Hypermobility Score Research Articles

CORRELATION BETWEEN VARIOUS ANTHROPOMETRIC AND MUSCULOSKELETAL MEASUREMENTS AND HEMORRHOIDS IN PREGNANCY

Purpose: The aim of this study was to determine the presence of hemorrhoids in pregnancy and symptoms related to hemorrhoids and to evaluate the relationship between hemorrhoids in pregnancy and various anthropometric and musculoskeletal parameters. Methods: The retrospective cross-sectional study included pregnant women in 3 different trimesters (1st, 11-15 weeks; 2nd, 16-23 weeks; 3rd, 24-40 weeks) without any anorectal problems before pregnancy. The presence of hemorrhoids and other anorectal symptoms during pregnancy was evaluated with yes/no questions on self-reported scales. Results: Evaluation was made of 268 pregnant women (92, 1st Trimester; 107, 2nd Trimester; 69, 3rd trimester). In the whole study sample, waist circumference measurement (p = 0.042; OR = 1.13; 95% CI 1.07–1.92), bi-iliac width (p = 0.036; OR = 1.17; 95% CI 1.09–1.38), rectus abdominis muscle strength (p = 0.006; OR = 0.45; 95% CI 0.04–0.58), Diastasis-recti-abdominis grade measured from umbilicus level (p = 0.023; OR = 1.38; 95% CI 1.14–1.83), hypermobility score (p = 0.006; OR = 3.34; 95% CI 1.98–7.94) and parity (p = 0.032; OR = 2.47; 95% CI 1.85–7.19) were found to be important risk factors for the presence of hemorrhoids in pregnancy. Conclusion: This is the first study to have evaluated hemorrhoids and hemorrhoid-related symptoms and to examine the associated risk factors comprehensively. It was also demonstrated for the first time that waist circumference measurement, bi-iliac width, increased grade of Diastasis-recti-abdominis measured at umbilicus level, hypermobility score, and decreased rectus abdominis muscle strength were risk factors for hemorrhoids in pregnancy.

The spectrum of gastrointestinal functional bowel disorders in joint hypermobility syndrome and in an academic referral center.

Joint hypermobility syndrome (JHS) is a non-inflammatory hereditary disorder of connective tissue with varied clinical presentations, including frequent joint dislocations, hyperextensible skin, easy bruising, and abnormal paper-thin scar formation. Many of these patients have unexplained gastrointestinal (GI) symptoms. Our aim was to evaluate the prevalence of JHS in a tertiary gastroenterology motility clinic and the spectrum of functional bowel disorders in JHS patients. In this retrospective case series, we screened the medical records of 277 patients seen over 4 years at an academic GI Motility Center. The patients who met the criteria for JHS by Beighton hypermobility score were evaluated for the presence of functional GI disorders by Rome IV criteria. They also underwent gastric emptying study and glucose breath testing for small intestinal bacterial overgrowth. The prevalence of JHS in the study population was 9.7%. The mean age was 27 years, and 92.5% were female. The symptoms experienced by these patients include nausea/vomiting (89%), abdominal pain (70%), constipation (48%), and bloating (18.5%). The disorders associated with JHS include gastroparesis (52%), irritable bowel syndrome (55.5%), and gastroesophageal reflux disease (30%). Also, 10 patients (37%) were diagnosed with postural hypotension tachycardia syndrome secondary to autonomic dysfunction. Approximately 10% of patients with suspected functional bowel disorders have hypermobility syndrome. Hence, it is crucial to familiarize gastrointestinal practitioners with the criteria utilized to diagnose JHS and the methods to identify physical examination findings related to this condition.

During Postless Hip Arthroscopy, Male Patients, High Body Mass Index, Low Beighton Scores, and Limited Range of Motion Require High Traction Force

