Hyperflexibility refers to an increased range of motion in the joints, which can sometimes lead to joint hypermobility syndrome (JHS).
What is Joint Hypermobility Syndrome (JHS)?
Joint hypermobility syndrome (JHS) is a condition where joints move beyond the normal range of motion. While some flexibility is healthy and normal, excessive joint flexibility can lead to issues such as joint pain, instability, and an increased risk of injury.
Diagnosis of Joint Hypermobility Syndrome:
One tool used to assess joint hypermobility is the Beighton score. A positive Beighton score indicates hypermobility. This score is determined by:
- Four points or more on flexibility maneuvers.
- Two points or more on relevant questions regarding joint flexibility.
Hypermobility Assessment Tool
The HAT app guides users through nine standard movements, uses AI to analyze motion, and then generates a Beighton score. It can be used by clinicians and patients over 18 years of age without any formal training. The free HAT app can be downloaded for Android and Apple devices.
It's important to note that a positive Beighton score alone cannot diagnose conditions like hypermobile Ehlers-Danlos syndrome (hEDS), Marfan syndrome, or osteogenesis imperfecta. If your child has a positive Beighton score, a referral to a specialist such as the Ehlers-Danlos Clinic, Genetics, or Rheumatology is recommended for further evaluation and appropriate treatment.
Diagnosis in those with biologic maturity
The clinical diagnosis of hEDS can be made in an individual who has reached biologic maturity with all three of the following criteria (for a full description of these see these guidelines ):
1. Generalized joint hypermobility with a Beighton score of:
a. 5 or more for adolescents who have reached biologic majority and adults under 50 years (6 or more for children who have not reached bone maturity)
b. 4 or more for those over years
2. Evidence of two of the following: systemic manifestations of a more generalized connective tissue disorder, family history, and musculoskeletal complications (see Criterion 2 below)
3. Exclusion of alternative diagnoses (see Criterion 3 below)
Key differences between the adult and pediatric diagnostic guidelines:
- Children cannot be diagnosed with hypermobile Ehlers-Danlos syndrome (hEDS) before puberty under the new guidelines.
- Generalized joint hypermobility is evidenced by a Beighton score of 6 or greater in children. This is one point higher than the threshold for adults because children are typically more hypermobile than adults.
- Eight new classification categories.
- Core comorbidities have been added - see below.
- Fewer tissue findings are included for children compared to adults. The symptoms included were those most relevant to children and adolescents.
- Children can be classified into categories based on their symptoms.
Comorbidities
Comorbidities are other health conditions that sometimes occur alongside joint hypermobility and can further impact quality of life. A person is considered to have core comorbidities if they are distressed or disabled by any of the following:
- Chronic primary pain
- Chronic fatigue
- Functional gastrointestinal disorders
- Functional bladder disorders
- Primary dysautonomia
- Anxiety
- POTS
- ADHD
Treatment and Management:
Physical Therapy
Working with a physical therapist who is knowledgeable about hypermobility syndromes can be beneficial. They can provide exercises and techniques to strengthen muscles, improve joint stability, and reduce the risk of injury. They also give guidance on proper posture and body mechanics to prevent injury.
Heart screenings
If people have some of the hyperflexible conditions they are at increased risk of cardiovascular issues. If there are any symptoms of dizziness, passing out, chest pain, or other concerning issues, a visit to discuss this is important.
Our area has a business that will do heart screenings for people 8- 25 years of age. These screenings include and echocardiogram and ECG, both read by a pediatric cardiologist. They do not take insurance, but it less expensive than seeing a cardiologist in person.
We sometimes rent rooms for this company, but people can do a screening at any of the locations and they are not afflilated with us other than room rentals.
For information on these screenings, see My Heart Check
.
Post-COVID Considerations:
It's important to be aware that individuals with hypermobility may be at increased risk of certain post-COVID conditions , such as Autonomic Dysfunction. This can impact various bodily functions, including heart rate, blood pressure, and digestion. If you suspect your child is experiencing symptoms related to autonomic dysfunction, it's essential to seek medical advice.
Resources
- For more information on managing symptoms associated with Autonomic Dysfunction, you can refer to the following resource: Mayo Clinic Teens Dysautonomia Guide .
- Hypermobile Ehlers-Danlos Syndrome characteristics, diagnostic criteria, and general management are outlined in this 2017 guidelines paper for adult hEDS.
- Pediatric joint hypermobility: a diagnostic framework and narrative review to clarify diagnostic criteria in children who have not reached bone maturity.
- Ehlers-Danlos Society : This website provides a wealth of information about EDS and related conditions. It can be a valuable resource for understanding these conditions and finding support.
- The Bendy Bulletin is a site with a lot of practical information.
Remember, if you have any concerns about your child's joint flexibility or any related symptoms, don't hesitate to reach out to us for guidance.
