Hyper Mobility Research Articles

Long-term efficacy of the trans-obturator and retropubic mid-urethral slings for stress urinary incontinence: update from a randomized clinical trial.

To report the extended long-term results of the use of tension-free vaginal tape(TVT) and trans-obturator tape (TOT) for the treatment of female stress urinary incontinence (SUI). A prospective, multicentre randomized clinical trial comparing the use of TVT and TOT was used to evaluate 87 patients. The inclusion criteria were stress or mixed UI associated with urethral hyper mobility (the stress component was clinically predominant), while the exclusion criteria were previous anti-incontinence surgery and/or pelvic organ prolapse. The objective cure criteria were a negative provocative stress test and a negative 1-h pad test, with no further treatment for SUI. The subjective cure criteria were a 3-day voiding diary, quality-of-life questionnaires (UDI6-IIQ7), and patient satisfaction on a scale from 0 to 10. Eighty-seven patients were evaluated (47 TOT and 40 TVT) at a median follow-up of 100 months. Subjective and objective cure rates were 59.6 and 70.2 % in the TOT group and 75 and 87.5 % in the TVT group. The mid-to-long-term trend was a decreasing continence rate in patients who underwent TOT, compared with a stable rate for TVT. The Kaplan-Meier survival curve showed that continence rate decreased for up to 25 months after surgery, with stabilization thereafter for the TVT group while continuing to drop in the TOT group, with no inter-group difference. The patients in both groups were highly satisfied at long-term follow-up. The overall continence rate worsened for both groups within 25 months. While the results tend to stabilize in the TVT group, a further decline in the TOT was observed.

Pediatric Temporomandibular Joint Disorders

Submit Manuscript | http://medcraveonline.com J Dent Health Oral Disord Ther 2015, 2(3): 00047 precise etiology. The etiology of TMD in children has been related to trauma, malocclusion, and oral Para-functions habits such as bruxism, nail biting, and non-nutritive sucking. However, the relationship between oral Para-functional habits and TMD, if it exists, seems to be controversial and unclear. Falls, sports-related injuries, and road traffic accidents are the most frequent causes of facial injuries in children which can affects the TMJ. Moreover: Early TMD is a common feature especially in girls at the beginning of puberty. The etiology is not clear but it can be considered caused by factors, such as hyper mobility and hormone influence. Fracture of the condyle is often followed by remodeling and a disturbance in the development of ramus height and mandibular body length, ankylosis of the TMJ, growth disturbances can be seen in most cases and can be severe. Bruxism (Greek: Bruko, “gnashing of teeth”) the main cause of pediatric TMD widely defined as an anxiety response to environmental stress. Clinically, bruxism characterized by presence of abnormal movements and clenching which can lead to tooth grinding, attrition. According to the International Classification of Sleep Disorders, the bruxism is a movement disturb related to sleep, characterized by repeated contractions of the masticatory muscles, resulting in grinding or clenching of the teeth. Wide range of muscles can be affected by bruxism. These groups of muscles include muscles of mastication (primary muscles) and muscles of the craniofacial complex, shoulders and neck (secondary muscles). These groups of muscles have anatomical and neural links. Neural link through trigeminalcervical complex, which is formed by the upper cervical and trigeminal nerves. And anatomical link, through the axes for the eccentric mandibular movements and the cervical column which concur in the occiput. The mandibular position can influence the activity of the muscles of the craniofacial complex, shoulders and neck through these two links. If the masticatory system, neck and shoulders are anatomically and physiologically connected, then the bruxism can easily affects all the above described structures.

No correlations between radiological angles and self-assessed quality of life in patients with hip dysplasia at 2–13 years of follow-up after periacetabular osteotomy

