Joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type: constructing a rehabilitative approach

Abstract

Ehlers–Danlos syndrome hypermobility type (EDS-HT) is a heritable connective tissue disorder mainly characterized by joint hyper mobility, chronic/recurrent pain, joint instability complications and minor skin changes [1]. Recently, a group of international experts considered EDS-HT one and the same with joint hypermobility syndrome (JHS), thanks to the impossibility to distinguish them on clinical grounds only in most cases [2]. The epidemiology of JHS/EDS-HT has not been properly established. Nevertheless, clinical practice suggests a very high prevalence of JHS/EDS-HT with a proposed frequency of 0.75–2% in the general population [3]. Recognizing JHS/EDS-HT is, at the moment, an exclusion diagnosis based on adherence to either the Brighton [4] and Villefranche criteria [5], which comprise sets of major and minor criteria. Musculoskeletal pain and orthopedic complications, such as myalgia, tendonitis, recurrent back pain and polyarticular arthralgias, have a major role in diagnosing, assessing and managing JHS/EDS-HT patients. In addition, a wide spectrum of chronic complaints and complications, not yet included in the Brighton and Villefranche criteria include: instability; proprioceptive impairment; fatigue; kinesiophobia; motor deconditioning; cephalalgia; postural orthostatic tachycardia syndrome; abdominal pain; and gastroesophageal reflux, among others. A rehabilitative approach may consider all these issues that may contribute to a failure treatment [6].