Pain Conditions
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      Joint Hypermobility Syndrome

      Brief Overview: According to Cleveland Clinic, “Joint hypermobility syndrome is a connective tissue disorder. Thick bands of tissue (ligaments) hold your joints together and keep them from moving too much or too far out of range. In people with joint hypermobility syndrome, those ligaments are loose or weak. Joint hypermobility syndrome is a genetic condition that involves extreme flexibility along with pain and other symptoms.”

      Etiology: The exact cause is unknown. Genetics are believed to be a factor.

      Risk Factors:

      • Family history
      • Female
      • Occupations/activities that place repetitive strain on joints (dance, gymnastics, athletics).

      Commonly Associated Conditions:

      • Chronic musculoskeletal pain.
      • Frequent joint dislocations/subluxations.
      • Early-onset osteoarthritis.
      • Fibromyalgia, chronic fatigue syndrome.
      • Irritable bowel syndrome (IBS), gastrointestinal dysmotility.
      • Anxiety, orthostatic intolerance (including POTS).
      • Temporomandibular joint (TMJ) dysfunction.

      Common Medications:

      • Analgesics: acetaminophen, NSAIDs (short-term)
      • Neuropathic agents: duloxetine, gabapentin, pregabalin for chronic widespread pain.
      • Muscle relaxants
      • Topical NSAIDs: safer option for localized joint pain.
      • Supplements: vitamin D, calcium if deficiency or osteoporosis risk.

      Common Labs, Imaging, and Tests:

      • Clinical diagnosis using Beighton score (joint hypermobility assessment).
      • No specific lab for JHS.
      • Imaging (X-ray, MRI) may show joint degeneration or damage from instability.
      • Labs may be ordered to exclude autoimmune/inflammatory arthritis (RF, ANA, ESR, CRP).

      Common Symptoms:

      • According to Cleveland Clinic, the most common symptoms are:
        • Joint and muscle pain
        • Frequent joint and ligament injuries, including dislocations and sprains.
        • Joint and muscle stiffness.
        • Tiredness (fatigue).
        • Clumsiness/poor balance.
        • Bladder and bowel issues.
        • Dizziness and fainting.
        • Thin, stretchy skin.

      Common Treatments:

      • Physical therapy: strengthening, stability, posture training.
      • Low-impact exercise: swimming, walking, cycling, Pilates, yoga (gentle, modified).
      • Joint protection: braces, taping, supportive footwear.
      • Occupational therapy: adaptive techniques for daily activities.
      • Cognitive-behavioral therapy (CBT): for pain coping.

      Physical Findings:

      • Hypermobility on Beighton criteria (thumb-to-forearm, elbow/knee hyperextension, flat palms on floor).
      • Soft tissue tenderness.
      • Joint instability (subluxations, “giving way”).
      • Flat feet, scoliosis, or postural changes.

      Potential Complications and Contraindications:

      • Complications:
        • Recurrent injuries → early osteoarthritis.
        • Chronic pain, reduced mobility.
        • Functional impairment, falls.
        • Anxiety, depression due to chronic symptoms.
        • GI dysfunction, autonomic symptoms in some patients.
      • Contraindications:
        • High-impact or contact sports → risk of injury.
        • Long-term systemic NSAIDs in older adults (renal/GI risks).
        • Muscle relaxants in seniors (fall risk, sedation).

       

      General Health and Lifestyle Guidance:

      • Prioritize muscle strengthening to stabilize joints.
      • Avoid high-impact activities; choose low-impact exercise. Ask your healthcare provider what exercises are safe and recommended for you.
      • Use supportive shoes, braces, or walking aids as needed.
      • Practice good posture and ergonomics.
      • Maintain healthy body weight to reduce joint strain.
      • Stress management and adequate sleep to reduce fatigue and pain sensitivity.

      Suggested Questions to Ask Patients:

      • Do your joints feel unstable or slip out of place?
      • How often do you experience joint pain or injuries?
      • Do certain activities make your pain worse?
      • Have you noticed digestive problems, dizziness, or palpitations?
      • Does fatigue or poor sleep affect your daily functioning?
      • Have you seen physical therapy, and was it helpful?
      • Do you use any braces, supports, or mobility aids?

      Suggested Talking Points:

      • Joint hypermobility means your joints move more than usual, which can lead to pain and instability.
      • Strengthening muscles around your joints is one of the best ways to protect them.
      • It’s important to avoid high-impact or repetitive stress activities that can cause injury.
      • Low-impact exercise like swimming, cycling, or yoga can help build strength and reduce pain.
      • Supportive devices like braces or shoe inserts can protect joints and improve comfort.
      • Managing fatigue, sleep, and stress is just as important as managing pain.

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.