Benign Joint Hypermobility Syndrome Research Articles

Uncovering the alterations in extrinsic foot muscle mechanical properties and foot posture in fibromyalgia: a case-control study.

The aim of the study was to evaluate foot posture and the mechanical properties of extrinsic foot muscles in fibromyalgia. Patients with fibromyalgia (n = 86) and age- and gender-matched controls (n = 41) were included in the study. Foot Posture Index (FPI), Beighton and Brighton criteria were used to evaluate static foot posture, joint hypermobility, and benign joint hypermobility syndrome (BJHS), respectively. Tonus, elasticity, and stiffness of the extrinsic foot muscles including gastrocnemius medialis, tibialis anterior, and peroneus longus were measured by the MyotonPRO® device. Foot function, quality of life, and physical activity level were assessed by the Foot Function Index (FFI), Short Form-36 (SF-36), and the International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively. The frequency of abnormal foot posture in the fibromyalgia and control groups was 68.6% versus 39%, respectively; and neutral foot posture was approximately twice as prevalent in the control group compared to the fibromyalgia group (p = 0.006). Pronated foot posture was the most common abnormality in fibromyalgia (61.6%) and observed in 85.5% of the patients with joint hypermobility and in 87.1% of those meeting BJHS criteria. The elasticity of peroneus longus at rest and the elasticity of tibialis anterior in the standing position were significantly different between the fibromyalgia group and the control group [1.08 (0.22) vs. 1.02 (0.25), p = 0.037 and 0.92 (0.29) vs. 0.87 (0.24), p = 0.011, respectively]. Regarding the fibromyalgia group, no difference was detected among foot posture groups in terms of myotonometric data. Pronation foot posture is common in fibromyalgia with a much higher frequency in fibromyalgia patients with hypermobility. In daily clinical practice for fibromyalgia, particular attention should be given to foot alignment.

Correlation between benign joint hypermobility syndrome and headache in children and adolescents

BackgroundBenign Joint Hypermobility Syndrome (BJHS) is a most common hereditary connective tissue disorders in children and adolescents. This study aimed to investigate the prevalence and subtypes of headache in children with BJHS.MethodsThis observational-analytical study was conducted in a case-control setting on school children aged 7 to 16 years in 2021–2023 in Isfahan, Iran. Students were examined for BJHS using Beighton criteria by a pediatric rheumatologist. Headache disorder was diagnosed according to the Child Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaires for child and adolescent and International Classification of Headache Disorders (ICHD-III).ResultsA total of 4,832 student (mean age 10.3 ± 3.1 years), 798 patients with BJHS and 912 healthy children were evaluated. The probability of headache in children aged 7–11 with hypermobility was 3.7 times lower than in children aged 12–16 with hypermobility (P = 0.001). The occurrence of headache in children with BJHS was more than the control group (P = 0.001), and the probability of headache in children with BJHS was 3.7 times higher than in healthy children (P = 0.001). Migraine was the most common headache type reported of total cases. The probability of migraine in children with BJHS was 4.5 times higher than healthy children ( P = 0.001).ConclusionThis study showed a significant correlation between BJHS and headache (especially migraine) in children and adolescents.

Gastroparesis in a patient with benign joint hypermobility syndrome.

Gastroparesis in a patient with benign joint hypermobility syndrome.

Hypermobility spectrum disorders: A review.

It remains a clinical challenge identifying when joint hypermobility (JH) is responsible for pain. Previous nomenclature utilized terms such as (benign) joint hypermobility syndrome (JHS) but this was updated in 2017 as advances in genetics provide a basis for nearly all variants of Ehlers-Danlos syndrome (EDS) with the exception of hypermobile EDS (hEDS). New terminology describes hypermobility spectrum disorders (HSDs) as the updated term for JHS. Diagnosis of a subtype of HSDs should be considered in patients who have JH coupled with the presence of secondary musculo-skeletal manifestations (trauma, chronic pain, disturbed proprioception, and other manifestations) and at the exclusion of hEDS. Extra-articular manifestations are common. Treatment relies on management strategies for other chronic pain syndromes with a multidisciplinary approach likely optimal. Lifestyle modifications focus on weight loss and exercise. Physical therapy helps strengthen periarticular muscles, improving mobility. Pharmacologic therapies focus on judicious use of non-steroidal anti-inflammatory drugs and acetaminophen. Serotonin and norepinephrine reuptake inhibitor may help widespread pain. Avoidance of opioids remains prudent. The purpose of this review is to provide clinicians the rationale for the update in nomenclature, understand the musculoskeletal and extra-articular manifestations of the subtypes of HSDs, considerations when making the diagnosis, and treatment.

