Walking and running in people who are hypermobile: A scoping review.

Growing evidence suggests an unexpected association between generalised joint hypermobility (GJH) and several psychiatric conditions, and a shared pathophysiology has been proposed. No previous studies on adult attention-deficit/hyperactivity disorder (ADHD) are available. This study aimed to evaluate the association between adult ADHD and GJH. A total of 431 adults with ADHD and 417 non-ADHD controls were included in this cross-sectional comparative study. GJH was assessed by physical examination following the Beighton scoring system (BSS). Furthermore, musculoskeletal symptoms and skin abnormalities were queried to create a proxy for symptomatic GJH (e.g., Hypermobility spectrum disorders and Ehlers-Danlos syndrome) to differentiate this from non-specified GJH defined by BSS only. Logistic regression examined the influence of ADHD and candidate covariates (age, sex, ethnicity) on GJH and symptomatic GJH, respectively. ADHD was significantly associated with GJH, as defined by the BSS, with adjusted odds ratios of 4.7 (95% confidence interval [CI] 3.0–7.2, p < .005). Likewise, ADHD was significantly associated with symptomatic GJH, as defined by the BSS and additional symptoms, with adjusted odds ratios of 6.9 (CI 95% 4.1–11.9, p < .005). Our results suggest that GJH may represent a marker for an underlying systemic disorder involving both connective tissue and the central nervous system. GJH with additional musculoskeletal symptoms and/or skin abnormalities has a considerable stronger link to adult ADHD than non-specified GJH has, and may need awareness in ADHD management. Future studies should investigate the mechanisms behind this association and how comorbid GJH affects ADHD outcome.

Category: Sports Introduction/Purpose: Chronic ankle instability with generalized joint hypermobility (GJH) is considered a contraindication for the modified Broström procedure. The most widely accepted definition of GJH is a Beighton-Horan score of ≥4 on a 9-point scale. However, it is not clear if this criterion can be applied to determine the GJH that would lead to a poor outcome after the modified Broström procedure. Methods: The modified Broström procedure was performed in 32 patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varus talar tilt and anterior talar translation during the stress tests. We hypothesized that when the contralateral uninjured ankle shows a normal varus talar tilt and anterior talar translation during stress tests in patients with GJH, GJH may have a smaller effect on the ankle ligaments, and the modified Broström procedure in these cases may have satisfactory outcomes. The mean patient age at surgery was 21.7 years. The mean follow-up duration was 27.4 months. Results: The Karlsson-Peterson ankle score significantly improved from 63.6 ± 7.1 points (p&lt; 0.001; 95% CI, 22.1 – 29.7) preoperatively to 90.4 ± 6.7 points at the final postoperative follow-up. Sixteen patients were very satisfied with the results, 10 patients were satisfied, 3 patients rated their satisfaction as fair, and 1 patient was dissatisfied with the results. We stratified the clinical outcomes according to the Beighton scores. There was no correlation between the Beighton scores and the Karlsson- Peterson ankle scores at the last follow-up (Spearman’s correlation coefficient, -0.11; p= 0.591). However, 1 patient with a Beighton score of 8 points and 1 patient with a score of 9 points had lower Karlsson-Peterson ankle scores (82 and 85, respectively) compared to the average scores at the last follow-up. Conclusion: The modified Broström procedure was successful in patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varustalar tilt and anterior talar translation during the stress tests. The repaired ligaments may eventually stretch out in patients with GJH secondary to connective tissue disorders such as Marfan syndrome as these patients have been found to have inherent connective tissue extensibility. However, GJH includes mild joint hypermobility without any symptoms or problems except increased joint range of motion. When the contralateral normal ankle shows negative stress tests that the modified Broström procedure may be successful.

