Joint Hyper-Mobility

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Having joint hyper-mobility, means that your joints will have a large range of movement. This is when your joints are very “supple” and in some cases you can be “double-jointed” or able to twist your limbs into unusual positions. Flexible joints are also known as “ joint-hyperlaxity”.

Women normally are more supple than men of the same age group and often depending on the racial group you can be more supple than others.

As you will read later on in causes, the proteins of which our ligaments are made of, will cause different effects in people.

The reason why women are normally more supple than men of the same age could be due to the fact that the female sex hormone alters the collagen proteins. Women are more supple just before their period and even more during the latter stages of pregnancy due to the effects of the sex hormone called “relaxin". This hormone is responsible for allowing the pelvis to expand enough to allow the head of the baby to pass through.

Different races also have differences in their joint mobility (this is reflected in the structure of the collagen proteins).

In general, the older we become the less supple we get, although there are exceptions.

Joint hyper-mobility can be difficult to measure from one person to another, due to the different variations in people.

The “Beighton Score” is one system devised to measure joint hyper-mobility and is still currently in use.

Questions such as these can determine your score and you can test them out yourself:

1. Can you put your hands flat on the floor with your knees straight? (Score = 1 point)

2. Can you bend your elbow backwards? (Score: Left side = 1 point / Right side = 1 point)

3. Can you bend your knee backwards? (Score: Left side = 1 point / Right side = 1 point)

4. Can you bend your thumb back on to the front of your forearm? (Score: Left side = 1 point / Right side = 1 point)

5. Can you bend your little finger up at 90º (right angles) to the back of your hand? (Score: Left side = 1 point / Right side = 1 point)

The maximum score is of 9 points. Most people will score less than 2 and only about three to four out of a hundred people will score 4 or more.

Anybody that scores 4 or more points and suffers from “arthralgia” (joint pains) in four or more joints for longer than 3 months at the same time, is likely to have joint hyper-mobility. Joint hyper-mobility can only be properly diagnosed by a doctor and even though the Beighton Score is a very useful guide, doctors must consider other factors and symptoms before diagnosis can be confirmed just in case something else could be causing the pain in the joints.

This is known as the “1998 Brighton Criteria” and allows for the fact that some people have joint hyper-mobility in less than 4 joints or that their hyper-mobility affects other parts of their body other than the joints.

The Brighton Criteria is divided into major and minor criteria.

With major criteria the following is expected: - Beighton score of 4 points or more. - Joint pain in 4 or more joints for longer than 3 months.

With minor criteria the following is expected: - Beighton score of 1 to 3. - Pain in 1 to 3 joints, or back pain, for longer than 3 months. - Joint dislocation. - 3 or more instances of damage to the soft tissues (lesions). - Exceptionally tall, slim build with unusually long, slender fingers (Marfanoid habitus). - Thin or unusually stretchy skin, stretch marks or scarring from minor cuts. - Drooping eyelids, short-sightedness or slanting eyes. - Varicose veins, hernia or prolapse of the womb (uterus) or rectum.

To diagnose joint hyper-mobility your doctor would expect you to show any of the following criterias: - 2 major criteria. - 1 major criteria + 2 minor criteria. - 4 minor criteria. - 2 minor criteria + a first-degree relative (parent, child, brother or sister) with confirmed joint hyper-mobility.

CAUSES OF JOINT HYPER-MOBILITY

People that suffer from joint hyper-mobility are always at high risk of injuring their joint due to over-stretching them. Dislocations sometimes occur, particularly at the shoulder or hips.

There are reasons to believe that the following factors are the cause of joint hyper-mobility:

The shape of the ends of the bones: This is from where the bones move at the joints. Some joints such as the ones at the hips or shoulders, normally have a large range of movement. These joints will appear to look like a ball in the socket. If for whatever reason you happen to inherit a shallow socket rather than a deep one, then the range of movement will be relatively large, but only in those joints affected. This means that dislocations are particularly more easy to happen.

Weak or stretched ligaments caused by problems with collagen and other proteins: The ligaments are generally tough, fibrous bands which hold your joints together in place. All ligaments are made out of a different type of protein fibre. Within this protein, you find elastin, which is what gives elasticity in the joint. The collagen gives the joints strength for supporting the bones. The collagen fibres in the ligaments, will bind together more as you grow older. This is what causes stiffness in the bones. These fibres are made out of a biochemical reaction within our bodies. Any small differences within these biochemical reactions will alter the protein fibres making the ligaments to become either weak or easily stretched. If the joint hyper-mobility is due to altered collagen fibres, the scores obtained by the Beighton system will be high. This will affect a wide variety of joints, with the knee and the base of the thumb being particularly supple.

The tone of your muscles: The tone of your muscles affects whether your joints are held in place loosely or rigidly. The tone of the muscles is controlled by the nervous system and is responsible for the range of movement experience in the joints. Muscle tone and joint flexibility can be possible to alter by doing a set of special exercises, which some athletes need to acquire the hyper-mobility they need.

Your sense of joint movement (proprioception): Propriception is the sense that tells you where exactly your joint is positioned and whether it is over-stretched. If you happened to experience difficulty in detecting where exactly your joints are positioned with your eyes closed, then it is likely that you could develop hyper-mobile joints. This normally occurs because you end up over stretching your joints without realising that you were doing so.

