Prevalence Of Generalized Joint Hypermobility Research Articles

493 Prevalence and Clinical Presentation of Chronic Neck Pain in Individuals with Generalized Joint Hypermobility

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.

Prevalence, frontal plane knee alignment, and lower limb joint pain and injury in generalized joint hypermobility in Thai physical therapy students.

ObjectivesThe primary aim was to study the prevalence of generalized joint hypermobility (GJH) among Thai physical therapy (PT) students. The secondary aims were to compare the lower limb alignments and lower limb joint pain and injury between GJH and non-GJH individuals. Furthermore, the association between GJH, lower limb alignment, and joint pain and injury were also evaluated.Material and methodsGeneralized joint hypermobility was assessed using the Beighton score with a cut-off of 4/9 in 255 PT students. The lower limb alignments measured in the study included pelvic tilt angle, tibiofemoral angle, quadriceps angle (QA), and navicular drop. Tibiofemoral angle and QA were measured with and without quadriceps contraction. The history of lower limb joint pain and injury was recorded with a simple questionnaire. Lastly, logistic regression analysis was used to study the association between GJH, lower limb alignment, and joint pain and injury.ResultsThe prevalence of GJH was 21.18% among the studied population. Quadriceps angle during quadriceps relaxation of the non-dominant leg of the GJH group was the only lower limb alignment found greater than those of the non-GJH group. The rate of lower limb joint pain and injury was not different between the two groups. Furthermore, no significant association between GJH, lower limb alignment, and lower limb joint pain and injury was found.ConclusionsGJH is not uncommon among Thai PT students. Only the non-dominant QA was found different between groups. Generalized joint hypermobility neither increase risk nor is it associated with lower limb joint pain and injury among Thai PT students.

Comparison of joint hypermobility in general and orthopaedic clinic population in south India

Background: Generalised joint hypermobility (GJH) is associated with musculoskeletal symptoms. Beighton score is universally used to measure hypermobility and the cut off score of ≥4 is quoted in literature to define GJH. No data exists on the prevalence of GJH in patients attending orthopaedic outpatients in India. Materials and methods: The objective of this study was to compare the prevalence of GJH in the general versus orthopaedic patients. 406 patients attending a wellness clinic and 1780 patients attending orthopaedic outpatient clinic in a large private hospital in south India were scored for hypermobility using Beighton score. The mean age of the cohorts attending the wellness clinic and orthopaedic clinic was 33.47± 11.63 years and 36.37± 9.36 years respectively. There were more males than females recruited in the orthopaedic clinic. Results: The wellness group had significantly higher numbers in the 20 to 39 year age range compared to the orthopaedic group (p value <0.00001). There was a significantly higher proportion of zero Beighton score in the orthopaedic group (p value <0.00001). The proportion of people with Beighton score 4-9 in the wellness and orthopaedic groups were 33% and 3.3% respectively. The proportion of GJH with Beighton score 5-9 was 16% and 2% in the wellness and orthopaedic groups respectively. Conclusions: This is the only study, to the best of our knowledge, to have attempted to compare GJH prevalence in orthopaedic patients with a control group. The prevalence of GJH is significantly higher in the general population than the orthopaedic out-patients. Beighton score is simple to perform and must be included in the management of every orthopaedic patient.

Prevalence of hypermobility in primary school children: a Saudi experience

Background: This study aims to determine the prevalence of generalized joint hypermobility (GJH) in primary school children in relation to age (6–12 years) and gender. It also aims to ascertain whether musculoskeletal pain (MSP) is associated with GJH among these children. Methods: This cross-sectional study was conducted in five primary schools in Al-Madinah al-Munawarah city. The demographic profile recorded includes age, gender, ethnic group, height, weight, and body mass index. The existence of GJH was assessed by the Beighton score (≥4 was acknowledged as hypermobility). Prior to physical examinations, the Nordic Musculoskeletal Questionnaire was distributed to the students to assist in detecting symptoms in their neck, back, shoulders, and extremities. Results: The study included 563 students (392 boys, 171 girls; average 10.12 ± 1.588 years; range 6–12 years). GJH was found in 144 students (25.6%). Out of the total number of participants, the occurrence of GJH in male students was 30.87% versus 13.5% in female students, indicating a significant difference (p = 0.001) by gender. GJH was also more prevalent in the age group of 6–9 years (29.2%) compared to that of 10–12 years (23.7%), with a considerable significant difference of p < 0.05. With respect to MSP, 222 (39.4%) of the total number of students reported pain. Pain was found in 31 (21.5%) and 191 (45.6%) of hypermobile students and non-hypermobile students, respectively, with a significant difference of p = 0.029. MSP was also not associated with GJH among these children. Conclusions: The prevalence of GJH in the primary school children in this study was markedly higher than the range revealed in some countries in the region but somewhat within the range reported internationally.