To determine the effects of demographic and anatomic factors on traction force required during postless hip arthroscopy. A prospectively collected database was retrospectively analyzed on patients undergoing hip arthroscopy by the senior author, including patient sex, age, body mass index (BMI), Beighton Hypermobility Score, hip range of motion in clinic and under anesthesia, hip dysplasia, acetabular version, and femoral version. All patients underwent postless hip arthroscopy under general anesthesia. At the initiation of hip arthroscopy, the traction force required to distract the hip joint was measured before and following interportal capsulotomy. Multiple regression analysis was performed to determine the effects of demographic and anatomic factors on measured distraction force. In total, 352 hips (114 male, 238 female) were included with a mean age of 32.6 years and a mean BMI of 24.1 kg/m2. Mean initial traction force was 109 lbs and decreased to 94.3 lbs following capsulotomy (P < .0001). The starting traction force was significantly greater in male patients (P < .001), patients with a lack of hypermobility (Beighton Hypermobility Score of 0-2) (P= .026), and in patients with lower abduction (P < .001), lower internal rotation (P= .002), and lower external rotation (P= .012) on multiple regression analysis. When performing a subanalysis divided by sex, male patients with elevated BMI required significantly greater starting traction force (P= .014). Lateral center edge angle, sourcil angle, and the presence of hip dysplasia did not demonstrate a significant correlation with traction force. Male patients, patients with reduced preoperative hip range of motion, patients with a lack of joint hypermobility, and male patients with an elevated BMI require greater initial traction force during postless hip arthroscopy. Level IV, retrospective case series.

GENDER-RELATED DIFFERENCE IN JOINT HYPERMOBILITY AMONG SCHOOL-AGED CHILDREN: A DESCRIPTIVE STUDY

Joint hypermobility is common among school-aged children and it may progressively lead to joint pain and developmental delay. Identifying joint hypermobility in school-aged children would facilitate the monitoring of early changes and planning for early rehabilitative intervention. This study aimed to describe gender-related difference in joint hypermobility among school-aged children. A descriptive study was conducted in an elementary school in Surakarta, Central Java, Indonesia. The study subjects were 261 students aged 6 to 12 years selected randomly. The study variables were gender and joint hypermobility. Beighton scale was used to assess joint hypermobility score. Gender-related difference in joint hypermobility among school-aged children was tested using t-test. The results of ≥4 points on Beighton scale was observed in 157 of 261 school-aged children (60.2%). Mean of Beighton score in female children (Mean= 3.87; SD= 0.19) was higher than male chidren (Mean= 4.15; SD= 1.82), but it was statistically non-significant (p= 0.256). It can conclude that there is no difference between gender in joint hypermobility among school-aged children. The need for joint hypermobility screening tests in elementary school children is highlighted.

Joint Status and Bleeding Phenotype Characterization in Severe and Non-Severe Hemophilia a and B

Introduction: Persons with hemophilia (PwH) A and B are known to have variable bleeding phenotypes and may have joint bleeding that is less clinically apparent. In recent years, musculoskeletal ultrasound (MSKUS) has become an established modality useful for evaluating joint status. Further, determination of individual bleeding phenotype can be challenging, but clinical tools including the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT), self-BAT, and the Beighton Hypermobility Score (BHS) have been developed. Methods: We hypothesize that presence and degree of joint disease, evaluated with MSKUS and physical assessment scoring, will correlate with severity of bleeding phenotype as characterized through clinical history, BAT assessment, and presence of joint hypermobility in PwH A and B. This will be accomplished through assessing baseline joint status and disease progression over time with MSKUS, as well as through use of the ISTH-BAT, self-BAT, and assessment of hypermobility with the BHS. Up to 100 individual subjects with severe, moderate, or mild hemophilia A or B will be enrolled and assessed at baseline and annually during the study period at our institution. Correlation of joint status with BHS and BAT scores will be analyzed with the generalized estimating equation (GEE) and other statistical methods. Results: Thus far, 15 male patients have been enrolled (Table 1). All moderate and severe hemophilia patients are on prophylactic therapies for bleed prevention, and 3 patients have history of inhibitors. Target joints were reported only in severe PwH. MSKUS measurements were completed using the JADE protocol1. Patient enrollment remains ongoing. Discussion: Knowledge pertaining to joint status and bleeding phenotype is PwH A and B is limited. This pilot study will assess the presence and degree of joint disease, evaluated with MSKUS and physical assessment scoring, and its correlation with severity of bleeding phenotype as characterized through clinical history, BAT assessment, and presence of joint hypermobility in PwH hemophilia A and B. The results will be used to justify a larger, multicenter study to expand understanding of joint status and bleeding phenotype in PwH.

Joint Hypermobility Syndrome in Patients With Functional Dyspepsia.

