Hypermobility of the joints

Hypermobility is a special condition of the joints and other body structures, in which the amplitude of the movements is much higher than the norm. Usually the flexibility and elasticity of hypermobile joints goes well beyond the natural, physiological flexibility of the body, and is considered by many specialists as an unconditional pathology.

The degree of mobility of the joints depends on the elasticity of the joint capsule and its ability to stretch. This also applies to tendons and ligaments. Doctors do not have a single point of view on this problem. There are various discussions on this subject. But still most people tend to believe that this condition is pathological and requires treatment. The main argument in favor of this view is that this condition is often painful.

Syndrome of hypermobility of joints

The condition in which the joints are subject to excessive mobility and flexibility, has been called the hypermobility syndrome. This condition occurs in both adults and children. It does not bypass even elderly people. At the same time, a distinctive feature is that this condition is characterized by soreness and discomfort. It is on the basis of this criterion that the state is classified as a pathological phenomenon. This state is especially intense when exercising, after prolonged activity, and also in young people during the period of intensive growth of bone structures. The main place of localization of painful sensations is the legs. But often the pain can be found in the hands, and even in the spine.

When it comes to hypermobility of joints, first of all imply increased mobility of the knee joint, since this is the most common pathology. Nevertheless, today there are more and more cases of discomfort and increased mobility of the ankle joint. How to explain such a transformation, doctors do not yet know.

Hypermobility syndrome disorder and excessive mobility

This pathology is characterized by excessive extensibility of the ligamentous apparatus, which leads to excessive mobility in the joint. Most often this form of pathology undergo joints of the spine, which become loosened up. This pathology is quite rare. Frequency of occurrence does not exceed 1%. It often develops in combination with spondylolisthesis, which is accompanied by a displacement of the vertebrae in the horizontal direction. Often considered as one of the symptoms of this disease. Surgery may be required to stabilize the affected joint.

Epidemiology

It can not be said that hypermobility is a rare condition. It occurs in about 15% of the population. At the same time, many do not even suspect that they have this condition, but consider it simply a property of the organism, naturally conditioned by flexibility. Many consider this symptom to be a non-pathological separate state, but simply weak ligaments. Indeed, it is quite difficult to differentiate the symptoms of weakness of ligaments and tendons from hypermobility.

In children, pathology is much more common than in adults and elderly people - approximately 9% of cases, while the adult population accounts for 4%. Among elderly people, this condition is only 2% of cases. It is also worth noting that women are more susceptible to hypermobility than men. At them such pathology meets approximately in 3,5 times more often, than at a man's part of the population. Often this syndrome occurs in combination with other diseases and acts as one of the symptoms of another disease, most often related to the musculoskeletal system.

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of the hypermobility of the joints

Unequivocally answer the question what exactly is the cause of pathology, it is not possible for any researcher, and even more so, a practicing doctor. The reasons are still unclear. There are only assumptions, and even individual theories, which only slightly shed light on the origin and etiology of this pathology.

Nevertheless, most scientists agree in a single opinion, and are inclined to consider the cause at the molecular level. So, many experts believe that it is the excessive extensibility of collagen, which is an important component of the tendons and muscles, is the trigger mechanism in the development of such a condition. If the indices of extensibility of collagen fibers exceed the norm, it can be said that the joint will have excessive mobility. This can provoke a large amplitude of movements, at the same time, provoking muscle weakness and disturbance of the ligamentous apparatus.

In accordance with another theory, the cause is a violation of metabolic processes in the body, and first of all, the violation of protein structures. There are suggestions that such changes are genetic, or due to the peculiarities of intrauterine development. Also, there is another point of view, according to which, the cause of increased mobility should be considered a lack of vitamin, especially in childhood. Some believe that rapid, rapid weight and lag in the set of muscle mass, can cause excessive mobility of the joints. Often the cause is different injuries, joint damage.

[9], [10], [11]

Risk factors

The risk group includes people who suffer from various genetic abnormalities and abnormalities, as well as those who are diagnosed as having metabolic disorders. Particularly negatively on the condition of the joints is a violation of protein metabolism, a lack of vitamins, a violation of protein synthesis. The risk group includes people who are quite large, especially if the weight is not enough. Rapid growth in childhood can also lead to hypermobility.

Excessive mobility threatens athletes who professionally engage in sports, exert excessive stresses on the body, constant overwork. Taking anabolic drugs, doping drugs, drugs intended for sports nutrition, can also affect the condition of the joints and their mobility.

It should be noted that many people engaged in hand-to-hand fighting, various martial arts forks, practicing qigong, yoga, various Chinese health practices, also have excessive joint mobility. But in this respect, the question remains whether this condition is pathological. The fact is that with such a regular practice of pain and discomfort, a person does not feel. Therefore, one can speak not about a pathological condition, but about mobilization of internal reserves of the organism, which allow a person to go beyond the limits of the organism's habitual possibilities. In the study of the joints of those who practice such practices, inflammatory and degenerative processes are not revealed. On the contrary, rejuvenation and intensive tissue regeneration are noted.