Joint hypermobility and its association with self-reported knee health: A cross-sectional study of healthy Australian adults.

The primary aim of this study was to determine the association between generalized joint hypermobility (GJH), knee-specific hypermobility (KSH) and self-reported knee health in an Australian population. Secondary aims included elucidating ethnic/gender differences in GJH/KSH prevalence and knee health, and identifying KSH using a novel knee extension range of motion cut-off method. Knee extension range, Beighton score, and 5 domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected from adults aged 18-101years self-identifying as healthy, and were grouped by ethnicity and gender. Two established Beighton score criteria and 1 novel knee extension range cut-off method were used to determine GJH and KSH respectively. Point-biserial correlation tested the associations between GJH/KSH and KOOS. Differences in GJH/KSH prevalence and knee health between ethnic/gender groups were determined with the Chi-squared test. Of 732 participants (50% male), 80.3% were Caucasian. No correlations were found between GJH and KOOS while a very weak correlation was found between KSH and 1 KOOS domain (r>-.30; P=.04). Prevalence of GJH was higher in non-Caucasians (17.4% vs 5.6%, P<.001) and females (4.4% vs 1.1%, P=.007). Prevalence of KSH between ethnic and gender groups was not significantly different (P=.50 and P=.69 respectively). Non-Caucasians scored higher (better) in all KOOS domains than Caucasians (all P<.05). Those who met the age- and gender-specific criteria for GJH/KSH did not report worse knee health than their non-hypermobile counterparts. Clinicians can assure individuals who exhibit GJH/KSH that these are not associated with lower knee health and function.

Generalized joint hypermobility among school-aged children in Majmaah region, Saudi Arabia

Generalized joint hypermobility (GJH) is common among schoolchildren and usually benign. However, it may progressively lead to joint pain and developmental delay. Identifying GJH in school-aged children would facilitate the monitoring of early changes and planning for early rehabilitative intervention. Epidemiological studies addressing the prevalence of GJH among children in the Gulf region and Arab ethnicity are lacking. Hence, we aimed to determine the prevalence, pattern, and factors associated with GJH among school-aged children in the Majmaah region, Saudi Arabia. Male and female school-aged children 8–14 years of age from the Majmaah region of Saudi Arabia participated in this cross-sectional study. Beighton score was used to assess GJH. Personal characteristics such as age, height, weight, body mass index, and handedness were also collected. Descriptive statistics were obtained for personal characteristics, the point prevalence of hypermobility, frequency of Beighton score distribution, and prevalence of GJH. The associations between specific factors and the presence of GJH were analyzed using chi-square and Mann-whitney tests. Using the Beighton score cutoff ≥ 4 and ≥ 6, 15.2% and 7.6% of the school children in our study were diagnosed with GJH respectively. The prevalence of GJH was higher among females (16.8%) than among males (13.4%), but the difference was not statistically significant. The elbow joints (17.2%) were the most common hypermobile joints and the trunk (0.7%) was the least involved. The children with GJH were younger and had lesser BMI compared to children without GJH (P < 0.05). The prevalence reported in this study among school-aged children was comparable with those reported worldwide.

Case–control study on generalised joint hypermobility in schoolchildren with functional gastrointestinal disorders according to Rome IV criteria in Spanish

IntroductionAlthough results show an association between the presence of generalised joint hypermobility (GJH) and functional gastrointestinal disorders (FGIDs) in children, they are limited and controversial. ObjectiveTo determine the association between GJH and FGIDs and the search for risk factors for GJH in girls from a Public Educational Institution of Tuluá, Colombia. Patients and methodsThe students completed the Rome IV Questionnaire to identify FGIDs. Each girl with a diagnosis of some FGIDs was matched with a healthy control of the same age. Joint laxity was assessed according to the Beighton score and was considered as GJH when it was ≥4. The prevalence of GJH was compared in girls with and without FGIDs. ResultsOut of a total of 921 girls between 10 and 18 years of age that participated in the study, 219 (23.8%) of them had some FGIDs. The analysis was performed in a total of 169 girls with FGIDs and 169 healthy control girls. There were no significant differences in GJH between girls with and without a diagnosis of some FGIDs (OR=1.12: 95% CI; 0.71–1.77, P=.5838), nor were there any risk factors. ConclusionIn this study, no relationship or any risk factor was found between GJH and the presence of FGIDs.

Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students.

The objective of this study was to investigate the prevalence of generalized joint hypermobility (GJH) in a university-aged population, whether young adults (aged 18–25 years) with GJH are prone to sustain more musculoskeletal injuries, and are more likely to suffer from chronic musculoskeletal pain. The study used an interactive survey to gather data; GJH was assessed using a cut-off Beighton score of ≥5 in accordance with the 2017 International Classification of EDS criteria. The analyzed sample consisted of 482 female and 172 male participants from Florida Gulf Coast University (USA). The prevalence of GJH in a university-aged population can be estimated at 12.5%. Women did not have higher rates of GJH than men. However, female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints. The Beighton scores did not differ by ethnicity/race. Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant. There was no difference in the proportion of all participants classified within different categories (0; 1–4; 5–9) of Beighton scores and whether or not they reported having been injured. Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories. Female participants, however, reported higher pain intensity for chronic neck and back pain. This study increases knowledge about a correlation between GJH, musculoskeletal injuries, and chronic pain of joints, neck, and back in a university-aged population.

The effect of generalised joint hypermobility on rate, risk and frequency of injury in male university-level rugby league players: a prospective cohort study

BackgroundRugby league is a collision sport where musculoskeletal injuries are common. There has been little research on generalised joint hypermobility (GJH) as a risk factor for injury in rugby league....

Hypermobility and Musculoskeletal Pain in Adolescents

To determine the prevalence of generalized joint hypermobility (GJH) in a large cohort of Australian children and determine the associations between GJH and musculoskeletal pain. This is a cross-sectional analysis of the Western Australian Pregnancy Cohort (Raine) Study. Hypermobility was measured in 1584 participants at 14 years of age using the Beighton scoring system, along with a range of other factors including musculoskeletal pain status. Logistic regression models were used to assess independent associations of GJH with factors of interest. The prevalence of GJH was 60.6% and 36.7% in girls and boys, respectively, when defined as a Beighton score of ≥4; when defined as ≥6, it was 26.1% and 11.5%. In girls, positive associations between GJH and higher socioeconomic status and better motor competence were observed. In boys, positive associations between GJH and lower body mass index were observed. After adjusting for potential confounders, an association between number of pain areas in the last month and made worse with sport were identified in boys but not girls. The high prevalence rates of GJH as defined by commonly used Beighton cutoff values in this cohort highlight the need to question the appropriateness of these cutoffs in future studies. Future prospective studies of the association between GJH and musculoskeletal pain should be adjusted for confounding variables identified in this study, and be powered for sex-specific analyses owing to the differing prevalence rates and hypermobility correlates in male and female samples.

Prevalence of generalised joint hypermobility in school-aged children from east-central European region.

There is no literature regarding joint mobility in children of the Central and Eastern Europe. Studies describing clinical characteristics and functional outcomes are still needed. The aim of this study was to assess the prevalence of generalised joint hypermobility (GJH) in the group of school-aged children from Vilnius, the capital city of Lithuania, in relation to different cut-off values of the Beighton score (BS), and to identify possible patients with joint hypermobility syndrome. The representative sample of this study was calculated to be 760 subjects. A total of 778 children from different schools were screened for the mobility of joints. The medical examination included an assessment of joints' hypermobility according to the BS. The presence of specific signs (marfanoid habitus, antimongoloid slant and drooping eyelids) was assessed additionally. Parents of all involved children were asked to answer the questions developed based on the Brighton criteria regarding the medical history of children. The prevalence of GJH in school-aged children from Vilnius, depending on the BS cut-off value, was 19.2% (BS ≥ 4), 9.5% (BS ≥ 5) or 5.7% (BS ≥ 6). The increased range of mobility was most frequently detected in thumbs of school- -aged children. The frequency of hyperextension > 10o in knees was 7- to 8-fold lower than the frequency of hyperextension > 10o in a passive opposition of the thumb. The evaluation results were similar on the left and right sides in 87.4% cases of thumb opposition, 90.1% cases of hyperextension of 5th finger, 87.9% cases of elbow manoeuvres, and 94.8% attempts to hyperextend knee. The prevalence of GJH in school-aged children from Vilnius depends on the BS cut-off value and ranges from 5.7% to 19.2%.

Is Motor Performance in 5.5-Year-Old Children Associated with the Presence of Generalized Joint Hypermobility?