INTRODUCTION:The pathophysiology underlying functional dyspepsia (FD) is multifactorial and focuses on gastric sensorimotor dysfunction. Recent studies demonstrated that joint hypermobility syndrome (JHS) is strongly associated with unexplained dyspeptic symptoms in patients attending gastrointestinal clinics. We aimed to study the relationship between symptoms, gastric sensorimotor function, and JHS in FD patients.METHODS:Tertiary care FD patients who underwent a gastric barostat study and a gastric emptying breath test with 13C-octanoic acid were recruited for assessment of JHS. The presence of JHS was evaluated by a 2-phase interview and clinical examination that included major and minor criteria of the Brighton classification.RESULTS:A total of 62 FD patients (68% women, age 44 ± 1.8 years, and body mass index: 21.7 ± 0.7 kg/m2) accepted to participate in the study. JHS was diagnosed in 55% of FD patients. Assessed symptom profiles during the visit did not differ between the groups. Delayed gastric emptying was not significantly more common in JHS group compared with non-JHS group (JHS group 32% vs non-JHS group 16%, P = 0.31). Prevalence of hypersensitivity to distention (JHS group 24% vs non-JHS group 29%, P = 0.76) and impaired gastric accommodation (JHS group 38% vs non-JHS group 42%, P = 0.79) was similar in patients with or without JHS. No correlations were found between the Beighton hypermobility score and gastric compliance (r = 0.09).DISCUSSION:A large subset of this study cohort of tertiary care FD patients has coexisting JHS. We did not identify any specific differences in gastric sensorimotor function between patients with and without JHS. Further prospective research will be required to elucidate the relationship between JHS, a multisystemic disorder with widespread manifestations, and FD symptoms.

Do Plantar Pressure and Loading Patterns Vary with Joint Hypermobility in Young Females?

Joint hypermobility is a connective tissue disorder that increases joint range of motion. Plantar pressure and foot loading patterns may change with joint hypermobility. We aimed to analyze static plantar pressure in young females with and without joint hypermobility. Joint laxity in 27 young females was assessed cross sectionally using the Beighton and Horan Joint Mobility Index. Participants were divided into the hypermobility (score, 4-9) and no hypermobility (score, 0-3) groups according to their scores. Static plantar pressure and forces were recorded using a pedobarographic mat system. Higher peak pressures (P = .01) and peak pressure gradients (P = .025) were observed in the nondominant foot in the hypermobility group. According to the comparison of dominant and nondominant feet in each group, the hypermobility group showed significantly higher peak pressures (P = .046), peak pressure gradients (P = .041), and total force values (P = .028) in the nondominant foot. The plantar pressure and loading patterns vary in young females with joint hypermobility. Evaluation of plantar loading as an injury prevention tool in individuals with joint hypermobility syndrome can be suggested.

Do asymptomatic generalised hypermobility and knee hyperextension influence jump landing biomechanics?

Background The Landing Error Scoring System (LESS) identifies movement patterns associated with Anterior Cruciate Ligament (ACL) injury. Hypermobility and knee hyperextension may alter these patterns given that hypermobile individuals present higher injury rates. Methods Eighty-five individuals were tested using the LESS and Beighton hypermobility score. Spearman rank correlation coefficients were calculated to investigate relationships between LESS and Beighton scores. T-tests and two-proportion z-tests were performed to explore differences in LESS scores and proportion of participants at risk of injury between non-hypermobile and asymptomatic hypermobile individuals, and individuals with non-hyperextended and hyperextended knees. Results The mean LESS score was 5.4 ± 1.4 errors and the median (interquartile range) Beighton score was 2 (4) points. No significant relationship was found between LESS and Beighton scores (ρ = −0.08, p = 0.490). LESS scores and proportions of participants at risk between non-hypermobile (5.3 ± 1.5 errors, 67.8%) and asymptomatic hypermobile (5.4 ± 1.3 errors, 76.9%) individuals, and between individuals with non-hyperextended (5.6 ± 1.5 errors, 68.3%) and hyperextended (5.3 ± 1.4 errors, 77.3%) knees were comparable (p > 0.05). Conclusions Asymptomatic hypermobile and knee hyperextended individuals do not present more high injury risk movement patterns during landing tasks.

Is joint hypermobility related to preterm birth?