Objectives:The role of hip instability in pre-arthritic hip disease is increasingly recognized, particularly in female patients. Generalized joint hypermobility (GJH) can be reliably assessed and quantified by the Beighton score with a score of 5 or greater is typically considered a marker of GJH. Given the female preponderance of symptomatic FAI, GJH may play a role in the pathophysiology of pre-arthritic hip pain as well as the outcomes of surgical treatment. The purpose of this study was (1) to determine the distribution of Beighton scores in a female cohort undergoing FAI surgery and (2) to determine if the Beighton score is correlated with patient-reported outcomes (PROs) in females undergoing hip arthroscopy for FAI.Methods:A prospective multicenter cohort study of 677 FAI patients undergoing primary hip arthroscopy was performed across 13 surgeons. The current study included a subgroup of 377 females from the larger cohort. Inclusion criteria were patients aged 14-45 years with idiopathic FAI. Exclusion criteria were the diagnosis of Ehlers-Danlos syndrome, previous ipsilateral hip procedures, lateral center edge angles less than 20 degrees, associated disorders, or Tönnis 2 or greater osteoarthritis. All patients underwent standardized hip arthroscopy with capsular closure/plication. The Beighton score (0-9) was self-scored by patients as has been shown to be a reliable method. Beighton scores were broken into five subgroups: 0-3 (normal), 4 (borderline GJH), 5-6 (mild GJH), and 7+ (moderate/severe GJH). PROs were measured at a minimum one-year follow-up. The modified Harris hip score (mHHS) was assessed relative to the minimal clinically important difference (MCID) of 8 and patient acceptable symptom state (PASS) of 74. Additional PROs included the HOOS domains of Pain and Sports/Recreation and the iHOT-12 score. Composite failure was defined as a reoperation for persistent symptoms or a failure to achieve either the mHHS, MCID, or PASS.Results:The mean Beighton scores in females was 4.1 with 56.9% having a Beighton score of 4 or greater. Mild GJH was present in 21.6%, while moderate/severe GJH was present in 22.2%. Overall, elevated Beighton scores were not predictive of inferior outcomes of hip arthroscopy for FAI in females and the presence of mild GJH was associated with superior outcomes relative to non-GJH and moderate/severe GJH subgroups. The rate of composite failure was lowest in the mild GJH group (6.2%) compared to the non-GJH group (9.7%), borderline (12.5%), and moderate/severe groups (13.6%), although this difference did not reach statistical significance. Females with mild GJH had significantly higher changes in iHot-12 and HOOS pain domain (p=0.012 and p=0.005, respectively).Conclusions:Over half of female patients undergoing FAI surgery have some level of underlying GJH as measured by the Beighton score. The presence of elevated Beighton scores did not appear to preclude excellent outcomes in females undergoing hip arthroscopy for FAI. Females with mild GJH actually demonstrated superior outcomes to other subgroups. Further longer-term outcomes are needed to better understand the role of GJH on the longevity outcomes of surgical treatment of FAI.

General Joint Hypermobility (GJH) is a common condition found in 2–57% of the population. Of those with GJH, 10% suffer from accompanying physical and/or psychological symptoms. While the understanding of GJH in the general population is unfolding, its implication in a cohort of children, adolescents and young adults are not yet understood. This systematic review explored GJH’s prevalence, tools to measure it, its physical and psychosocial symptoms, with a special interest in aesthetic sports. The CINHAL, MEDLINE, PsycINFO, SPORTDiscus and Scopus databases were searched for relevant studies. Inclusion criteria were (1) Age range of 5–24; (2) Participants had GJH; (3) A measurement for GJH; (4) Studies written in English language. Study screening for title, abstract and full text (when needed) and quality assessment were performed by two independent individuals. 107 studies were included in this review and were thematically grouped into six clusters expressing different foci: (1) GJH’s Core Characteristics; (2) Orthopedic; (3) Physical Other; (4) Psychosocial; (5) Treatment and (6) Aesthetic Sports. The review revealed a growing interest in GJH in this cohort in the last decade, especially regarding non-musculoskeletal physical implications and psychosocial aspects. Prevalence varied between different ethnic groups and as a parameter of age, gender and measurement. The most widespread tool to measure GJH was the Beighton scale, with a cut-off varying between 4 and 7. Children show fewer, but similar GJH implication to those in the general population, however, more research on the topic is warranted, especially regarding psychosocial aspects and treatment.