Increased Prevalence of Generalized Joint Hypermobility Observed in Patients With Recurrent Temporomandibular Joint Dislocation

Generalized joint hypermobility (GJH), determined by the Beighton score, is a fundamental part of diagnosing benign joint hypermobility syndrome (BJHS), which may also present extra-articular manifestations, and is determined by the Brighton criteria. This study was designed to investigate whether there is an association between recurrent temporomandibular joint (TMJ) dislocation and these disorders. A retrospective cross-sectional study was conducted. Hospital-based patients with a history of recurrent TMJ dislocation were compared to population-based patients that did not experience TMJ dislocations or any other TMJ disorders. Age and sex matching were performed between the study groups. All subjects reached the age of skeletal maturity. A history of recurrent TMJ dislocations. Measurements of Beighton score (range from 0 to 9 with a score of ≥ 4 indicating GJH) and correspondence to the Brighton criteria (with at least two "major" criteria or one "major" criterion plus two "minor" criteria or four "minor" criteria indicating BJHS). Included age and sex. Mann-Whitney U-test for continuous variables and the χ2 test or Fisher's exact test for categorical variables. Statistical significance was set at P<.05. A total of 68 participants were included, of whom 34 patients presented with recurrent TMJ dislocations compared with a control population of 34. The Mean participants were 31.35±8.06years, and 29.4% (n=20) were males. Of the dislocation group, 16 (47.0%) patients had a Beighton score of 4 or higher. The Beighton sum score was significantly higher, with a TMJ dislocation group mean score of 3.06±2.8, compared with a control score of 0.82±1.1 (P=.001). A total of 58.8% (n=20) of the TMJ dislocation group participants met the Brighton criteria versus none (0.0%) of the control group (P=.001). We found an association between recurrent TMJ dislocation and GJH. An association with BJHS was also found, based mainly on articular manifestations. Early detection of these disorders in patients suffering from recurrent TMJ dislocation may help identify individuals at increased risk for joint instabilities and allow the implementation of appropriate preventive management strategies.

Outcomes of rectal prolapse surgery in patients with benign joint hypermobility syndrome.

Rectal prolapse is a debilitating disorder of the pelvic floor, and treatment outcomes are variable. Previous studies have identified underlying benign joint hypermobility syndrome (BJHS) in some patients. We sought to determine the outcomes of these patients after undergoing ventral rectopexy surgery (VMR). All consecutive patients who were referred to the pelvic floor unit at our institution between February 2010 and December 2011 were considered for recruitment into the study. Following recruitment, they were assessed using the Beighton criteria to determine the presence or absence of benign joint hypermobility syndrome. Both groups underwent similar surgical interventions and were then followed up. The need for revisional surgery was recorded in both groups. Fifty-two patients [34 normal; M:F, 1:6; median age 61 (range 22-84) years; 18 BJHS; M:F, 0:1; median age 52 (range 25-79) years] were recruited. A total of 42 patients completed the full 1-year follow-up (26 normal, 16 benign joint hypermobility syndrome). Patients with benign joint hypermobility syndrome were significantly younger (median age 52 versus 61years, p < 0.001) with male to female ratio of 0:1 versus 1:6, respectively. In addition, they were significantly more likely to require revisional surgery than those without the condition (31% versus 8% p < 0.001). In most cases, this was in the form of a posterior stapled transanal resection of the rectum procedure. Patients with BJHS presenting for rectal prolapse surgery were younger and are more likely to require further surgery for rectal prolapse recurrence than those without the condition.