Aim The aim of this study was to investigate whether women giving preterm birth have joint hypermobility. Methods The study included 44 women giving preterm birth (study group) and 48 women with the history of term birth (control group). After demographic data were recorded, the presence of joint hypermobility based on the Beighton diagnostic criteria and subgroup scores were noted down. Total Beighton scores were compared between the study and control groups. Results The total Beighton scores were significantly higher in the study group (p < .001). The study group had the highest hypermobility score for elbow hyperextension and the lowest hypermobility score for thumb hyperextension. Conclusions It should be kept in mind that joint hypermobility detected during follow-up of pregnancy can be related to the risk of preterm birth. Informing pregnant women with joint hypermobility about the possibility of preterm birth could be helpful.

Evaluation of Dental Status and Temporomandibular Joint in Children With Generalized Joint Hypermobility.

The aim of this study was to evaluate the dental status and temporomandibular diseases (TMDs)-related symptoms in children with generalized joint hypermobility (GJH) and compare them with healthy controls (HCs). This is a cross-sectional, observational study carried out between September 2016 and April 2017. A total of 124 children with GJH (n = 62) and HC (n = 62) were enrolled. The GJH was assessed with the Beighton hypermobility score. The subjects were screened for dental status and TMD-related symptoms. The assessment included the index for "decayed," "missing," and "filled teeth" (DMFT, dmft); plaque; gingival bleeding; tooth mobility; and temporomandibular joint (TMJ) evaluation. The mean Beighton hypermobility score was 6.3 ± 1.2 in the GJH group. Visible plaque index and gingival bleeding index scores were found to be significantly higher in children with GJH then in the HC (p = 0.031, p = 0.023). No differences were found regarding the DMFT scores between the groups (p = 0.16). Temporomandibular disorder-related symptom frequencies were significantly higher in children with GJH (p < 0.001). The most common clinically determined sign of TMD was clicking with a maximum active mouth-opening. Combined TMJ symptoms and TMD were observed in approximately one third of the children with GJH. The presence of GJH in a child may be indicative of future dental or TMJ problems, and it may cause dental problems due to increased gingival bleeding index and visible plaque index scores. Therefore, children with GJH require preventive dental and TMJ care.

Comparison of effects of joint flexibility on the lumbo-pelvic rhythm in healthy university students while bending the trunk forward.

[Purpose] To clarify the influence of flexibilities of the hip and lumbar spine joints on bending the trunk forward. [Participants and Methods] We assessed the joint flexibility of 47 healthy university students using the Beighton hypermobility score and assigned them to the group of normal or poor flexibility. We performed electromyography to acquire kinematic data and analyzed the three-dimensional motion while the students bent their trunks forward. Further, we compared the groups based on angular displacements of the hip joint and lumbar spine in each phase of the movement. Offset of the erector spinae and hip extensor muscle activity was calculated as a percentage (%) of the maximum range of motion. [Results] The lumbo-pelvic rhythm differed between participants with and without poor flexibility of the hip joint in the second half of the forward bending task. Participants with poor flexibility of the hip joint showed activation of the erector spinae and biceps femoris for a longer period compared to those with normal flexibility. Notably, flexion–relaxation responses were not found in the biceps femoris of 30% of the participants. [Conclusion] Poor hip joint flexibility may cause low back pain. Measuring the lumbo-pelvic rhythm might help identify individuals at a high risk of low back pain while they are still healthy.

Generalized hypermobility syndrome (GHS) alters dynamic plantar pressure characteristics.

