Hypermobility spectrum disorder

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Hypermobility spectrum disorder
Other namesHypermobility syndrome
Joint hypermobility syndrome
Hypermobility-11.jpg
Hypermobile thumb
Specialty Rheumatology, genetics   OOjs UI icon edit-ltr-progressive.svg
Symptoms Joint hypermobility, musculoskeletal pain, fatigue [1]
Causes Genetic [2]

Hypermobility spectrum disorder (HSD), related to earlier diagnoses such as hypermobility syndrome (HMS), and joint hypermobility syndrome (JHS) is a heritable connective tissue disorder [3] that affects joints and ligaments. Different forms and sub-types have been distinguished, but it does not include asymptomatic joint hypermobility, sometimes known as double-jointedness.

Contents

Symptoms can include the inability to walk properly or for long distances, and pain in affected areas. Some people with HSD have hypersensitive nerves and a weaker immune system. It can also cause severe fatigue and some cases cause depressive episodes. It is somewhat similar to other genetic connective tissue disorders such as Ehlers–Danlos syndromes. There is a strong association between HSD and neurodevelopmental disorders such as attention deficit hyperactivity disorder and autism spectrum disorder. [4]

Classification

Hypermobility spectrum disorders are diagnosed when individuals have symptomatic joint hypermobility but do not meet the criteria for other connective tissue disorders, such as Ehlers–Danlos syndrome. [5]

In March 2017, the International Consortium on the Ehlers-Danlos syndromes published a revised classification naming two syndromes: Hypermobile EDS (hEDS), which has narrowly defined criteria, and Hypermobility Spectrum Disorder (HSD) for those with some but not all the features of hEDS [6] [7] [8] . This reclassification aimed to address the overlap between joint hypermobility syndrome and what was previously termed EDS-hypermobile type (EDS-HT). [6] Patients who have a diagnosis of EDS-HT or JHS will fall into one of these two new categories. [7]

Hypermobility Spectrum Disorder does not include people with asymptomatic hypermobility or people with double-jointedness but no other symptoms. Hypermobile Ehlers–Danlos syndrome and hypermobility spectrum disorders may be equally severe. [5] [6]

HSD is further classified into different subtypes, which include [6] :

These classifications help in identifying the specific pattern and extent of joint hypermobility and in determining the appropriate management strategies.

Signs and symptoms

Some common symptoms of Hypermobility Spectrum Disorder may include: [9]

Musculoskeletal Symptoms

Extra-Articular Symptoms

Symptom expression varies widely, with different combinations and severities seen in individuals. Symptoms may fluctuate over time, often triggered by physical exertion, stress, illness, or injury.

Diagnosis

Beighton score Hypermobility Beighton Score.png
Beighton score

Being diagnosed with hypermobility syndrome can be a difficult task. There is a lack of wide understanding of the condition and it can be considered a zebra condition. As hypermobility syndrome can be easily mistaken for being double-jointed or categorised as nothing more than perhaps an achy body from lack of exercise, medical professionals may diagnose those affected incorrectly and not adequately investigate the symptoms. Due to these circumstances many affected individuals can live not knowing they have it. As a result, those affected without a proper diagnosis can easily injure themselves and not take proper care to ensure they go about working safely.

The Beighton Score can be used to determine generalised joint hypermobility (GJH) related to hypermobility syndrome. [10] The newer term "generalised hypermobility spectrum disorder" includes people with generalised joint hypermobility, often determined using the Beighton Score, and other symptoms. Those who do not meet the Beighton Score criteria may be diagnosed with historical joint hypermobility spectrum disorder, peripheral hypermobility spectrum disorder, or localised hypermobility spectrum disorder. [6]