Effect of comorbid benign joint hypermobility and juvenile fibromyalgia syndromes on pediatric functional gastrointestinal disorders

ABSTRACT Objectives Musculoskeletal pain has a considerable frequency in pediatric outpatients. Benign joint hypermobility (BJHS) and juvenile fibromyalgia syndrome (JFMS) are non-inflammatory causes of musculoskeletal pain. In these syndromes, pain is often accompanied by various symptoms such as fatigue, sleep difficulties, mood disorders, cognitive dysfunction, dizziness, headaches, abdominal pain, irritable bowel syndrome, and restless legs syndrome. Functional dyspepsia, functional vomiting, functional abdominal pain, functional constipation, and irritable bowel syndrome all together are termed functional gastrointestinal (GI) disorders. We aimed to evaluate the functional gastrointestinal disorders association of BJHS and JFMS. Methods Patients aged 10–18 years who were diagnosed with functional GI disorder in the pediatric gastroenterology department were included in the study. The findings of BJHS and JFMS were evaluated by the pediatric rheumatology department. Scales for anxiety, somatization, and depression were administered by a child psychiatrist. COMPASS 31 scoring was used in autonomic dysfunction. Results The prevalence of JFMS and BJHS was 64% and 32%, respectively in children with a functional GI disorder. Retrosternal chest pain, dysphagia, early satiation, nausea, vomiting, and regurgitation were common in JFMS (p = 0.007; p = 0.005; p = 0.018; p = 0.002, p = 0.013; p = 0.014, respectively). Gastrointestinal symptoms did not differ with BJHS. One hundred six (88.3%) and 99 (82.5%) had orthostatic intolerance and reflex syncope, respectively. One hundred three (85.6%) had anxiety symptoms, 101 (84.2%) had somatization symptoms, and 102 (85%) had depression symptoms. Conclusions Functional GI disorders, JFMS, and BJHS are complex intertwined disorders influenced by emotional distress. Therefore, a multidisciplinary approach is necessary for the diagnosis and treatment process.

Effects of Benign Joint Hypermobility Syndrome on the Clinical Characteristics of Carpal Tunnel Syndrome in Females.

Background and PurposeThe study aim was to determine the effects of benign joint hypermobility syndrome (BJHS) on symptom severity and functional capacity in females with carpal tunnel syndrome (CTS) based on the findings of physical examinations.MethodsOne hundred female patients diagnosed with bilateral CTS in electrophysiological testing were included in this study. The participants were evaluated for BJHS using the Brighton 1998 criteria, and divided into two groups: one consisting of 56 CTS patients with BJHS, and the other comprising 44 CTS patients without BJHS. Tinel’s, Phalen’s, and reverse Phalen’s tests were applied to all patients, and the severity and functional capacity of CTS were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire.ResultsSymptom severity and functional capacity varied significantly between the two groups in the right hand (p=0.037 and p=0.039, respectively) and in the left hand (p=0.016 and p=0.029). The hypermobile group yielded more positive results on the right side during Tinel’s, Phalen’s, and reverse Phalen’s tests (p=0.032, p=0.032, and p=0.018, respectively).ConclusionsHypermobility in females exacerbated the symptoms of CTS and led to a further reduction of functional capacity. Therefore, hypermobility should be tested and an intense exercise program should be implemented in BJHS patients, especially in females with CTS.

Knee Trauma.

Knee Trauma.

Оптимізація терапії у пацієнтів з болем в нижній частині спини в залежності від наявності синдрому доброякісної гіпермобільності суглобів

Оптимізація терапії у пацієнтів з болем в нижній частині спини в залежності від наявності синдрому доброякісної гіпермобільності суглобів

The evaluation of nailfold capillaroscopy pattern in patients with fibromyalgia.

