Generalized Joint Hypermobility: A Review

Generalized Joint Hypermobility (GJH) is a condition where most of an individual’s synovial joints are found to have a range of motion (ROM) beyond their normal limits. Like most human traits, joint hypermobility is multifactorial resulting from a combination of environmental factors (eg. age, trauma, injury, conditioning, infection, inflammation) and multiple genetic factors, each contributing a small amount to the total phenotype. Clinical features of JHS are mainly associated to the connective tissue and can either be articular or extra-articular. The Beighton 9-point scoring system – also referred to as the modified or revised Beighton score – is a widely accepted method used to define GJH. Management of Generalized Joint Hypermobility is multidisciplinary which requires a team of physicians, physiotherapists, occupational therapists and podiatrists, among others. Physical therapy rehabilitation comprising of core stabilizing, joint stabilizing, strengthening and proprioception enhancing exercise coupled with general fitness program form the basis of GJH management. Keywords: Generalized Joint Hypermobility, Beighton Score, Joint Hypermobility.

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Generalized Joint Hypermobility among School-going children in Majmaah region, Saudi Arabia

10.21203/rs.2.17255/v1 ◽

2019 ◽

Author(s):

Mohamed Sherif Sirajudeen ◽

Mohamed Waly ◽

Mazen Alqahtani ◽

Msaad Alzhrani ◽

Hariraja Muthusamy ◽

...

Keyword(s):

Saudi Arabia ◽

School Children ◽

Personal Characteristics ◽

Joint Hypermobility ◽

Primary School Children ◽

Cutoff Score ◽

Score Distribution ◽

Beighton Score ◽

Cross Sectional ◽

Generalized Joint Hypermobility

Abstract Background Generalized Joint Hypermobility (GJH) is common among schoolchildren and usually benign. However, progressively may lead to joint pain and developmental delay. Identifying the GJH at the school-age would facilitate to monitor early changes and to plan for early rehabilitative intervention. Hence, we aimed to determine the prevalence, pattern, and factors associated with the GJH among school-going children in the Majmaah region, Saudi Arabia. Methods The school children of both genders aged 8 to 14 years from the Majmaah region of Saudi Arabia participated in this cross-sectional study. The Beighton’s score was used to assess the joint hypermobility. Personal characteristics like age, height, weight, Body mass index (BMI), and handedness was also collected. Descriptive statistics were produced for personal characteristics, the point prevalence of hypermobility, frequency of Beighton score distribution, and prevalence of GJH. The association between specific factors and the presence of GJH was analyzed using Chi-square tests and logistic regression measures. Results The occurrence of GJH as defined by Beighton cutoff score ≥ 4 in the 303 participated primary school children was 15.2%. The prevalence of GJH was high among females (16.8%) compared to males (13.4%), but this difference is not statistically significant. Younger male children (age 8 to 11 years) were 16.7 times more probable to develop hypermobility (adjusted OR 0.06 [95% CI 0.01 – 0.56]) compared to older male children (age 12 to 14 years). No associations were observed among female children. Conclusion The prevalence rate reported in this study among school-going children was in the lower range in comparison with the rates reported across the globe. Beighton score of ≥4 was adequate for use in identifying GJH among children in Saudi Arabia.

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Joint hypermobility and its relevance to common mental illness in adolescents: a population-based longitudinal study

10.1101/2020.09.14.20191130 ◽

2020 ◽

Author(s):

Jessica A Eccles ◽

Hannah E Scott ◽

Kevin A Davies ◽

Rod Bond ◽

Anthony S David ◽

...

