you can do about it.” “See a geneticist.” “It’s probably fibromyalgia.” “Have you thought of getting counseling?” None of these is helpful, if you are hurting and tired all the time, and getting worse, with an assortment of other symptoms that your doctors discount, or perhaps hint may be all in your mind.
    [Show full text]
  • Coracohumeral Ligament Reconstruction for Patients with Multidirectional Shoulder Instability Zachary S
    Technical Note Coracohumeral Ligament Reconstruction for Patients With Multidirectional Shoulder Instability Zachary S. Aman, B.A., Liam A. Peebles, B.A., Daniel Shubert, M.D., Petar Golijanin, B.S., Travis J. Dekker, M.D., and CAPT Matthew T. Provencher, M.D., MC, USNR Abstract: Coracohumeral ligament pathology arises from acute trauma, capsular thickening, or congenital connective tissue disorders within the glenohumeral joint. Recent studies have highlighted the significance of this pathology in multidirectional shoulder instability because insufficiency of the rotator interval has become increasingly recognized and attributed to failed shoulder stabilization procedures. The diagnosis and subsequent treatment of coracohumeral ligament pathology can be challenging, however, because patients usually present with a history of failed surgical stabilization and persistent laxity. At the time of presentation, most patients have undergone failed nonoperative treatments and are indicated for surgical intervention. One of the options for the treatment of coracohumeral ligament pathology is recon- struction. The purpose of this Technical Note is to describe our preferred surgical technique for the reconstruction of the coracohumeral ligament. Research was performed at the Steadman Philippon Research Institute. ultidirectional instability (MDI) affecting the surgical intervention and historically has led to poor Mglenohumeral joint was initially defined as outcomes.7-10 instability in 2 or more directions1,2 and has long been a For these patients, surgery consisting of capsular shift challenge for the orthopaedic surgeon. Muscular or plication, including additional measures such as imbalance, bony abnormalities that affect joint closure of the rotator interval or augmentation of other congruency, repetitive microtrauma, and congenital dynamic stabilizers, is prone to poor outcomes because of pathology are just some of the causes of MDI.3-5 In the compromise of collagen structural integrity.
    [Show full text]
  • Hypermobility: Misdiagnosed, Which Leads to a Lack of Bracing May Be Necessary
    Who is Affected? Is there a solution? Hypermobility is a genetic and systemic condition Anyone with a genetic predisposition, meaning that affects the entire body to varying degrees in it runs in families, and multiple individuals in different individuals. There is currently no known the same family may be impacted. Males and cure for it, and no supplement, cream, or drug that females can be hypermobile, although it is Appalachian Physical Therapy will affect it. Management is key, and begins with “Always Getting Better” found more often in females. Since it is identification of this condition. Education is critical present from birth and not a condition acquired so as to avoid aggravating or exacerbating habits and later in life, children can certainly be affected. activities. Guidance with appropriate exercises and Sadly, many children go undiagnosed or workouts can minimize injuries. In some cases Hypermobility: misdiagnosed, which leads to a lack of bracing may be necessary. Supportive shoe wear and appropriate intervention. Sometimes sometimes inserts can be helpful. As these Too Much of a Good Thing hypermobile children are diagnosed with rheu- individuals are prone to soft tissue overload, matoid diseases or “growing pains” when con- interventions such as Fascial Manipulation® and dry nective tissue laxity is actually the problem. needling may be helpful in resolving dysfunctional and painful movements. As in most conditions, early recognition and intervention can prevent escalating problems. For additional information please stop by our office, contact us by phone, visit our website, Broadway Harrisonburg or email us at [email protected]. 171 East Springbrook Rd. 2035 East Market St., Suite 45 Broadway, VA 22815 Harrisonburg, VA 22801 In many cases a referral may not 540-901-9501 540-209-8977 be necessary, and insurance Strasburg Pinehurst may cover.
    [Show full text]
  • Hypermobility, the Ehlers-Danlos Syndromes and Chronic Pain D
    Hypermobility, the Ehlers-Danlos syndromes and chronic pain D. Syx, I. De Wandele, L. Rombaut, F. Malfait Center for Medical Genetics, ABSTRACT the nature and mediators of chronic Ghent University and Ghent Chronic widespread pain is a common pain are needed in order to potentially University Hospital, Ghent, Belgium. complaint among individuals affected identify novel targets for therapeutic in- Delfien Syx, PhD by generalised joint hypermobility. In tervention and optimise treatment. Inge De Wandele, PT, PhD the absence of other conditions that Lies Rombaut, PT, PhD cause chronic pain, these individuals Hypermobility, joint hypermobility Fransiska Malfait, MD, PhD are usually diagnosed with joint hyper- syndrome and Ehlers-Danlos Please address correspondence to: mobility syndrome (JHS). JHS is a mul- syndromes Dr Fransiska Malfait, Center for Medical Genetics, tifactorial trait with a strong genetic Joint hypermobility (JH) implies a Ghent University Hospital, basis, but no specific genetic markers. range of joint movement that exceeds De Pintelaan 185, Clinical overlap of JHS is seen with what is considered to be normal for that 9000 Ghent, Belgium. heritable connective tissue disorders, joint, taking into account the individu- E-mail: [email protected] particularly with the Ehlers-Danlos al’s age, gender and ethnicity. JH can be Received and accepted on September 8, syndrome, hypermobile type (hEDS). limited to one or a few joints (localised 2017. The Ehlers-Danlos syndromes (EDS) JH), but when present at multiple sites Clin Exp Rheumatol 2017; 35 (Suppl. 107): comprise a heterogeneous group of rare the term generalised JH (GJH) is pre- S116-S122. monogenic conditions that are charac- ferred (1).
    [Show full text]