In comparison to the diagnostic criteria of hypermobile Ehlers–Danlos syndrome, the criteria for hypermobile spectrum disorder are less strict. However, these criteria are differentiated from criteria of other EDS types and therefore its less-strict criteria are only comparable to the criteria of hEDS. As those with HSD experience a considerable amount of discomfort, it is important to focus on the treatment, not the labels. The severity of each condition can be equivalent. In particular, musculoskeletal involvement is a requirement for diagnosis with any form of hypermobility spectrum disorder but not for hypermobile Ehlers–Danlos syndrome. Like hypermobile Ehlers–Danlos syndrome, hypermobility spectrum disorders are associated with orthostatic tachycardia, gastrointestinal disorders, and pelvic and bladder dysfunction. [8]

Treatment

Treating hypermobility syndrome can be difficult. The condition has no direct cure, but its symptoms can be treated. Physiotherapy, particularly exercise, is the main treatment for the condition, although there is only limited evidence for its effectiveness. [11]

Treatments for pain include:

Prevalence

Prevalence of HSD alone is unknown, though previous estimates have placed the combined prevalence of hEDS and HSD between 194.2 per 100 000 (0.19%) or 1 in 500 people. [7] The condition is relatively common in those attending musculoskeletal services. [12] [13]

Related Research Articles

<span class="mw-page-title-main">Ehlers–Danlos syndrome</span> Group of genetic connective tissues disorders

Ehlers–Danlos syndromes (EDS) are a group of 13 genetic connective-tissue disorders. Symptoms often include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Complications may include aortic dissection, joint dislocations, scoliosis, chronic pain, or early osteoarthritis. The current classification was last updated in 2017, when a number of rarer forms of EDS were added.

<span class="mw-page-title-main">Dysautonomia</span> Any disease or malfunction of the autonomic nervous system

Dysautonomia, autonomic failure, or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels. Dysautonomia has many causes, not all of which may be classified as neuropathic. A number of conditions can feature dysautonomia, such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies, Ehlers–Danlos syndromes, autoimmune autonomic ganglionopathy and autonomic neuropathy, HIV/AIDS, mitochondrial cytopathy, pure autonomic failure, autism, and postural orthostatic tachycardia syndrome.

<span class="mw-page-title-main">Conditions comorbid to autism</span> Medical conditions more common in autistic people

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that begins in early childhood, persists throughout adulthood, and is characterized by difficulties in social communication and restricted, repetitive patterns of behavior. There are many conditions comorbid to autism spectrum disorder, such as attention deficit hyperactivity disorder, anxiety disorders, and epilepsy.

<span class="mw-page-title-main">Postural orthostatic tachycardia syndrome</span> Abnormally high heart rate after a postural change

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, numbness or tingling in the extremities, chest pain, and shortness of breath. Other conditions associated with POTS include myalgic encephalomyelitis/chronic fatigue syndrome, migraine headaches, Ehlers–Danlos syndrome, asthma, autoimmune disease, vasovagal syncope, and mast cell activation syndrome. POTS symptoms may be treated with lifestyle changes such as increasing fluid, electrolyte, and salt intake, wearing compression stockings, gentle and slow postural changes, avoiding prolonged bedrest, medication, and physical therapy.

Malouf syndrome is a congenital disorder that causes one or more of the following symptoms: intellectual disability, ovarian dysgenesis, congestive cardiomyopathy, broad nasal base, blepharoptosis, and bone abnormalities, and occasionally marfanoid habitus.

<span class="mw-page-title-main">Ligamentous laxity</span> Looseness of the ligaments

Ligamentous laxity, or ligament laxity, is a cause of chronic body pain characterized by loose ligaments. When this condition affects joints in the entire body, it is called generalized joint hypermobility, which occurs in about ten percent of the population, and may be genetic. Loose ligaments can appear in a variety of ways and levels of severity. It also does not always affect the entire body. One could have loose ligaments of the feet, but not of the arms.

<span class="mw-page-title-main">Hypermobility (joints)</span> Joints that stretch further than normal

Hypermobility, also known as double-jointedness, describes joints that stretch further than normal. For example, some hypermobile people can bend their thumbs backwards to their wrists and 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.