Keyword(s):

Mental Illness ◽

Longitudinal Study ◽

Connective Tissue ◽

Common Mental Disorders ◽

Joint Hypermobility ◽

Birth Cohort Study ◽

Sensitivity Index ◽

Depression And Anxiety ◽

Data Set ◽

Generalized Joint Hypermobility

Importance: Depression and anxiety are common mood disorders that show higher prevalence in adults with joint hypermobility, a consequence of a constitutional variant of connective tissue structure. In adolescents, an association between mood disorder and hypermobility may enhance the potential understanding of risk factors for emotional disorder and provide opportunities for early intervention approaches. Objective: To test the hypothesis that joint hypermobility, a consequence of constitutional variant of connective tissue, is associated with common mental illness in adolescents. Design: This was a longitudinal prospective study. Setting: The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective ongoing general population birth cohort study based in Avon County, England. Participants: The original data set comprised 6105 individuals from the cohort with data available on joint hypermobility at age 14 years; a sub-sample (n=3803) had later psychiatric assessments. Measurement of Exposure: Joint hypermobility was measured by physical examination at age 14 and 18 years, using the Beighton Scale Main Outcome and Measures: Participants were assessed at age 18 years. ICD 10 diagnoses of Depression and Anxiety were obtained using the Clinical Interview Schedule-Revised (CIS R) and levels of anxiety quantified using the Anxiety Sensitivity Index (ASI) Results: Presence of generalized joint hypermobility (GJH) at age 14 years predicted depression at 18 years in males (Odds Ratio (OR) 2.10; 95%CI, 1.17 - 3.76) but not females. After accounting for missing data it was determined that this relationship was mediated by heart rate, a potential measure of physiological arousal. Symptomatic hypermobility ((GJH plus chronic widespread pain (CWP)) at age 18 years was further associated with the presence of anxiety disorder (OR 3.13; 95% CI 1.52 - 6.46) and level of anxiety (Beta = 0.056, t(3315)=3.27), depressive disorder (adjusted OR 3.52; 95%CI, 1.67 - 7.40) and degree of psychiatric symptomatology (Beta 0.096, t(2064)=4.38) Conclusions and relevance: Generalized joint hypermobility and symptomatic hypermobility are associated with common mental disorders in adolescence. Consideration of hypermobility may provide important opportunities for intervention to mitigate psychiatric disorder.

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Assessment of cerebral blood flow in children with myopia in combination with undifferentiated connective tissue dysplasia

Archive of Ukrainian Ophthalmology ◽

10.22141/2309-8147.9.2.2021.241503 ◽

2021 ◽

Vol 9 (2) ◽

pp. 10-13

Author(s):

T.V. Frolova

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Connective Tissue ◽

Clinical Signs ◽

Joint Hypermobility ◽

Visual Analyzer ◽

Elastic Parameters ◽

Beighton Score ◽

Connective Tissue Dysplasia ◽

Progressive Myopia

Background. In practice, patients with numerous undifferentiated forms of connective tissue dysplasia are more common. With regard to the combination of myopia and undifferentiated connective tissue dysplasia, one of the links in the mechanism of origin of this refractive anomaly is decreased thickness of the sclera and a change in its elastic parameters. Myopia in children often occurs against the background of impaired blood supply to the visual analyzer associated with circulatory pathology in the vertebral vessels. The purpose was to evaluate cerebral blood flow in patients with myopia in combination with undifferentiated connective tissue dysplasia. Materials and methods. The study involved 86 children (170 eyes) diagnosed with progressive myopia. All patients were consulted by related specialists to detect undifferentiated connective tissue dysplasia and underwent a complete ophthalmological exa-mination. The diagnostic coefficient of expression of phenotypic and clinical signs of undifferentiated connective tissue dysplasia was also determined using the expert table of T. Kadurina. Results. Phenotypic and clinical signs of undifferentiated connective tissue dysplasia were noted in 41 (100 %) cases when evaluating according to the criteria of T. Mil-kovskaya-Dimitrova and T. Kadurina, and in 34 (83.0 %) children du-ring screening for joint hypermobility on Beighton score. As for increased axial length of the eye in the examined patients with myopia and undifferentiated connective tissue dysplasia, it was noted that an increase had a direct correlation with the severity of undifferentiated connective tissue dysplasia, with the greatest correlation obtained in children with pronounced phenotypic manifestations in the musculoskeletal system (correlation coefficient was 0.83). Chemical regulation of carotid artery tone (respiratory failure test) is altered in the vast majority of patients with myopia. Conclusions. All children with progressive myopia are re-commended to be examined by related specialists to identify undif-ferentiated connective tissue dysplasia and hemodynamic disorders. Only a comprehensive approach to this refractive anomaly can be effective in combating its progression.