SYMPTOMS OF JOINT HYPER-MOBILITY

One of the most common symptoms of joint hyper-mobility is pain. Pain happens after physical exercise or work due to your muscles having to work much harder because your joints are supple rather than stiff.

The result is “over-use” in the muscles around the joints, which in turn causes the pain. More often than not, the pain feels like it is coming from the joint rather than the muscle itself but that is not the case.

Sometimes, fluid builds up inside the hyper-mobile joint also, making it feel tense and stiff. This happens because your body is trying to repair the damaged caused around the over-stretched joints.

The pain will often get worse as the day progresses as the joints are in constant use, and will get better throughout the night while the joints are rested. However, pain can still occur at night time or after rest.

If the reason the joints are hyper-mobile is due to the altered collagen protein, then collagen can also be weakened in other parts of the body. This can lead to hernias and various veins.

Foot aches, specially after standing for long periods of time, can also happen due to having a flat arches.

If the base of the spine is particularly supple, this can also represent a problem, causing backache due to one of the bones in the back (vertebra) slipping on another. This is referred as “spondylolisthesis”.

Having any of these problems does not necessarily mean that you suffer from a disease, they are just the unfortunate effects of having more supple joints than most.

Also, not everyone that suffers from hyper-mobility necessarily develops any of these symptoms. The reason for this is totally unknown to this day and it is not fully understood why a large portion of the hyper-mobile population do not experience any problems or symptoms while a small portion can suffer terribly.

TREATMENTS FOR JOINT HYPER-MOBILITY

Physiotherapy: Research has shown that exercise can help. In most cases some of the symptoms can be reduced by doing gentle exercises that help strengthen and condition the muscles around the joints which are particularly supple. The important thing when doing these exercises is to do them frequently and regularly and not to over do them.

Seek advise from a physiotherapist and speak to your doctor if you are unsure of what types of exercises will be suitable for your condition.

Pain Medicines: Your doctor can always prescribe painkillers in order to control any pain or symptoms caused by hyper-mobile joints, if rest and physiotherapy fails.

Paracetamol (Acetaminophen) is often the best one and safest to use if painkillers are to be used regularly, since they are the least likely ones to cause any interactions with any other medications or further problems due to constant use.

The doctor can always prescribe something stronger but be aware that stronger painkillers often causes drowsiness or other unwanted side-effects.

If inflammation becomes a problem, especially if dislocation occurs, a non-steroidal anti-inflammatory drug (NSAID) may be a better option as a method of pain relief since these will also help with inflammation and not just pain.

Painkillers or NSAIDs are also available in cream, gel, foam or spray forms, which can be more convenient since they can be applied directly to the troublesome joint.

Long-term (chronic) pain can often leave the sufferer tired and run-down so further help can be obtained form pain management clinics. Ask to be referred by your doctor.

Surgery: Surgery is often not recommended for this type of condition since supple joints often take longer to recover and do not always heal properly.

Also people who suffer from hyper-mobility often bruise fairly easy and could require more blood transfusions if major surgery is carried out.

So unless you were to be unlucky enough to suffer from a ruptured tendon (which is often common when you also have supple collagen) that would require to be repaired surgically, then surgery should be avoided at all costs.

Operations that involve removing a knee-cap that dislocates frequently or stabilizing a joint that is very supple with a pin to fuse it, should be avoided since these type of operations can increase the risk of osteoarthritis later on in life.

Self-help: Wearing splints or elasticised bandages over the supple joints can help protect them against dislocation and damage. Occupational therapists or physiotherapists can offer advise on these.

Swimming is also a good way to exercise if you suffer from joint hyper-mobility since the weight of the body is supported by the water while exercising.

A balance diet is also very important in order to keep weight under control. The more you weight the more pressure will be applied to the joints and the risk of damage becomes higher so stay healthy with a good body weight.

RARE INHERITED CONDITIONS ASSOCIATED WITH JOINT HYPER-MOBILITY

Occasionally, joint hyper-mobility is only one part of a more widespread problem. In those rarer conditions, much more serious damage to the tissue proteins in the body occurs, resulting in other parts of the body being affected.

These rare conditions include:

- Osteogenesis Imperfecta (OI) which causes the bones to become fragile.

- Marfan’s Syndrome which involves the heart, eyes and blood vessels.

- Ehlers-Danlos Syndrome (EDS) which is the most difficult to diagnose since there are many different types.

FACTS FOR PEOPLE WHO SUFFER FROM JOINT HYPER-MOBILITY

Unfortunately is hard to predict whether joint hyper-mobility can be passed on to your children due to the different factors involve with the condition and it is often recommended to seek advise from a specialist such as a rheumatologist or geneticist.

There is normally enough evidence suggesting that hyper-mobility will be passed on to the next generation, if the hyper-mobility is caused by abnormal collagen proteins, it is widespread affecting many joints or causes easy bruising.

Unfortunately, the degree to which each child will be affected will be variable, and girls are often more affected than boys.

Also, many doctors believe that joint hyper-mobility is linked to the development of premature osteoarthritis.

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