Objectives This study aims to evaluate nailfold capillaroscopic pattern in patents with fibromyalgia and to assess the relation of capillaroscopic parameters with clinical variables and disease-related measures.Patients and methods This cross-sectional, case-control study included 60 participants (4 males, 56 females; mean age: 44.0±8.2 years; range, 26 to 64 years) between August 2019 and November 2019. All participants were divided into two groups as the primary fibromyalgia group (n=30) who met the 2016 modified American College of Rheumatology Diagnostic Criteria for Fibromyalgia and the control group (n=30) consisting of age- and sex-matched healthy individuals. Nailfold capillaroscopy was performed by a digital microscope under a magnification of 200X. Capillary density, capillary loop diameter, number of dilated, giant and neoangiogenic capillaries, capillary shape, number of avascular areas, micro-aneurysms and micro-hemorrhages were evaluated by an assessor who was blind to the group allocation. In the fibromyalgia group, Widespread Pain Index, Symptom Severity Scale scores, and Fibromyalgia Severity scores were calculated. Health status and presence of benign joint hypermobility syndrome (BJHS) were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) and revised Brighton criteria, respectively.Results Of the capillaroscopic parameters, the mean capillary loop diameter, number of micro-aneurysms, avascular areas, and neoangiogenic capillaries were significantly higher in the patient group compared to the controls (p<0.001, p=0.016, p=0.038, and p=0.04, respectively). Nailfold capillaroscopic findings did not significantly differ between the patients with (n=16) and without concomitant BJHS (n=14). Of the disease-related measures, only FIQ score showed a weak correlation with the number of dilated capillaries (p=0.324).Conclusion Patients with fibromyalgia have distinct capillaroscopic patterns than healthy population. Capillaroscopic features, in general, are not related to clinical variables and disease-related measures.

Показники еластичності клубово-поперекового м`язу у пацієнтів з болем в нижній частині спини в залежності від наявності синдрому доброякісної гіпермобільності суглобів

Pain in the lower back is a highly urgent problem that leads to a decrease in the quality of life of a large number of patients in the modern world. At the same time, the causes of pain in the lower back are different and their combination has not been sufficiently studied to date. It is known that the presence of benign joint hypermobility syndrome in a patient significantly worsens the course and manifestations of pain in the lower back. One of the components of pain in the lower back is changes in the iliopsoas muscle. This is psoas syndrome. At the same time, the diagnosis of psoas syndrome in practical medicine is complicated by the lack of specific laboratory tests and imaging techniques. The purpose of this work was to study the possibilities of determining the tension of the iliopsoas muscle using shear wave elastometry in patients with pain syndrome in the lower back and the difference between their tensions depending on the presence of benign hypermobility syndrome in patients. Material and methods. We examined 83 patients with lower back pain aged 42.31±1.54 years, 41 were female and 42 were male. To participate in the study, all patients underwent X-ray and ultrasound examination of the hip joints. Patients were excluded from the study in the presence of signs of osteoarthritis. To determine the presence of signs of hypermobility of the joints, we used the criteria of Baiton; the diagnosis was made on condition of obtaining more than 5 points. Among the patients examined by the Bayton criteria, 18 patients were diagnosed with benign joint hypermobility syndrome, among them 13 women and 5 men. As a control group, we selected 15 patients aged 45.6±1.74 years without complaints of pain in the lumbar region of the back and hips and without signs of benign joint hypermobility syndrome. We used shear wave elastometry to determine the stiffness of the distal parts of the lumbosacral muscle. A visual analog scale of pain (from 1 to 10) was used to determine the severity of the pain syndrome. Conclusion. We found that all patients with complaints of pain in the lower back had a significantly higher tension of the iliopsoas muscle in comparison with the group of conditionally healthy patients. The increase in tension had a strong correlation with the severity of pain syndrome according to the data of the visual analogue scale. Indicators of muscle tissue rigidity did not depend on the presence and severity of benign joint hypermobility syndrome

Correlation between benign joint hypermobility syndrome and primary focal hyperhidrosis in children: a novel concept

BackgroundBenign joint hypermobility syndrome (BJHS) is one of the most common hereditary connective tissue disorders in children in which autonomic nervous system involvement has been reported. This study aimed to evaluate the frequency of primary focal hyperhidrosis in children with BJHS.MethodsThis observational-analytical study was conducted in a case-control setting on children aged 3 to 15 years in 2018 at Mofid Children’s Hospital, Tehran, Iran. Benign joint hypermobility syndrome was diagnosed according to the Brighton criteria; then, the patients referred to a dermatologist for evaluation of hyperhidrosis.ResultsIn total, 130 eligible patients with confirmed BJHS and 160 age- and sex-matched healthy subjects were enrolled in this study. Primary focal hyperhidrosis (PFH) was seen in 56.2 and 16.3% of the cases and controls, respectively, indicating a significant difference (P < 0.05). The severity of hyperhidrosis did not differ between the two groups.ConclusionAlthough the results of the study showed a significant correlation between BJHS and PFH, more comprehensive studies are needed to confirm these findings.