<span class="mw-page-title-main">Sack–Barabas syndrome</span> Medical condition

Sack–Barabas syndrome (SBS) is an older name for vascular Ehlers–Danlos syndrome (vEDS). It is a medical condition, a subset of Ehlers–Danlos syndrome which especially affects the body's vascular system, including blood vessels and organs, and makes them prone to rupture.

Small fiber peripheral neuropathy is a type of peripheral neuropathy that occurs from damage to the small unmyelinated and myelinated peripheral nerve fibers. These fibers, categorized as C fibers and small Aδ fibers, are present in skin, peripheral nerves, and organs. The role of these nerves is to innervate some skin sensations and help control autonomic function. It is estimated that 15–20 million people in the United States have some form of peripheral neuropathy.

<span class="mw-page-title-main">Hitchhiker's thumb</span> Condition in which the thumbs can bend backwards 90°

Hitchhiker's thumb, also known as distal hyperextensibility of the thumb, is the condition of having a thumb that has a distal phalange that bends backwards in an angle of 90°. This condition is benign and does not cause pain or affect the thumb with the trait negatively.

<span class="mw-page-title-main">Orthostatic headache</span> Medical condition

Orthostatic headache is a medical condition in which a person develops a headache while vertical and the headache is relieved when horizontal. Previously it was often misdiagnosed as different primary headache disorders such as migraine or tension headaches. Increasing awareness of the symptom and its causes has prevented delayed or missed diagnosis.

<span class="mw-page-title-main">Dopamine beta hydroxylase deficiency</span> Medical condition

Dopamine beta (β)-hydroxylase deficiency is a human medical condition involving inadequate dopamine beta-hydroxylase. It is characterized by increased amounts of serum dopamine and the absence of norepinephrine (NE) and epinephrine.

Marfanoid is a constellation of signs resembling those of Marfan syndrome, including long limbs, with an arm span that is at least 1.03 of the height of the individual, and a crowded oral maxilla, sometimes with a high arch in the palate, arachnodactyly, and hyperlaxity.

<span class="mw-page-title-main">Genu recurvatum</span> Orthopedic deformity

Genu recurvatum is a deformity in the knee joint, so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee. This deformity is more common in women and people with familial ligamentous laxity. Hyperextension of the knee may be mild, moderate or severe.

<span class="mw-page-title-main">Myalgic encephalomyelitis/chronic fatigue syndrome</span> Chronic medical condition

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling chronic illness. People with ME/CFS experience profound fatigue that does not go away with rest, sleep issues, and problems with memory or concentration. The hallmark symptom of ME/CFS is post-exertional malaise, a worsening of the illness which starts hours to days after minor physical or mental activity. This "crash" can last from hours or days to several months. Further common symptoms include dizziness, nausea and pain.

<span class="mw-page-title-main">De Barsy syndrome</span> Medical condition

De Barsy syndrome is a rare autosomal recessive genetic disorder. Symptoms include cutis laxa as well as other eye, musculoskeletal, and neurological abnormalities. It is usually progressive, manifesting side effects that can include clouded corneas, cataracts, short stature, dystonia, or progeria.

<span class="mw-page-title-main">Daniel Browning Smith</span> American contortionist and actor

Daniel Browning Smith, also known as The Rubberboy, is an American contortionist, actor, television host, comedian, sports entertainer, and a stuntman, who holds the title of the most flexible person in history, owning a total of seven Guinness World Records. Smith owes his flexibility to the genetic condition hypermobile Ehlers–Danlos syndrome.

<span class="mw-page-title-main">Ehlers-Danlos Society</span> International patient advocacy and support organization

The Ehlers–Danlos Society is an international nonprofit organization dedicated to patient support, scientific research, advocacy, and increasing awareness for the Ehlers–Danlos syndromes (EDS) and hypermobility spectrum disorder (HSD). The society has organized multiple events around the world in an attempt to raise awareness for EDS and HSD. These events include a rally in Baltimore's Inner Harbor, and a conference in India. The society also organizes symposiums dedicated to research on EDS and HSD. The 2016 symposium resulted in the reclassification of Ehlers–Danlos subtypes. Ehlers-Danlos Society has collaborated with XRP Healthcare to offer a Prescription Savings Card, providing up to 80% off medications for EDS and HSD, including pain relievers and muscle relaxants. Accepted at over 68,000 U.S. pharmacies, including Walmart, CVS, and Walgreens, this partnership offers significant savings.