BackgroundThere is some evidence that indicates generalized joint hypermobility (GJH) is a risk factor for pain persistence and recurrence in adolescence. However, how early pain develops and whether GJH without pain in childhood is a risk factor for pain development in adolescence is undetermined. The aims for this study were to investigate the association between GJH and development of joint pain and to investigate the current GJH status and physical function in Danish adolescents.MethodsThis was a longitudinal cohort study nested within the Copenhagen Hypermobility Cohort. All children (n = 301) were examined for the exposure, GJH, using the Beighton test at baseline at either 8 or 10 years of age and then re-examined when they reached 14 years of age. The children were categorized into two groups based on their number of positive Beighton tests using different cut points (i.e. GJH4 defined as either < 4 or ≥ 4, GJH5 and GJH6 were similarly defined). The outcome of joint pain was defined as arthralgia as measured by the Brighton criteria from the clinical examination. Other outcome measures of self-reported physical function and objective physical function were also collected.ResultsChildren with GJH had three times higher risk of developing joint pain in adolescence, although this association did not reach statistical significance (GJH5: 3.00, 95% [0.94-9.60]). At age 14, the adolescents with GJH had significantly lower self-reported physical function (for ADL: GJH4 p = 0.002, GJH5 p = 0.012; for pain during sitting: GJH4 p = 0.002, GJH5 p = 0.018) and had significantly higher body mass index (BMI: GJH5 p = 0.004, GJH6 p = 0.006) than adolescents without GJH. There was no difference in measured physical function.ConclusionThis study has suggested a possible link between GJH and joint pain in the adolescent population. GJH was both a predictive and a contributing factor for future pain. Additional studies with larger sample sizes are needed to confirm our findings.

ObjectivesTo investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported...

CIRNE III Abstracts: Congresso Internacional de Reabilitação Neuromusculoesquelética e Esportiva, May 18–21, 2011, Vitória, Brazil

BackgroundAltered knee muscle activity in children with asymptomatic Generalized Joint Hypermobility (GJH) is reported during isometric contraction, static and dynamic balance tasks and jumping, but has not been studied during gait. Therefore, the aim was to investigate group differences in knee muscle activity simultaneously with knee joint kinematics during treadmill walking between children with and without GJH.MethodsGirls 14–15 years of age with GJH (inclusion criteria: Beighton score ≥6 of 9 and positive hyperextension ≥10° (one/both knees)) and a matched control group without GJH (inclusion criteria: Beighton score ≤5 and no knee hyperextension ≥10° ) were recruited. In total 16 participants with GJH and 10 non-GJH participants were included in the study.Surface electromyography (sEMG) was measured from the quadriceps, hamstrings and gastrocnemius muscles of the dominant leg during treadmill walking. Maximal voluntary isometric contractions while sitting were used for normalisation of sEMG to % of Maximum Voluntary EMG (%MVE). Knee joint angles during treadmill walking were measured by electrogoniometer. Furthermore, co-contraction index (CCI) was calculated, and presented for muscle groups of hamstrings-quadriceps (HQ) and gastrocnemius-quadriceps (GQ). CCI of medial and lateral sides of the knee, including ratio of the medial and lateral CCI for HQ and GQ were calculated.ResultsNo group differences were found in demographics, muscle activation level, nor CCI and CCI ratios. However, participants with GJH displayed significantly decreased knee joint angle, mean (153º vs. 156º; p =0.03) and minimum (105º vs. 111º; p=0.01), during treadmill walking compared with controls.ConclusionMuscle activity during gait was not different between participants with GJH and non-GJH participants. However, participants with GJH displayed minor but statistically significant increased knee flexion during gait. Since the clinical consequences of increased knee joint flexion during gait are unknown, future studies should follow a larger cohort longitudinally during overground walking for development of clinical complications in this group.