In the relevant literature generalized hypermobility syndrome (GHS) has been shown to alter the kinetic and kinematic patterns of the human movement system. Although GHS affects the general body biomechanics of individuals, the body of knowledge in plantar pressure distribution in GHS is far from sufficient. The aim of this study was to determine whether individuals with joint hypermobility syndrome have abnormal plantar pressure distribution during normal gait compared to healthy individuals. A total of 37 participants (mean age: 22.16 ± 2.58 years) diagnosed with GHS and 37 aged-matched participants (mean age: 23.35 ± 2.85 years) without GHS were included in the study. Dynamic plantar pressure distribution was obtained as each participant walked in barefoot at a self-selected pace over EMED-m system (Novel GmbH, Munich, Germany). Correlations between hypermobility score (HS) (Beighton score) and plantar pressure variables, and between group differences in peak pressure (PP), pressure-time integral (PTI), average pressure (AP) and maximum force (MxF) were computed for 10 regions under the sole. HS was significantly correlated with peak pressure under the mid-foot (MF) (r= 0.24, p= 0.043), 5th metatarsal head (MH5) (r= 0.33, p= 0.001), big toe (BT) (r= 0.44, p< 0.001), and second toe (ST) (r= 0.38, p= 0.001). A similar trend was observed for pressure-time integrals under hindfoot (HF) (r= 0.24, p= 0.04), MF (r= 0.30, p= 0.009), MH5 (r= 0.25, p= 0.033), BT (r= 0.37, p= 0.001) and ST (r= 0.34, p= 0.003). The only significant MxF detected was under the ST (r= 0.23, p= 0.048), and AP was determined to be significantly higher as HS increases indicated by APs under MH5 (r= 0.24, p= 0.042), BT (r= 0.32, p= 0.005) and ST (r= 0.40, p< 0.001). Peak pressure values under HF were significantly higher in the hypermobile group (p= 0.023), MH5 (p= 0.001), BT (p< 0.001) and ST (p= 0.003). AP and PTI were also found to be significantly higher in the hypermobile group under MH5 (p= 0.009), BT (p= 0.037), and ST (p= 0.003). MxF was higher only under MF5 (p= 0.029) and SF (p= 0.041) in the hypermobile group. The forefoot regions received a higher load in GHS during gait. This could be useful in clinical evaluation of the foot in GHS, preventing potential injuries of lower extremity, and also in processes related to decision making for foot orthotics and/or rehabilitation protocols.

The correlation of muscle strength, flexibility and range of motion with pain in musicians playing string instruments

The aim of this study was to determine the correlation of muscle strength, flexibility, and range of motion with pain in musicians playing string instruments. This randomized, controlled trial included 37 in musicians aged range of 19 to 41, including 17 male and 20 female string players. The mean of age, weight, height, and BMI values of musicians playing a string instrument were examined. The amount of pain parameters was measured with the visual analog scale, joints’ range of motion measured with universal goniometer and flexibility measured with Beighton Hypermobility Score. Measured variables were analyzed, compared, and correlated. The mean age of participants was 24.97±5.52 years, and the mean body mass index of participants was 21.69±2.46 kg/m2. Regarding the rough grip, pinch grip muscle strength, pain parameter scores between male and female string players, statistically significant differences were observed (p 0.05). A weak positive correlation observed between muscle strength and pain parameters; a weak negative correlation observed between joints’ the range of motion and pain parameters. Also, a significantly strong negative relationship observed between flexibility and pain parameters. In conclusion, according to scores between female and male string players, statistically significant differences were noticed in the rough grip, pinch grip muscle strength, pain parameters in contrast with flexibility. This study found that flexibility and joints’ range of motion has a negative correlation with pain in musicians playing a string instrument in contrast to muscle strength.

Temporomandibular joint dysfunction in adults: Its relation to pain, general joint hypermobility, and head posture

BACKGROUND: The first objective is the questioning of the presence of general joint hypermobility (GJH) and temporomandibular joint dysfunction (TMJD) in adults and examining the existence of the relationship between GJH and TMJD. The secondary purpose of this study questions whether there is a relationship between the forward head posture and GJH. MATERIALS AND METHODS: GJH assessments were carried out with the Beighton Hypermobility Score. Participants were assessed by a plumb line for postural assessment. During mouth opening, the examination of temporomandibular joint (TMJ) was evaluated based on if the mandible shows deflection or deviation. Pain assessment in TMJ was evaluated through three different pain areas, during rest and chewing activity and at night with the visual analog scale. Masseter muscle pressure sensitivity was recorded by measuring it with a dolorimeter. RESULTS: There was a positive correlation between hypermobility status and temporalis muscle pain at night (r: 0.218, P CONCLUSION: In the presence of GJH, in order to maintain rehabilitation in the most effective way and to anticipate the secondary problems that may occur, the TMJ should be thoroughly examined for pain, sensitivity, and functionality.

Upsloping lateral sourcil: a radiographic finding of hip instability.