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No Effect of Generalized Joint Hypermobility on Injury Risk in Elite Female Soccer Players: A Prospective Cohort Study

The American Journal of Sports Medicine ◽

10.1177/0363546516676051 ◽

2016 ◽

Vol 45 (2) ◽

pp. 286-293 ◽

Cited By ~ 14

Author(s):

Donna Blokland ◽

Karin M. Thijs ◽

Frank J.G. Backx ◽

Edwin A. Goedhart ◽

Bionka M.A. Huisstede

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Joint Hypermobility ◽

Ankle Injuries ◽

Soccer Players ◽

Injury Incidence ◽

Beighton Score ◽

Generalized Joint Hypermobility ◽

Significant Difference ◽

Cutoff Points

Background: Although it has been suggested that generalized joint hypermobility (GJH) is a risk factor for injury in soccer players, it remains unclear whether this applies to elite female soccer players. Purpose: To investigate whether GJH is a risk factor for injury in elite female soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: Elite female soccer players in the Netherlands were screened at the start of the 2014-2015 competitive season. GJH was assessed using the Beighton score. Soccer injuries and soccer exposure were registered throughout the entire season. Poisson regression was performed to calculate incidence risk ratios (IRRs) using different cutoff points of the Beighton score (≥3, ≥4, and ≥5) to indicate GJH. Results: Of the 114 players included in the study, 20 were classified as hypermobile (Beighton score ≥4). The mean (±SD) injury incidence per player was 8.40 ± 9.17 injuries/1000 hours of soccer, with no significant difference between hypermobile and nonhypermobile players. GJH was not a risk factor for injuries when using Beighton score cutoff points of ≥3 (IRR = 1.06 [95% CI, 0.74-1.50]; P = .762), ≥4 (IRR = 1.10 [95% CI, 0.72-1.68]; P = .662), or ≥5 (IRR = 1.15 [95% CI, 0.68-1.95]; P = .602). Similarly, GJH was not a significant risk factor for thigh, knee, or ankle injuries evaluated separately. Conclusion: This study indicates that GJH is not a risk factor for injuries in elite female soccer players, irrespective of Beighton score cutoff point. Hypermobile players at this elite level might have improved their active stability and/or used braces to compensate for joint laxity.

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Evaluation of the Anterior Talofibular Ligament by Stress Ultrasound for Assessing Generalized Joint Hypermobility

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00453 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0045

Author(s):

Jaehwang Song ◽

Chan Kang ◽

Je Hyung Jeon ◽

Chang Uk Ham

Keyword(s):