Children with generalized hypermobility of the joints and musculoskeletal complaints frequently visit pediatric clinics, but many show no currently known collagen or other possibly related diseases. Whether the symptoms are confined to the musculoskeletal system is unknown. We assessed whether such children have detectable differences in laxity of connective tissue present in organ systems other than joints. We also assessed whether children with generalized joint hypermobility and musculoskeletal complaints have more profound systemic changes in connective tissue of various organ systems as compared with children with generalized joint hypermobility without musculoskeletal complaints. Anthropometrics, range of joint motion, muscle strength, skin extensibility, blood pressure, quantitative ultrasound measurements of bone, and degradation products of collagen were studied in 15 prepubertal children with generalized joint hypermobility and musculoskeletal complaints and compared with a population-based reference group of 95 nonsymptomatic prepubertal children. Symptomatic hypermobile children were also compared with children of the population-based reference group who had asymptomatic hypermobility of the joints (n = 16). Children with symptomatic generalized joint hypermobility had significantly higher skin extensibility (5.6 mm/15 kPa, 95% confidence interval [CI]: 4.0-7.1), lower quantitative ultrasound measurements (speed of sound: -26.8 m/s; 95% CI: -41.1 to -12.6) in bone, and lower systolic and diastolic blood pressure (-8.0 mmHg, 95% CI: -13.3 to -2.8; and -6.0 mmHg, 95% CI: -10.0 to -2.2, respectively) as compared with the total reference group. Also, they had significantly lower excretion of urinary hydroxylysylpyridinoline cross-links (mean difference: -51.3 micro mol/mmol; 95% CI: -92.2 to -10.4) as well as lysylpyridinoline cross-links (-18.7 micro mol/mmol; 95% CI: -36.9 to -0.5). Age, gender, body weight, height, and particularly cross-links excretion did not explain group differences in clinical and bone characteristics. After adjustment for age, gender, body weight, and height, children with symptomatic generalized joint hypermobility (n = 15) had significantly higher total range of joint motion (117.8 degrees; 95% CI: 77.7-158.0), skin extensibility (3.5 mm/15 kPa; 95% CI: 1.6-5.3), lower quantitative ultrasound measurements in bone (speed of sound: -27.9 m/s; 95% CI: -48.4 to -7.5), borderline lower diastolic blood pressure (-4.9 mmHg; 95% CI: -10.7-0.9), and significantly higher degradation products in urine (hydroxyproline/creatinine: 21.2 micro mol/mmol; 95% CI: 2.3-40.1) as compared with asymptomatic hypermobile children of the total reference group (n = 16). After adjustment for possible confounders, children with generalized joint hypermobility without musculoskeletal complaints had a significantly higher total range of joint motion and more profound skin extensibility, as compared with the reference group (n = 79). Clinically manifested symptoms in otherwise healthy children with generalized joint hypermobility are accompanied by increases in the laxity of other body tissues. Thus, generalized joint hypermobility with musculoskeletal symptoms does not seem to be restricted to joint tissues. In symptomatic hypermobile children, a more systemic derangement was also present as compared with asymptomatic hypermobile children.

Background: The role of generalized joint hypermobility (GJH) in the setting of femoroacetabular impingement (FAI) and how it affects clinical presentation has begun to be investigated. It is possible that GJH and hip instability are contributors to the symptoms in this population. Elevated Beighton scores represent GJH. The study purpose was to investigate GJH prevalence in patients with symptomatic FAI and correlate this with complaints of pain, mobility, or stability. Methods: A prospective multicenter study of FAI patients undergoing primary hip arthroscopy was reviewed. Inclusion criteria were patients aged 14-45 years with idiopathic FAI. Exclusion criteria were previous ipsilateral hip procedures, associated disorders, or Tönnis 2+ osteoarthritis. Beighton ≥4 was considered a marker of GJH. Patients recorded whether their primary and secondary complaint was pain, mobility, or instability. Chi-squared or Fisher’s Exact test were utilized to compare groups. Results: The study included 665 patients with mean age of 24.9±7.8 years and 55.8% being female. The GJH (Beighton ≥4) was 56.9% in females and 28.6% in males (p&amp;lt;0.001). In females, 43.9%, 22.4%, and 7.0% had Beighton of 5+, 7+, and 9 respectively, compared to 16.3%, 5.4%, and 1.7% in males (p&amp;lt;0.001). Overall, pain was the primary complaint in 71.6 % of patients, compared to 24.2% complaining primarily of issues of mobility and 4.2% complaining primarily of issues with stability. Among females, the presence of GJH did not influence primary complaints with pain being the predominant symptom in 73.2% of females with Beighton 4+, compared to 70.3% of females with Beighton score under 4 (p=0.402). Overall, 18.0% had stability as primary or secondary complaint. This was unchanged for females (17.8%) and males (18.4%) (p=0.844). GJH had no effect either for Beighton ≥4 (19.3%) and Beighton &amp;lt;4 (17.0%) (p=0.445). Conclusions: Over half of female patients undergoing FAI surgery have underlying GJH as measured by the Beighton score. Even in the setting of females with GJH, primary complaint remains pain, followed by mobility then instability. Further research is needed to better understand the role of generalized joint hypermobility in the pathophysiology of FAI and the outcomes of surgical treatment.