To determine the prevalence of generalized joint hypermobility (GJH) in Dutch children aged 5.5 years, and to examine the association between GJH and motor performance and development over time. A prospective cohort of 249 children was recruited. GJH was assessed with the Beighton test at age 5.5 years. Motor performance was evaluated at age 2.0 years using the Bayley Scales of Infant Development, Second Edition and at age 5.5 years using the Movement Assessment Battery for Children-Second Edition (subscore categories: manual dexterity, aiming and catching, and static and dynamic balance). In 249 children, the prevalence of GJH, defined by the Beighton test score, was 34.1% for a score ≥ 4, 22.5% for a score ≥ 5, and 16.5% for a score ≥ 6. No significant association was found between GJH and total motor performance. Manual dexterity in girls (Beighton score ≥ 4) was positively associated with higher level of motor performance (β [SE] = 0.38 [0.17]; P = .028), ranging from +0.04 SD to +0.72 SD, even after correction for covariates. A significant interaction between GJH and body mass index (BMI) growth was found, indicating that the effect of GJH on the rate of development of motor performance declines with increasing BMI growth (β = 0.05 [0.02]; P = .031). In this healthy pediatric cohort, GJH was present in one-third of the sample, and no significant association was found between GJH and total motor performance. The effect of GJH on the rate of development of motor performance appears to decline with increasing BMI growth. Longitudinal prospective studies are recommended to detect influences of GJH on motor performance over time, as well as the influence of body composition and Beighton cutoff points.

Generalised Joint Hypermobility in Caucasian Girls with Idiopathic Scoliosis: Relation with Age, Curve Size, and Curve Pattern

The aim of the study was to assess the prevalence of generalised joint hypermobility (GJH) in 155 girls with idiopathic scoliosis (IS) (age 9–18 years, mean 13.8 ± 2.3). The control group included 201 healthy girls. The presence of GJH was assessed with Beighton (B) test. GJH was diagnosed in 23.2% of IS girls and in 13.4% of controls (P = 0.02). The prevalence of GJH was significantly (P = 0.01) lower in IS girls aged 16–18 years in comparison with younger individuals. There was no difference regarding GJH occurrence between girls with mild (11–24°), moderate (25–40°), and severe scoliosis (>40°) (P = 0.78), between girls with single thoracic, single lumbar, and double curve scoliosis (P = 0.59), and between girls with thoracic scoliosis length ≤7 and >7 vertebrae (P = 0.25). No correlation between the number of points in B and the Cobb angle (P = 0.93), as well as between the number of points in B and the number of the vertebrae within thoracic scoliosis (P = 0.63), was noticed. GJH appeared more often in IS girls than in healthy controls. Its prevalence decreased with age. No relation between GJH prevalence and curve size, curve pattern, or scoliosis length was found.

Inter-tester reproducibility and inter-method agreement of two variations of the Beighton test for determining Generalised Joint Hypermobility in primary school children

BackgroundThe assessment of Generalised Joint Hypermobility (GJH) is usually based on the Beighton tests, which consist of a series of nine tests. Possible methodological shortcomings can arise, as the tests do not include detailed descriptions of performance, interpretation nor classification of GJH. The purpose of this study was, among children aged 7-8 and 10-12 years, to evaluate: 1) the inter-tester reproducibility of the tests and criteria for classification of GJH for 2 variations of the Beighton test battery (Methods A and B) with a variation in starting positions and benchmarks between methods, and 2) the inter-method agreement for the two batteries.MethodsA standardised three-phase protocol for clinical reproducibility studies was followed including a training phase, an overall agreement phase and a study phase. The number of participants in the three phases was 10, 70 and 39 respectively. For the inter-method study a total of 103 children participated. Two testers judged each test battery. A score of ≥5 was set as the cut-off level for GJH. Cohen's kappa statistics and McNemar´s test were used to test for agreement and significant differences.ResultsKappa values for GJH (≥5) were 0.64 (Method A, prevalence 0.42) and 0.59 (Method B, prevalence 0.46), with no difference between testers in Method A (p = 0.45) and B (p = 0.29). Prevalence of GJH in the inter-method study was 31% (A) and 35% (B) with no difference between methods (p = 0.54).ConclusionsInter-tester reproducibility of Methods A and B was moderate to substantial, when following a standardised study protocol. Both test batteries can be used in the same children population, as there was no difference in prevalence of GJH at cut point 5, when applying method A and B. However, both methods need to be tested for their predictive validity at higher cut-off levels, e.g. ≥6 and ≥7.