Ankle Joint ◽

Ankle Instability ◽

Plantar Flexion ◽

Joint Hypermobility ◽

Anterior Talofibular Ligament ◽

Specific Method ◽

Ultrasound Images ◽

Beighton Score ◽

Generalized Joint Hypermobility ◽

Ultrasound Parameters

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Chronic ankle instability with generalized joint hypermobility (GJH) is considered a relative contraindication for the modified Bröstrom procedure. Most clinicians use the Beighton score to assess GJH. However, the Beighton score itself does not involve investigation of the ankle joint. In our experience, resting, longitudinal ultrasound images of the uninjured, intact ATFL frequently show a loose, wavy pattern in patients with high Beighton scores. We evaluated anterior talofibular ligament (ATFL) status according to Beighton score and the manual anterior drawer test (ADT). It was hypothesized that the value of ultrasound for ATFL would be significantly different between participants with GJH (Beighton score >= 5) and without GJH and show a correlation with participant’s Beighton scores and manual ADT grades. Methods: Forty-four healthy young patients (44 ankles) aged 20 to 40 years and without a history of ankle trauma or disease were included in the study. To assess GJH and ankle instability, Beighton scores and manual ADT grades were evaluated, respectively. For the investigation of ATFL, resting and stress ultrasonography were performed to assess its length, height, and thickness. Ultrasound images were taken in resting position and during maximal plantar-flexion and inversion (Figure: Ultrasound images of the ATFL in (a) the resting position and (b) stress position in a 21-year-old woman with Beighton score of 9. Dotted red line: Length, Yellow line: Height, Green double-headed arrow: Thickness). Beighton scores, manual ADT grades, and ultrasound parameters of participants with and without GJH were compared and the correlation coefficients among Beighton scores, manual ADT grades, and the length, height, and thickness of resting and stress ATFLs were analyzed. Results: The participants were divided into two groups, those without GJH (24 ankles) and with GJH (20 ankles). Mean Beighton scores and manual ADT grades were significantly different between the two groups (P < .05). The mean length, height of resting, stress ATFL and mean difference in height between resting and stress ATFL were significantly different between the two groups (P < .05). The resting and stress ATFL length, height, and difference in height between resting and stress ATFL showed a moderately positive linear relationship with Beighton scores and manual ADT grades (P < .05). Among the ATFL parameters, resting ATFL height showed the strongest relationship with the Beighton score (r = 0.763, P < .001) and ADT grade (r = 0.763, P < .001). Conclusion: The ATFL stress ultrasound parameters showed significant differences between participants with high and low Beighton scores and were correlated with Beighton scores and manual ADT grades. We believe that this ankle joint specific method might provide significant, quantitative parameters for assessing GJH in addition to the Beighton score.

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Generalized joint hypermobility among school-aged children in Majmaah region, Saudi Arabia

PeerJ ◽

10.7717/peerj.9682 ◽

2020 ◽

Vol 8 ◽

pp. e9682

Author(s):

Mohamed Sherif Sirajudeen ◽

Mohamed Waly ◽

Mazen Alqahtani ◽

Msaad Alzhrani ◽

Fahad Aldhafiri ◽

...

Keyword(s):

Saudi Arabia ◽

Personal Characteristics ◽

Epidemiological Studies ◽

Joint Hypermobility ◽

Score Distribution ◽

Gulf Region ◽

Beighton Score ◽

Cross Sectional ◽

School Aged Children ◽

Generalized Joint Hypermobility

Generalized joint hypermobility (GJH) is common among schoolchildren and usually benign. However, it may progressively lead to joint pain and developmental delay. Identifying GJH in school-aged children would facilitate the monitoring of early changes and planning for early rehabilitative intervention. Epidemiological studies addressing the prevalence of GJH among children in the Gulf region and Arab ethnicity are lacking. Hence, we aimed to determine the prevalence, pattern, and factors associated with GJH among school-aged children in the Majmaah region, Saudi Arabia. Male and female school-aged children 8–14 years of age from the Majmaah region of Saudi Arabia participated in this cross-sectional study. Beighton score was used to assess GJH. Personal characteristics such as age, height, weight, body mass index, and handedness were also collected. Descriptive statistics were obtained for personal characteristics, the point prevalence of hypermobility, frequency of Beighton score distribution, and prevalence of GJH. The associations between specific factors and the presence of GJH were analyzed using chi-square and Mann-whitney tests. Using the Beighton score cutoff ≥ 4 and ≥ 6, 15.2% and 7.6% of the school children in our study were diagnosed with GJH respectively. The prevalence of GJH was higher among females (16.8%) than among males (13.4%), but the difference was not statistically significant. The elbow joints (17.2%) were the most common hypermobile joints and the trunk (0.7%) was the least involved. The children with GJH were younger and had lesser BMI compared to children without GJH (P < 0.05). The prevalence reported in this study among school-aged children was comparable with those reported worldwide.

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HUBUNGAN GENERALIZED JOINT HYPERMOBILITY (GJH) DENGAN KESEIMBANGAN STATIS PADA PENARI DI KOTA DENPASAR

Majalah Ilmiah Fisioterapi Indonesia ◽

10.24843/mifi.2020.v08.i02.p08 ◽

2020 ◽

Vol 8 (2) ◽

pp. 37

Author(s):

Elfiera Kang ◽

Ni Luh Nopi Andayani ◽

Nila Wahyuni ◽

Luh Putu Ratna Sundari

Keyword(s):

