Introduction
Joint hypermobility means some or all of your joints have an unusually large range of movement.Someone with hypermobility is particularly supple and able to move their limbs into positions that other people find impossible.
Hypermobile joints affect people to different extents:
- Those with mild hypermobility may hardly be affected by it and may not need treatment.
- Those with more severe hypermobility, or hypermobility syndrome, may experience pain, dislocated joints and injuries.
Who is affected?
Joint hypermobility affects women more than men, because female hormones increase flexibility.
It's often first noticed in children who can bend into unusual positions (often referred to as ‘double-jointed’).
What causes it?
There are different causes of joint hypermobility, but it is often hereditary (runs in families).
It often occurs because the connective tissue in the joints and ligaments is particularly loose and stretchy. This is because the protein fibres inside the connective tissue, called collagen, are altered. As a result, the joints can extend further than usual.
See Causes, above, for information on other causes.
How serious can it be?
Occasionally, joint hypermobility is part of a rare and serious condition that affects the tissue protein, such as:
- Osteogenesis imperfecta (affects the bones).
- Marfan Syndrome (affects the heart, eyes and blood vessels).
- Ehlers-Danlos Syndrome (causes easy bruising and stretchy skin).
Symptoms
Many people with hypermobile joints have few problems or none at all. Being hypermobile doesn't necessarily mean you will have any pain or difficulty.
If you do have symptoms, it is likely that you have hypermobility syndrome. You may have:
- joint pains, particularly after physical work or exercise (this is because your muscles have to work harder with supple joints),
- a tendency to bruise easily,
- tense, stiff joints, or
- pain that gets worse throughout the day and tends to get better at night, after you've rested.
In some cases, hypermobility can lead to hernias, varicose veins, flat feet, foot ache or backache. This happens when your collagen (a protein in connective tissue) is affected.
A common complaint in people with joint hypermobility is impaired hand function. An occupational therapist can help you find ways to make writing, for example, easier.
People with joint hypermobility are at risk of injury if they overstretch. Joints can dislocate if overstretched, particularly the shoulder, and have to be manipulated back into place.
Causes
There are four factors that cause hypermobility:
1. The shape of the ends of the bones.
A joint is the junction between two bones. The shape of the bones determines how far you can move your limbs. Your limbs will be more flexible if the socket that the bone moves around in (for example, the shoulder or hip socket) is shallow, because it will allow more movement.
2. Weak or stretched ligaments (bands that hold your joints in place).
This is caused by problems with collagen (protein fibres in the ligaments). Collagen fibres strengthen ligaments, so when collagen is altered, ligaments become weakened and easily stretched. This affects all the joints, especially knees and thumbs.This type of hypermobility in particular can be hereditary.
Hormones appear to have an effect, as the female hormone oestrogen increases flexibility, probably by affecting collagen. Women can find they're more supple before a period and less supple after the menopause. It's why women are more flexible than men.
3. The tone of your muscles.
The tone(stiffness) of your muscles is controlled by your nervous system. You can increase your suppleness with activities such as yoga, which helps relax the muscles.
4. Your sense of joint movement.
If you have an abnormal sense of joint movement you may not be able to sense when a joint is over-stretched.
Diagnosis
It can be difficult to measure joint hypermobility as the extent of it varies from person to person. But you can use a system called the Beighton score to see if you have hypermobility.
The Beighton score
The Beighton score consists of a series of nine tests, which each score one point:
1. Can you put your hands flat on the floor with your knees straight?
2. Can you bend your left elbow backwards?
3. Can you bend your right elbow backwards?
4. Can you bend your left knee backwards?
5. Can you bend your right knee backwards?
6. Can you bend your left thumb back on to the front of your forearm?
7. Can you bend your right thumb back on to the front of your forearm?
8. Can you bend your little finger on your left hand up at 90° to the back of your hand?
9. Can you bend your little finger on your right hand up at 90° to the back of your hand?
If you score four or more and have had joint pains in at least four joints for longer than three months, you're probably hypermobile (most people score less than two). It's worth seeing your GP to confirm this diagosis and check that your symptoms are not caused by another condition.
The Brighton criteria
To make a proper diagnosis, your GP will usually consider other factors, called the Brighton criteria. These criteria allow for the fact that some people are very supple at some joints but not all, and take account of symptoms such as joint pain and dislocated joints.
For further information, you can visit The Hypermobility Syndrome Association's page on the Brighton criteria (links to external site).
Your GP may also do blood tests and X-rays to rule out rheumatic diseases.
Treatment
Exercises and physiotherapy
Research has shown that gentle exercises to build up muscle strength around the hypermobile joints can help to control and support the joints. Your physiotherapist will show you some suitable exercises and stretches that can be done at home. The exercises should be done frequently, but not overdone.
It is important to keep generally fit, as this will ensure good blood flow around the body and keep the joints healthy.
Go to The Hypermobility Syndrome Association’s page on managing pain for detailed advice on how to ease pain through stretches, muscle relaxation, gentle exercises and the use of aids. (see selected links section)
Painkillers and anti-inflammatories
Painkillers such as paracetamol can be used if there is pain. Stronger painkillers such as codydramol are available on prescription. Anti-inflammatory drugs (NSAIDs) such as ibuprofen can be used to relieve any swelling of the joint.
Painkillers and anti-inflammatories can also be sprayed or rubbed on to the joint.
Steroid injections
Steroid injections can reduce swelling and pain. Steroid injections should be used with care as they have side effects, can cause scarring and increase the risk of tendon rupture.
It is often recommended that no more than three injections per year be given into weight-bearing joints.
Occupational therapy
An occupational therapist can help you adapt your home and way of life to take into consideration your hypermobile joints. For example, bed rails can help you to get out of bed, toilet seats can be raised, and small pieces of equipment can help with dressing.
Visit The Hypermobility Syndrome Association’s page on occupational therapy for information. (see selected links section).
Surgery
Surgery is not recommended, as the joint tissue does not heal very well, and it can lead to osteoarthritis (arthritis that affects the cartilage within the joint). The exception is a ruptured tendon, which should be repaired surgically.
All surgery has some risk, and with hypermobility, (especially if there is a problem with the collagen) there is an increased risk of bruising, bleeding, infection and poor wound healing.
Surgery to the spine may relieves local symptoms but cause strain elsewhere and make the problem worse.
Complications
People who are hypermobile may be slightly more at risk of developing osteoarthritis (arthritis that affects the cartilage within the joint). This is particularly likely in people whose hypermobility is caused by abnormal bone shape or an abnormal sense of joint movement.
source: NHS Direct Wales