Показники жорсткості менісків колінних суглобів за даними зсувнохвильової еластометрії в залежності від наявності синдрому доброякісної гіпермобільності суглобів

Показники жорсткості менісків колінних суглобів за даними зсувнохвильової еластометрії в залежності від наявності синдрому доброякісної гіпермобільності суглобів

Classification, nosology and diagnostics of Ehlers-Danlos syndrome

Ehlers-Danlos syndrome (EDS) comprises a group of heritable connective tissue disorders which has as cardinal features varying degrees of skin hyperextensibility, joint hypermobility, easy bruising and skin fragility. The 2017 New York nosology distinguishes 13 types of EDS, which all, except hypermobile EDS, have a known molecular basis. Hypermobile EDS is recognized as a common and often disabling disorder, incorporating benign joint hypermobility syndrome. EDS needs to be differentiated from other connective tissue disorders, in particular Marfan syndrome, Loeys-Dietz syndrome and cutis laxa. The frequent types of EDS can be diagnosed after careful history taking and clinical examination, but for definite diagnosis molecular confirmation is needed in all types. Management for EDS patients preferably is provided by multidisciplinary teams in expertise centres. After diagnosing EDS genetic counselling is an essential part of the management of patients and their family.

Comorbid Bipolar Disorder and Benign Joint Hyper Mobility Syndrome (BJHS): More than a Mere Coincidence?

Comorbid Bipolar Disorder and Benign Joint Hyper Mobility Syndrome (BJHS): More than a Mere Coincidence?

Correlation between Generalized Joint Hypermobility and Chronic Musculoskeletal Pain in College Students

The main complaint of patients with benign joint hypermobility syndrome (BJHS) is chronic musculoskeletal pain (MSP) that may affect their daily activities, leading to a decreased quality of life. While some studies support an association between generalized joint hypermobility (GJH) and MSP in children and adolescents, there is no published study yet looking into a correlation of GJH and MSP in a college-aged population in the US. PURPOSE: To determine whether young adults with generalized joint hypermobility are more likely to suffer from chronic musculoskeletal pain. METHODS: Undergraduate students studied the general structure of joints and range of motion, including joint hypermobility, before completing a survey that included questions about chronic musculoskeletal pain and the severity of pain. They worked in groups to evaluate each other’s joints for hypermobility under supervision by the research team. RESULTS: Overall, 20.8% of 654 participants showed GJH based on a cutoff Beighton score of ≥ 4. Women had statistically significant higher rates of GJH (23.9%) than men (12.2%) (Wald Test, DF = 1, Chi-square = 10.049, P = 0.0015; odds ratio female to male: 0.44).Ninety four of 650 participants (14.4%) recalled chronic joint pain. The most commonly named joints were knee (n =59), shoulder (n = 17), hip (n = 14), ankle (n = 9), and elbow (n = 7). Male and female participants with GJH reported higher rates of chronic joint pain than participants without GJH. There was, however, no significant difference (Pearson Chi-square Test, Chi-square = 1.386, p = 0.5001, n = 650). The prevalence of chronic neck/back pain in our study was 20.8%. Participants with GJH reported higher rates of chronic back/neck pain, yet, the difference was not statistically significant (Pearson Chi-square Test, Chi-square = 3.850, p = 0.1459, n = 650). The average pain intensity on a scale from 0 to 10 was more or less the same for both types of chronic pain (4.5 for chronic joint pain, 4.2 for chronic neck/back pain) and for respondents with and without GJH. The ranges for the reported pain intensity as well as the standard deviations for all averages were also very similar. CONCLUSION: Young adults with GJH are not reporting higher rates of chronic pain in joints, the neck or the back nor do they suffer from more severe pain than their peers without GJH.