Joint Hypermobility ◽

Beighton Score ◽

Cross Sectional ◽

Generalized Joint Hypermobility ◽

Spearman's Rho ◽

Spearman’S Rho

Keseimbangan adalah komponen yang penting dalam kehidupan manusia. Keseimbangan terdiri dari keseimbangan statis dan dinamis. Keseimbangan statis adalah dasar terbentuknya keseimbangan dinamis. Jika keseimbangan statis terganggu, keseimbangan dinamis pun akan mengalami gangguan. Menari adalah aktivitas yang membutuhkan fungsi keseimbangan yang tinggi. Gerakan tarian yang repetitif dan melebihi lingkup gerak sendi dapat menyebabkan kondisi generalized joint hypermobility (GJH) pada penari. Tujuan Penelitian ini adalah untuk dapat menganalisis adanya hubungan antara generalized joint hypermobility (GJH) dengan keseimbangan statis pada penari di Kota Denpasar. Metode pada penelitian ini merupakan penelitian analitik cross sectional yang dilakukan pada bulan April-Mei 2019. Jumlah sampel pada penelitian ini adalah 48 perempuan usia 16-25 tahun. Variabel independen yang diukur ialah generalized joint hypermobility (GJH) dengan menggunakan beighton score. Pengukuran variabel dependen, yaitu keseimbangan statis dilakukan dengan standing stork test. Uji korelasi dengan uji Spearman’s Rho menunjukan hasil p = 0,000 (p<0,05). Hasil tersebut menunjukkan hubungan yang signifikan antara generalized joint hypermobility (GJH) dengan keseimbangan statis pada penari usia 16-25 tahun di Kota Denpasar.

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Generalized Joint Hypermobility and Injuries: A Prospective Cohort Study of 185 Pre-Professional Contemporary Dancers

Journal of Clinical Medicine ◽

10.3390/jcm10051007 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1007

Author(s):

Rogier M. van Rijn ◽

Janine H. Stubbe

Keyword(s):

Potential Risk ◽

Injury Risk ◽

Joint Hypermobility ◽

Research Centre ◽

Injury Incidence ◽

Time Loss ◽

Beighton Score ◽

Generalized Joint Hypermobility ◽

Professional Dancers ◽

Academic Year

Generalized joint hypermobility (GJH) has been mentioned as one of the factors associated with dance injuries, but the findings are inconclusive. This study aims to investigate whether GJH, based on different Beighton score cut-off points, is a potential risk factor for injuries in pre-professional dancers. Four cohorts of first-year pre-professional dancers (N = 185), mean age 19.1 ± 1.3 years, were screened on musculoskeletal functioning at the start of their academic year. The Beighton score was used to measure GJH. During the academic year, the dancers completed monthly questionnaires about their physical and mental health. Based on the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC), three injury definitions were used (i.e., all complaints, substantial injury, and time-loss injury). To examine potential risk factors for injuries, univariate and multivariate regression models were applied. The response rate of monthly completed questionnaires was 90%. The overall mean (SD) Beighton score was 2.8. The 1-year injury incidence proportion was 67.6% (n = 125), 43.2% (n = 80), and 54.6% (n = 101) for all complaint injuries, substantial injuries, and time-loss injuries, respectively. The multivariate analyses showed a significant association between a previous long lasting injury in the past year and the three injury definitions (p < 0.05). Pre-professional contemporary dancers are at high risk for injuries and hypermobility. However, these two variables are not associated with each other. Health professionals should take injury history into account when assessing dance students, because this variable is associated with increased injury risk.

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Outcome of Hip Impingement Surgery: Does Generalized Joint Hypermobility Matter?

The American Journal of Sports Medicine ◽

10.1177/0363546516688636 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1309-1314 ◽

Cited By ~ 8

Author(s):

Florian D. Naal ◽

Aileen Müller ◽

Viju D. Varghese ◽

Vanessa Wellauer ◽

Franco M. Impellizzeri ◽

...