Only few studies have described patients' health-related quality of life (QoL) after periacetabular osteotomy (PAO). Thus, there is a lack of data on the self-assessed outcome of patients operated with PAO, and none of the existing studies correlate the results from Medical Outcomes Short Form-36 questionnaire (SF-36) with the radiological parameters. To investigate the health-related QoL for patients with hip dysplasia operated with PAO and to investigate whether QoL is associated with the acetabular angles or hypermobility. Out of 388 patients, 228 patients (mean age, 40.5 years; mean follow-up, 7.1 years) returned the SF-36 and Beighton questionnaires. The patient's QoL was compared to reference data from a Danish population. Center-edge (CE) and acetabular index (AI) angles were measured before and after PAO and the association with the patients' QoL was tested with logistic regression. For both men and women the postoperative SF-36 score was significantly lower than for the reference data for a Danish population, especially for those dimensions concerning physical health. No association was found between the patients' CE or AI angles before or after PAO and their subsequent QoL. Significant associations were found between both Physical Component Score (PCS) and physical function (PF) and follow-up time after the operation. The adjusted OR for a PCS ≥ 50 was 0.87 (95% CI 0.76-0.99) and for a PF ≥ 85 0.81 (95% CI 0.71-0.91). No association between hyper mobility and PCS, PF, or bodily pain (BP) was found. The physical components of QoL in patients undergoing PAO are significantly lower than the Danish population used as reference. Furthermore, the results suggest that physical function after PAO decreases with longer follow-up time. Neither the acetabular angles nor hypermobility is associated with the physical components of QoL.

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

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].

PTU-125 Joint Hypermobility is a Risk Factor for Oesophageal Hypersensitivity

IntroductionGeneralised joint hypermobility (HM) refers to an increased flexibility of the joints which is present in 5–17% of the population, and is assessed by clinical examination or validated hypermobility questionnaire....

Knee Dislocation from Minor Trauma in Morbidly Obese Patients

Objectives:To present a series of atraumatic knee dislocations in obese and morbidly obese patients.Methods:An IRB approved retrospective study was preformed at a level 1 tertiary care trauma center. Eighteen patients who presented with a knee dislocation from a minor injury were included in the study. Charts, Radiographs, MRI’s were reviewed and patients were contacted in to examine them at latest follow up. We include patients in our database from 2001-2011.Results:The mean age at presentation was 33 (range of 15-74 years) with 4 males and 14 females. The average BMI was 43 range (34- 64.4) with an average follow up of 29 months (range 9- 72 months) Five patients (27%) had a popliteal artery injury and 8 (44.4%) had a peroneal nerve injury at presentation. All 5 had a vascular repair, and 4/8 patients had return of peroneal nerve. Surgical repair was preformed on 10 individuals. The average operating time for ligament reconstruction was 183% of that with injury matched patients. All patients had external fixation to protect the repair post op which was removed at 6 weeks post op and accompanied with a manipulation intra-op. Two patients failed reconstruction, one at 5 years due to a second injury and another at 4 months from a fall. We were unable to fit custom braces on these individuals so it was abandoned. Opposite knees were determined to have hyper mobility in all 16 patients who had an adequate exam. Eight operative patients who complied with therapy had an average range of 91.4 degrees (60-110). One patient was noncompliant by not taking therapy and ended up with only 40 degrees of flexion..The non operative patients had an avg ROM of 53.6 degrees (range 30-90) and may have been that they had less aggressive rehabilitation. Three of these had gone on to TKA.Conclusion:Knee dislocations from minor falls occur in obese patients and often have neurovascular complications. Surgical reconstruction is more time consuming and more difficult then in normal weighted individuals. It may be preferable to non operative treatment

The role of benign joint hypermobility in the pain experience in Juvenile Fibromyalgia: an observational study

BackgroundJuvenile Fibromyalgia (JFM) is characterized by chronic widespread musculoskeletal pain and approximately 40% of children and adolescents with JFM also suffer from benign joint hypermobility (HM). It is not currently known if the presence of HM affects the pain experience of adolescents with JFM. The objective of this study was to examine whether there were any differences in self-reported pain intensity and physiologic pain sensitivity between JFM patients with and without joint HM.MethodsOne hundred thirty-one adolescent patients with JFM recruited from four pediatric rheumatology clinics completed a daily visual analogue scale (VAS) pain rating for one week and underwent a standardized 18-count tender point (TP) dolorimeter assessment. Medical records were reviewed for the presence of joint HM. Average pain VAS ratings, tender point count and tender point sensitivity were compared between JFM patients with and without hypermobility (HM+ and HM-).ResultsNearly half (48%) the sample of JFM patients were found to be HM+. HM+ and HM- patients did not differ in their self-reported pain intensity. However, HM + patients had significantly greater pain sensitivity, with lower TP thresholds (p = 0.002) and a greater number of painful TPs (p = 0.003) compared to HM- patients.ConclusionThe presence of HM among adolescent patients with JFM appears to be associated with enhanced physiologic pain sensitivity, but not self-report of clinical pain. Further examination of the mechanisms for increased pain sensitivity associated with HM, especially in adolescents with widespread pain conditions such as JFM is warranted.