Comparable patient-reported outcomes in females with or without joint hypermobility after hip arthroscopy and capsular plication for femoroacetabular impingement syndrome.

Hip arthroscopy is widely utilized to treat femoroacetabular impingement syndrome (FAIS). In order to evaluate the postoperative clinical and functional outcomes at 2-year follow up in patients with and without benign joint hypermobility syndrome following hip arthroscopy with capsular plication for FAIS, consecutive female patients with generalized ligamentous laxity undergoing primary hip arthroscopy with complete T-capsulotomy closure via plication for FAIS were prospectively identified. Patients were matched in a 4:1 ratio based on Beighton-Horan joint mobility index (BHJMI) then classified into no generalized joint laxity (NGJL, Score<4) or generalized joint laxity cohort (GJL, Score=4). Patient and surgical-related factors were analyzed using univariate and paired analysis with statistical significance set at a = 0.05. A total of 125 female patients were included in the study: 25 generalized joint laxity (GJL) patients and 100 matched to age, sex and BMI (NGJL cohort). The results demonstrated that there were no significant differences between demographics, preoperative range of motion, or radiographic analysis on univariate analysis. There was no statistical difference in postoperative range of motion between groups, though both groups demonstrated significant increases in postoperative flexion and postoperative internal rotation following hip arthroscopy. Paired analysis demonstrated no significant difference in HOS-SS, HOS-ADL, mHHS or VAS-pain, while GJL patients reported significantly greater patient satisfaction score at 2-years follow-up (p=0.007). In summary, hip arthroscopy with capsular plication is a highly effective treatment for FAIS in patients with and without generalized joint laxity. In our analysis, patients with and without generalized joint laxity demonstrated statistically similar and significant improvement in outcomes.

Musculoskeletal pain and musculoskeletal syndromes in adolescents are related to electronic devices

ObjectiveTo evaluate television and simultaneous electronic devices use in adolescents with musculoskeletal pain and musculoskeletal pain syndromes. MethodsA cross‐sectional study was performed in 299 healthy adolescents of a private school. All students completed a self‐administered questionnaire, including: demographic data, physical activities, musculoskeletal pain symptoms, and use of simultaneous television/electronic devices (computer, internet, electronic games, and cell phones). Seven musculoskeletal pain syndromes were also evaluated: juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendinitis, bursitis, epicondylitis, and complex regional pain syndrome. ResultsInter‐rater agreement between pretest and retest was 0.83. Musculoskeletal pain and musculoskeletal pain syndrome were found in 183/299 (61%) and 60/183 (33%), respectively. The median age (15 [10–18] vs. 14 [10–18] years, p=0.032) and years of education (10 [5–12] vs. 9 [5–12] years, p=0.011) were significantly higher in adolescents with musculoskeletal pain when compared with those without this condition. The frequencies of female gender (59% vs. 47%, p=0.019), cell phone use (93% vs. 81%, p=0.003), and simultaneous use of at least two electronic devices (80% vs. 67%, p=0.011) were significantly higher in the former group. Further comparisons between adolescents with and without musculoskeletal pain syndromes revealed that the frequency of female gender was significantly higher in the former group (75% vs. 25%, p=0.002), and with a significantly reduced median of weekends/holidays electronic games use (1.5 [0–10] vs. 3 [0–17]h/day, p=0.006). ConclusionsA high prevalence of musculoskeletal pain/syndromes was observed in female adolescents. Musculoskeletal pain was mostly reported at a median age of 15 years, and students used at least two electronic devices. Reduced use of electronic games was associated with musculoskeletal pain syndromes.

Study of the Comparative Efficacy of Strengthening Exercise between Extensor Group of Muscles and Both Flexor and Extensor Groups of Muscles in Patient presenting with Symptoms in Affected Joints of Benign Joint Hypermobility Syndrome

Study of the Comparative Efficacy of Strengthening Exercise between Extensor Group of Muscles and Both Flexor and Extensor Groups of Muscles in Patient presenting with Symptoms in Affected Joints of Benign Joint Hypermobility Syndrome