Chapter 2 - Generalized joint hypermobility and pain: When generalized joint hypermobility changes from an asset to a health concern

Abstract

For many decades it has been recognized that joint hypermobility can be associated with acute and chronic musculoskeletal (MSK) pain. Individuals affected by joint hypermobility-related pain and disorders are likely to constitute a significant proportion of patients seeking help from musculoskeletal services. However, following the exclusion of autoimmune and inflammatory rheumatic conditions, clinicians often miss the presence of joint hypermobility and its potential role in pathology and disease diagnosis. Delays in appropriate treatment can lead to poorer physical, psychosocial, and overall function and quality of life. Although the terminology related to the more common joint hypermobility-related disorders has changed over the last three decades, the fundamental association between joint hypermobility and MSK pain remains a consistent feature in clinical criteria. The pain mechanisms include joint instability and biomechanical overload, onset of fibromyalgia, complex interactions with psychological disorders, nonarticular pathologies (such as the viscera and pelvic floor), and mast cell-related inflammatory mediators. Joint hypermobility can be completely benign, and even an asset, but it may also be a clinical trait that alerts the clinician to the possible presence of an underlying mechanical or multisystemic disorder.