Craniocervical instability (CCI) is a medical condition characterized by excessive movement of the vertebra at the atlanto-occipital joint and the atlanto-axial joint located between the skull and the top two vertebra, known as C1 and C2. The condition can cause neural injury and compression of nearby structures, including the brain stem, spinal cord, vagus nerve, and vertebral artery, resulting in a constellation of symptoms.

<span class="mw-page-title-main">Amplified musculoskeletal pain syndrome</span> Condition characterized by amplified and chronic pain

Amplified musculoskeletal pain syndrome (AMPS) is an illness characterized by notable pain intensity without an identifiable physical cause.

References

  1. "What Is HSD?". The Ehlers–Danlos Society. Retrieved 30 May 2018.
  2. Hakim, Alan. "Hypermobility Disorders- An Update for Clinicans". Hypermobility Syndromes Association. Archived from the original on 5 June 2018. Retrieved 30 May 2018.
  3. "Hypermobile Ehlers–Danlos syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Archived from the original on 20 January 2023. Retrieved 19 June 2017.
  4. Kindgren, Erik; Perez, Antonia Quiñones; Knez, Rajna (10 February 2021). "Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers–Danlos Syndrome: A Retrospective Study". Neuropsychiatric Disease and Treatment. 17: 379–388. doi: 10.2147/NDT.S290494 . PMC   7882457 . PMID   33603376.
  5. 1 2 "What are the hypermobility spectrum disorders?". The Ehlers Danlos Society. Retrieved 20 October 2020.
  6. 1 2 3 4 5 6 Castori, Marco; Tinkle, Brad; Levy, Howard; Grahame, Rodney; Malfait, Fransiska; Hakim, Alan (March 2017). "A framework for the classification of joint hypermobility and related conditions". American Journal of Medical Genetics. Part C, Seminars in Medical Genetics. 175 (1): 148–157. doi: 10.1002/ajmg.c.31539 . hdl: 1854/LU-8510229 . ISSN   1552-4876. PMID   28145606.
  7. 1 2 3 Demmler, Joanne C.; Atkinson, Mark D.; Reinhold, Emma J.; Choy, Ernest; Lyons, Ronan A.; Brophy, Sinead T. (1 November 2019). "Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: a national electronic cohort study and case–control comparison". BMJ Open. 9 (11): e031365. doi:10.1136/bmjopen-2019-031365. ISSN   2044-6055. PMC   6858200 . PMID   31685485.
  8. 1 2 Ehlers–Danlos Society. "Hypermobile Ehlers–Danlos syndrome (hEDS) vs. hypermobility spectrum disorders (HSD): What's the difference?" (PDF). Ehlers–Danlos Society. Retrieved 31 January 2019.
  9. Carroll, Matthew B (22 July 2023). "Hypermobility spectrum disorders: A review". Rheumatology and Immunology Research. 4 (2): 60–68. doi:10.2478/rir-2023-0010 (inactive 26 November 2024). ISSN   2719-4523. PMC   10457547 . PMID   37637226.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  10. "Assessing Joint Hypermobility". The Ehlers–Danlos Society. Retrieved 30 May 2018.
  11. Palmer et al., 2014 [ permanent dead link ]
  12. Palmer et al., 2017
  13. E. Connelly, A. Hakim, S. Davenport, J. Simmonds. "A study exploring the prevalence of joint hypermobility syndrome in patients attending a musculoskeletal triage clinic." Physiother. Pract. Res., 36 (1) (2015), pp. 43-53