IntroductionThere is growing evidence that generalised joint hypermobility (GJH) is associated with several psychiatric conditions. There are no previous studies on adult ADHD.ObjectivesTo evaluate, in a large Swedish sample, if generalised joint hypermobility and adult ADHD are associated.Methods431 adults with ADHD and 417 controls were included. GJH was assessed by the Beighton Score, a physical examination, and the 5PQ, a self-report screening tool. Exploratively, reported musculoskeletal symptoms and abnormal skin manifestations suggestive of symptomatic GJH (e.g. Ehlers-Danlos syndrome), were assessed to differentiate this group from the general GJH group. Logistic regressions determined the influence of an ADHD diagnosis and known covariates (age, sex and ethnicity) on GJH and symptomatic GJH respectively.ResultsADHD was associated to GJH, as defined by the Beighton Score and the 5PQ, with adjusted odds ratios of 4.65 (CI 95% 3.01-7.18, p&lt;.005) and 1.86 (CI 95% 1.39-2.48, p&lt;.005), respectively. Likewise, ADHD and symptomatic GJH were associated with adjusted odds ratios of 6.94 (CI 95% 4.05-11.89, p&lt;.005) and 2.66 (CI 95% 1.94-3.66, p&lt;.005).ConclusionsGJH and adult ADHD are associated conditions. Symptomatic GJH, defined as additional symptoms of pain and/or skin manifestations, has a considerably stronger link to adult ADHD than unspecific GJH has. GJH may represent a marker of an underlying systemic disorder with physical manifestations in connective tissue as well as behavioural manifestations including hyperactivity, impulsiveness and inattentiveness. Future studies should investigate if this represents a novel subtype of ADHD and if symptomatic GJH affects the ADHD management.DisclosureNo significant relationships.

Neuromuscular knee joint control in adolescents with and without generalised joint hypermobility during landing in the single leg hop for distance test

BackgroundKnee injuries often occur due to biomechanical factors such as knee joint laxity. Individuals with Generalised Joint Hypermobility (GJH) frequently have knee joint hypermobility. Thus, GJH has been proposed as...

OBJECTIVES/GOALS: Evidence suggests that individuals with generalized joint hypermobility (GJH), or excessive joint range of motion, are at higher risk of developing chronic neck pain. The objective of this study is to determine the prevalence and clinical presentation of chronic neck pain in GJH and investigate its associations with other measures of spine health. METHODS/STUDY POPULATION: Data was collected at the Driven to Discover Research Facility at the 2022 Minnesota State Fair. Individuals 18 years and older were invited to participate. All enrolled participants completed Phase 1, which included: the Beighton Score (measure of GJH), the 5-Point-Questionnaire (self-report survey for current or historical GJH), and a custom self-report survey for demographics and musculoskeletal pain. A subset of participants was also asked to complete Phase 2 of the study. Phase 2 consisted of additional self-report surveys (Neck Disability Index (NDI) and PROMIS-10 Global) and the following physical measures: neck range of motion in all planes, neck strength in flexion-extension and lateral bending, and grip strength. RESULTS/ANTICIPATED RESULTS: A total of 559 participants were enrolled in the study. All participants completed Phase 1, and 285 of those individuals completed Phase 2. Those with a Beighton Score≥4 were categorized as having GJH. The overall prevalence of GJH was 23.8% for females and 9.1% for males. Consistent with previous studies, multiple linear regression analysis (R2=0.20, F(2,552) = 69.37, p DISCUSSION/SIGNIFICANCE: This is one of the largest studies investigating GJH, pain, and physical measures of neck function in the general population. The results highlight the higher prevalence of chronic neck pain in those with GJH and will form the basis for a subsequent study to identify mechanisms and potential therapeutic targets for individuals with GJH and chronic pain.

AB1146 Musculo-skeletal pain and joint hypermobility in children: A complex relationship