Keyword(s):

Risk Factors ◽

Joint Hypermobility ◽

Injury Incidence ◽

Inverse Association ◽

Failure Rates ◽

Joint Degeneration ◽

Beighton Score ◽

Generalized Joint Hypermobility ◽

Patient Reported

Background: Generalized joint hypermobility (JH) might negatively influence the results of surgical femoroacetabular impingement (FAI) treatment, as JH has been linked to musculoskeletal pain and injury incidence in athletes. JH may also be associated with worse outcomes of FAI surgery in thin females. Purpose: To (1) determine the results of FAI surgery at a minimum 2-year follow-up by means of patient-reported outcome measures (PROMs) and failure rates, (2) assess the prevalence of JH in FAI patients and its effect on outcomes, and (3) identify other risk factors associated with treatment failure. Study Design: Cohort study; Level of evidence, 3. Methods: We included 232 consecutive patients (118 females; mean age, 36 years) with 244 hips surgically treated for symptomatic FAI between 2010 and 2012. All patients completed different PROMs preoperatively and at a mean follow-up of 3.7 years. Satisfaction questions were used to define subjective failure (answering any of the 2 subjective questions with dissatisfied/ very dissatisfied and/or didn’t help/ made things worse). Conversion to total hip replacement (THR) was defined as objective failure. JH was assessed using the Beighton score. Results: All PROM values significantly ( P < .001) improved from preoperative measurement to follow-up (Oxford Hip Score: 33.8 to 42.4; University of California at Los Angeles Activity Scale: 6.3 to 7.3; EuroQol−5 Dimension Index: 0.58 to 0.80). Overall, 34% of patients scored ≥4 on the Beighton score, and 18% scored ≥6, indicating generalized JH. Eleven hips (4.7%) objectively failed and were converted to THR. Twenty-four patients (10.3%) were considered as subjective failures. No predictive risk factors were identified for subjective failure. Tönnis grade significantly ( P < .001) predicted objective failure (odds ratio, 13; 95% CI, 4-45). There was a weak inverse association ( r = −0.16 to −0.30) between Beighton scores and preoperative PROM values. There were no significant associations between Beighton scores and postoperative PROM values or subjective failure rates, but patients who objectively failed had lower Beighton scores than did nonfailures (1.6 vs 2.6; P = .049). Conclusion: FAI surgery yielded favorable outcomes at short- to midterm follow-up. JH as assessed by the Beighton score was not consistently associated with subjective and objective results. Joint degeneration was the most important risk factor for conversion to THR. Although statistical significance was not reached, female patients with no joint degeneration, only mild FAI deformity, and higher Oxford scores at the time of surgery seemed to be at increased risk for subjective dissatisfaction.

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Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students

PeerJ ◽

10.7717/peerj.7625 ◽

2019 ◽

Vol 7 ◽

pp. e7625 ◽

Cited By ~ 8

Author(s):

Peter R. Reuter ◽

Kaylee R. Fichthorn

Keyword(s):

Chronic Pain ◽

Musculoskeletal Pain ◽

Gulf Coast ◽

Joint Hypermobility ◽

Musculoskeletal Injuries ◽

Chronic Musculoskeletal Pain ◽

Beighton Score ◽

Aged Population ◽

Generalized Joint Hypermobility ◽

Florida Gulf Coast

The objective of this study was to investigate the prevalence of generalized joint hypermobility (GJH) in a university-aged population, whether young adults (aged 18–25 years) with GJH are prone to sustain more musculoskeletal injuries, and are more likely to suffer from chronic musculoskeletal pain. The study used an interactive survey to gather data; GJH was assessed using a cut-off Beighton score of ≥5 in accordance with the 2017 International Classification of EDS criteria. The analyzed sample consisted of 482 female and 172 male participants from Florida Gulf Coast University (USA). The prevalence of GJH in a university-aged population can be estimated at 12.5%. Women did not have higher rates of GJH than men. However, female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints. The Beighton scores did not differ by ethnicity/race. Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant. There was no difference in the proportion of all participants classified within different categories (0; 1–4; 5–9) of Beighton scores and whether or not they reported having been injured. Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories. Female participants, however, reported higher pain intensity for chronic neck and back pain. This study increases knowledge about a correlation between GJH, musculoskeletal injuries, and chronic pain of joints, neck, and back in a university-aged population.

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