Sa2014 Questionnaire Based Detection of Joint Hyper Mobility in Children Referred to a Tertiary Paediatric Gastroenterology Centre

Sa2014 Questionnaire Based Detection of Joint Hyper Mobility in Children Referred to a Tertiary Paediatric Gastroenterology Centre

Taquicardia postural ortostática en 15 pacientes: disautonomía compleja

Patients with postural orthostatic tachycardia syndrome (POTS) report dizziness, lightheadedness, weakness, blurred vision, and fatigue upon standing. The diagnosis of the syndrome is made when an orthostatic intolerance and tachycardia appear in the standing position. To report 15 patients with POTS. Review of Tilt test reports in a period of 15 years. Those reports in which orthostatic postural tachycardia and symptoms compatible with POTS appeared, were selected for analysis. We identified 15 patients (3.1% of all positive Tilt test reports) with compatible signs and symptoms. There was a lag of 8 -10 years between the onset of symptoms and the time of diagnosis. Most patients complained of orthostatic intolerance, dizziness and frequent fainting. Orthostatic tachycardia and symptoms occurred on average after 2.9 and 6.1 minutes, respectively,of staying in the standing position. These patients had a high frequency of family history of syncope orpresyncope (66% frequency) and hyper mobility syndrome (53% prevalence). Only 33% of the patients reported relief of their symptoms after being treated (most of them with fludrocortisone). Most patients that reported little or no relief, did not use medications or were treated for a short period. POTS syndrome is uncommon but disturbs quality of life of those who suffer it. Its association with hyper mobility syndromes must be investigated.

Mechanical Instability On Lumbar Spine At The Adjacent And Subjacent Segment After Rigid Fixation

To investigate the effect of PLIF and after rigid fixation on adjacent segment and subjacent mechanical instability moreover under loading adjacent and subjacent segment mechanical behavior. Eleven fresh-frozen lamb lumbar spines (Sacrum-T12) were loaded, in axial, flexion-extension, right-left bending directions. All specimens were tested intact and after implantation with posterior pedicle screws and rod fixation. All specimens were fixed in a biomechanical test frame. The biomechanical tests were performed by using the axial compression testing machine. The displacements between S1 and L5 of markers were measured superior-inferior displacement and anterior-posterior displacement with two non-contact CCD cameras. The axial compression was applied to each specimen with testing machine was used to generate an increasing moment up to 8400 Nmm in flexion and extension right left bending and axial compression. The load was applied to each specimen consecutively before and after intact spine and implanted rigid fixation. In all direction after rigid fixation of spine adjacent and subjacent segment (S1-L5, L5-L4) vertical (superiorinferior) displacements were lower but anterior-posterior displacements were higher. Displacement values were evaluated and compared statistically. When we checked the statistical data, there were numerical differences and there was significant change between the intact spine and the spine implanted pedicular screws and rods. Biomechanical alterations likely play a primary role in causing adjacent and subjacent segment disease. After rigid fixation adjacent and subjacent mobile segment (anterior-posterior) displacement of the lumbar spine was significantly greater than intact spine. Rigid fixation of lumbar spine alters adjacent and subjacent segment level ROM. Therefore abnormal stress and hyper mobility on adjacent and subjacent segment may cause spinal instability, which may develop facet joint degeneration and low back pain.

Ehlers-Danlos syndrome, with special emphasis in the joint hypermobility syndrome

There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome QHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research.

Síndrome de Ehlers-Danlos con especial énfasis en el síndrome de hiperlaxitud articular

There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome QHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research.