ABSTRACTWhile radiographic findings of frank hip dysplasia are well defined, there is a lack of diagnostic criteria for patients with radiographically ‘normal’ hips who have borderline morphologic deficits and clinical instability. In this study, we aim to define and validate a new radiographic finding associated with hip instability known as the upsloping lateral sourcil (ULS). Patients (316) were reviewed for lateral center edge angles, generalized joint laxity assessed with the Beighton Hypermobility Score and the presence of the ULS. The ULS was defined as a caudal-to-cranial inclination of the middle-to-far lateral aspect of the acetabular sourcil with loss of the normal lateral acetabular concavity. The prevalence of the ULS correspondingly increased with the degree of under-coverage as defined by LCEA. Within the normal coverage group, hips with a ULS had smaller LCEAs than those without ULS (29° versus 32°, P < 0.001). Among hips with a ULS, 59.00% had generalized joint laxity. The association between the ULS finding and generalized joint laxity was statistically significant (P < 0.01). The ULS is seen with higher prevalence in patients with clinical hip laxity and radiographically decreasing LCEA and may serve as an adjunctive finding in patients presenting with hip pain and instability. The ULS may help to characterize patients with borderline hip dysplasia and laxity that fall outside conventional imaging criteria for dysplasia.

Patient-Specific Parameters Associated With Traction in Primary and Revision Hip Arthroscopic Surgery.

Background:Distraction of the hip joint is a necessary step during hip arthroscopic surgery. The force of traction needed to distract the hip is not routinely measured, and little is known about which patient factors may influence this force.Purpose:To quantify the force of traction required for adequate distraction of the hip during arthroscopic surgery and explore the relationship between hip joint stiffness and patient-specific demographics, flexibility, and anatomy.Study Design:Case series; Level of evidence, 4.Methods:A total of 101 patients (61 female) undergoing primary hip arthroscopic surgery were prospectively enrolled. A load cell attached to the traction boot continuously measured traction force. Fluoroscopic images were obtained before and after traction to measure joint displacement. The stiffness coefficient was calculated as the force of traction divided by joint displacement. Relationships between the stiffness coefficient and patient demographics and clinical parameters were investigated using a univariable regression model. The regression analysis was repeated separately by patient sex. Variables significant at P < .05 were included in a multivariable regression model.Results:The instantaneous peak force averaged 80 ± 18 kilogram-force (kgf), after which the force required to maintain distraction decreased to 57 ± 13 kgf. In univariable regression analysis, patient sex, alpha angle, hamstring flexibility, and Beighton hypermobility score were each correlated to stiffness. However, patient sex was the only significant variable in the multivariable regression model. Intrasex analysis demonstrated that increased hamstring flexibility correlated with decreased final holding stiffness in male patients and that higher Beighton scores correlated with decreased maximal stiffness in female patients.Conclusion:Male patients undergoing primary arthroscopic surgery have greater stiffness to hip distraction during arthroscopic surgery compared with female patients. In male patients, stiffness increased with decreasing hamstring flexibility. In female patients, increased Beighton scores corresponded to decreased stiffness. The presence of a labral tear was not correlated with stiffness to distraction. These data may be used to identify patients in whom a specific focus on capsular repair and/or plication may be warranted.

Patient-Specific Parameters Associated with Traction Stiffness in Primary and Revision Hip Arthroscopy

Objectives:To quantify the force of traction required for adequate distraction of the hip during arthroscopy and explore the relationship between hip joint stiffness and patient-specific demographics, flexibility, and anatomy.Methods:101 primary arthroscopy patients (61 females) and 23 patients undergoing revision arthroscopy for capsular repair (all female) were prospectively enrolled. A load cell attached to the traction boot continuously measured traction force. Fluoroscopy images were obtained before and after traction to measure joint displacement. The stiffness coefficient was calculated as the force of traction divided by joint displacement. Primary patients were analyzed in a univariable regression model and re-analyzed separately by gender. Variables significant at p<0.05 were included in a multivariable regression model. Stiffness was compared between female primary and revision patients using independent t-tests.Results:For primary arthroscopy, instantaneous peak force averaged 80 ± 18 kgf, after which the force required to maintain distraction decreased to 57 ± 13 kgf. In univariable regression analysis, gender, alpha angle, hamstring flexibility and Beighton hypermobility score were each correlated to stiffness. However, gender was the only significant variable in the multivariable regression model. Intragender analysis demonstrated increased hamstring flexibility correlated with decreased stiffness in males and higher Beighton scores correlated with decreased stiffness in females. Stiffness was significantly less in the revision cases than the primary cases (p=0.006).Conclusion:A substantial force is required to achieve and maintain hip distraction, with males requiring higher forces. Males with increased hamstring flexibility and females with higher Beighton scores are less stiff than their same gender counterparts. Patients indicated for revision capsule repair were less stiff, supporting the importance of the hip capsule on hip stability. These data may be used to identify patients with microinstability and patients where specific focus on capsular repair and/or plication may be warranted.

Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial.

Background:Limited evidence is available regarding the effects of insoles on pediatric flexible flatfoot because of the heterogeneity and low methodological quality of previous studies. The purpose of this prospective trial is to examine the short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children by using the International Classification of Functioning, randomized controlled Disability, and Health (ICF) framework.Methods:This study was conducted in a rehabilitation outpatient clinic of a teaching hospital. Fifty-two children with symptomatic flexible flatfoot were included. The children in the treatment group wore customized arch support insoles for 12 weeks, whereas those in the control group did not wear the insoles. Both clinical and radiographic measurements, including the navicular drop, foot posture index, Beighton hypermobility score, talonavicular coverage angle, calcaneal inclination angle, and calcaneal-first metatarsal angle, were used for diagnosing flexible flatfoot. Physical activity (10-m normal and fast walking, stair ascent, stair descent, and chair rising), physical function, and psychometric properties (Pediatric Outcome Data Collection Instrument and Pediatric Quality of Life Inventory) were evaluated at the baseline and 12 weeks after the intervention.Results:Compared with the control group, the treatment group exhibited significant improvement in pain/comfort (P = .048), physical health (P = .035), stair ascent time (P = .015), upper extremity and physical function (P = .016), and transfer and basic mobility (P = .042) during the intervention period.Conclusion:Children with flexible flatfoot who wore customized arch support insoles for 12 weeks exhibited significantly improved pain/comfort, physical health, stair ascent time, upper extremity and physical function, and transfer and basic mobility. These variables belong to the domains of body functions and structures and activity and participation in the ICF framework. However, because the groups were not comparable, additional studies with larger sample sizes should be conducted.

The Beighton score as a predictor of Brighton criteria in sport and dance

ObjectivesTo determine the efficacy of using the Beighton joint hypermobility score as a predictor of Brighton criteria components, considering the influence of gender and sports participation. DesignCross sectional study design. Setting: A University. ParticipantsSixty-five female rugby players, 38 male rugby players, 61 netball players, 42 female dancers, 40 male controls and 40 female controls. Main outcome measuresThe Beighton score was assessed using the Beighton and Horan Joint Mobility Index. The Brighton criteria was used to assess joint hypermobility syndrome. A binary logistic regression was performed for a pooled sample (n = 286), and subsequently for gender and sport to assess the Beighton score as a predictor of Brighton criteria. ResultsBeighton scores were found to be a predictor of arthralgia (P = 0.002), dislocation and subluxation (P = 0.048) in the pooled analysis; a predictor of dislocation and subluxation (P = 0.047) in males and arthralgia (P = 0.001) in females. Beighton scores were a predictor of arthralgia in female rugby (P = 0.003) and in female controls (P = 0.012). ConclusionsThe potential of the Beighton score to predict joint arthralgia and dislocation/subluxation may allow clinicians to implement effective injury prevention strategies.

Lack of joint hypermobility increases the risk of surgery in adolescent idiopathic scoliosis.

Generalized joint hypermobility (GJH) is a risk factor for developing adolescent idiopathic scoliosis (AIS); however, it is not known whether joint hypermobility influences the risk of progression to surgery. Beighton joint hypermobility scores were assessed in 570 female AIS patients. Multivariate analysis was carried out to determine whether Beighton hypermobility scores were predictors of surgical intervention. In this female AIS cohort, 24.7% (141/570) had GJH (Beighton score ≥4). Multivariate analysis showed that GJH did not influence the risk of surgery, although having no joint hypermobility (Beighton score=0) increased risk (odds ratio: 1.89; P=0.003). Females who had no hypermobility (score=0) had significantly larger curves than individuals who scored at least one point on the Beighton scale [50° (interquartile range: 26) vs. 42° (interquartile range: 24), P=0.001]. Evaluation of specific measures of joint hypermobility indicated that females who could not touch their palms to the floor were 2.1-fold more likely to have surgery than patients who could perform this task (P=0.001). None of the other features measured on the Beighton score correlated with surgical risk. The lack of joint hypermobility increases the odds of surgery in females with AIS. Specifically, inability to touch the palms to the floor is an indicator of progression to surgery.