Hypermobility in reproduction

Peripartum pelvic pain (PPPP) syndrome is thought to be caused by decreased stability of the pelvic girdle, caused by increased relaxin levels during pregnancy. The resulting hypermobility (HM) may result in back pain, symphysiodynia and waddling gait. The hypothesis that pre-existent hypermobility is a major cause of PPPP was investigated. Surveys of HM and HM plus PPPP were conducted in different populations in several countries. The prevalence of HM in non-pregnant nulliparous women ranged between 10% and 39%; cross-sectional studies in pregnant women showed a prevalence between 5% and 19%. Significant correlations between HM and PPPPS were found in the Dutch subjects only. There seems to be a genetic difference between populations with regard to the development of PPPP in HM pregnant women. Pregnancy is the main trigger causing development of benign joint hypermobility syndrome (BJHS) in later life. South African Journal of Obstetrics and Gynaecology Vol. 12(1) 2006: 38-43

Arteriovenous malformation in Mandible

Arteriovenous malformations (AVM) are errors of vascular morphogenesis that are present at birth and become evident due to an event like trauma, surgery, infection, etc. The management of this condition in the maxillofacial region is difficult because of the abundant vascular network. One of the most common signs of these patients, especially in the mixed dentition period, is hyper mobility of the teeth with spontaneous haemorrhage from the surrounding gingival sulcus [1]. Mandibular AVM is a potentially life-threatening pathology requiring radical treatment.

Globalization and the Urban Property Boom in Metro Cebu, Philippines

AbstractThe hyper mobility of capital and the associated growth of international investment in real estate which occurred across the world in the late twentieth century, led to bursts of property development and market booms. This article examines how this global trend interfaced with local processes in the setting of a secondary metropolis of a developing country, in Metro Cebu, Philippines, and resulted in a property‐led development dominated by production of high‐end residential real estate commodities, the rise of a speculative land market, and a highly regressive spatial allocation. It is argued that this regressive outcome was mediated by a weak state, controlled and dominated by predatory and rent‐seeking bosses who, in Cebu in particular, are not simply representatives of the local oligarchy but are big real estate developers and brokers themselves. During the boom period, neither the middle classes, whose members were also attracted to speculative property buying, nor the low‐income and urban poor groups, who were largely hoodwinked by official rhetoric of social housing reform and by token participation, provided any significant social force to constrain the opportunism and rent‐seeking of these bosses or to challenge the pro‐growth governing agenda.

The postmodern subject--between multiphrenia and self concern

As opposed to scientific psychiatry, social psychiatry draws its resources from sociological sources and must continuously adapt its self-image and concept of action to changes in society. Sociological analysis of the present describes dramatic changes in society, which also have consequences for the subject's mastering of everyday routines and formation of identity. As opposed to neo-liberal promises of sheer limitless new opportunities, respectable interpretations of current times describe an ambivalent process that by far does not positively effect all groups in society, and in fact increases the danger of social exclusion. Exclusionary processes particularly affect persons, who do not fulfill the new requirements of hyper flexibility, mobility and allround fitness. Justifiably the question arises whether these requirements themselves induce the destruction of personality. This brings up the question if there is an alternative to the neoliberal view of humankind. This paper picks up the idea of a civil society centered on an individual and recalcitrant subject.

Hypermobility and peripartum pelvic pain syndrome in pregnant South African women

Objective. To determine the incidence and correlation of joint hypermobility (HM) and peripartum pelvic pain (PPPP) in an homogeneous pregnant South African population.Study design. A cross-sectional study among Cape Coloured pregnant women. Joint mobility was measured by Beighton score; PPPP with a specially developed PPPP score.Results. Using the Beighton scores with a cut-off point of HM≥5/9, only 4.9% of the 509 pregnant women were hypermobile. Hyperextension of the elbow was the largest contributor to HM (35.4%). No correlation of HM with the incidence of PPPP was established. Only 20 very mild cases of PPPP were recorded. Back pain increased significantly during pregnancy to a mean of 38%. Right handedness occurred in 95.9%. No significant relation was found between HM and the non-dominant side.Conclusion. Hypermobility in pregnant Cape Coloured women was surprisingly low (4.9%) with a decrease with age, but no increase during pregnancy. Peripartum pelvic pain is virtually absent and has no correlation with joint laxity. Back pain increased during pregnancy to a mean of 38%. Right handedness was high (96%) in comparison with the world-wide figure of 85%. No correlation was found between the dominant body side and hypermobility.