[12], [13], [14], [15], [16], [17], [18], [19], [20]

Pathogenesis

At the heart of pathogenesis is the violation of natural biochemical processes in the body at the molecular level. At the same time there is a violation of the normal synthesis of collagen, and other protein compounds. This entails the violation of other types of metabolic processes in the body. Since collagen provides mobility and extensibility of tissues, when it is excessively synthesized or deposited in the body, excessive mobility and violation of the processes of hardening and ossification are noted. Collagen can also provoke rapid aging and deterioration of the surface of the tendons and ligaments, as a result of which they lose elasticity and resistance, and easily undergo transformation and various types of mechanical action.

Also, the softening of the surrounding soft tissues becomes softening, which is unable to support the joint and provide it with mechanical strength. Swelling of soft tissues, effusion of articular fluid that have arisen for various reasons, becomes the factor that reduces strength and destroys the carcass base of the joint.

When carrying out histological and cytological studies, it can be established that there are no inflammatory processes in the joint. Nevertheless, there is a high level of regeneration and a condition close to post-traumatic tissue repair. Also significantly increases the amount of collagen and elastin in the body. When studying the synovial fluid surrounding the joint, a reduced amount of protein, epithelial cells is noted.

[21], [22], [23], [24], [25]

Symptoms of the hypermobility of the joints

First of all, this condition can be recognized by the excessive, unnatural flexibility of the joints, which significantly exceeds the norm indicators taking into account the age characteristics of the organism, and significantly exceeds the possibility of other people. In some people this is simply a state of increased flexibility, which does not bother the person and does not cause inconvenience. But in the majority this is a pathological condition, which is accompanied by pain and discomfort.

Usually, a person suffers from a severe pain in the joint, and the pain intensifies in the evening and at night. Nevertheless, many people say that an easy pain syndrome is present in the daytime, and even in the morning, after the person has woken up. With minor trauma or mechanical damage, the pain intensifies. With physical exertion, there is also a feeling of increasing pain. Most often knee and ankle pains. If this condition progresses and develops for a sufficiently long time, a person can turn and tilt his legs. This is especially marked in the morning, after sleep, and when the person is in a relaxed state.

Hypermobility can be recognized by the frequent dislocations that accompany a person during life. Moreover, the feature of many dislocations is that they are also easily and painlessly refilled, sometimes even spontaneously, when moving by the joint, without outside help.

A sign that hypermobility develops in a person can also be synovitis, an inflammatory process in the joint region. In this case, the most intense inflammation is exposed to the membrane lining the surface of the joint. Anxiety must cause permanent pain in the spine, especially in the thoracic region.

Scoliosis, in which the spine is curved, may also be one of the signs of developing hypermobility. At the same time, the distinctive feature is that a person is not able to accept one position, and for a long time to be in it. He is not able to control his joints. Even if he makes maximum efforts to hold the pose, after some time, spontaneous distortion will occur anyway. The appearance of muscle pain also makes it possible to suspect hypermobility in the early stages.

Hypermobility of knee joints

This is the most common pathology with which patients turn to the doctor. It occurs equally often both in children and in adults. Characterized by an increased sense of discomfort and pain. Basically, the pain is localized in the knee region, but it can also spread to the ankle joint. The pain after exercise increases. Also, quite a lot of pain is expressed in the period of bone growth.

People who professionally engage in sports, and receive constantly heavy loads on their feet, the pain is associated with swelling of soft tissues. Synovial fluid effusion is also quite common.

When carrying out a histological examination, the inflammatory process is not diagnosed. The overall clinical picture has many similarities with the consequences of trauma. Significant differences are characteristic for the composition of the synovial fluid. It is possible to detect a large amount of protein. Also there are various cells, for example, epithelial. The degree of destruction of tissue structures is maintained within normal limits, therefore, at an average degree of severity of the pathological process, a person can continue playing sports.

[26], [27]

Hypermobility of patella

The main complaint is pain. This pathology can occur at any age. Symptoms are quite diverse, and often masked by the symptoms of another disease. Almost always differential diagnostics with many genetic and congenital anomalies of joints is required. Usually it is difficult for a doctor to immediately identify a pathology, so the diagnosis and further treatment is often based on the patient's initial complaints.

Interest is that the "golden mean" for this pathology is extremely rare. Usually a person either does not feel any symptoms other than increased mobility and flexibility, or suffers from spasms and severe pain, which gives reason to suspect a serious genetic abnormality. Therefore, in order to make the correct diagnosis, a good diagnosis is required.

The main method of diagnosis is an examination, which includes physical examination using classical clinical methods, as well as additional functional tests that assess the condition and degree of flexibility of the joints. Laboratory and instrumental methods are rarely used. Basically, they are used for suspected inflammation or the presence of concomitant diseases. The main method of evaluation is the Beaton scale, which makes it possible to evaluate the flexibility on a 9-point scale. In this case, the patient is asked to perform 3 simple movements for flexibility.

Hypermobility of the hip joint

This pathology represents excessive flexibility and mobility of the hip joints. Most often occurs in childhood. Most girls suffer from this pathology. The incidence rate among girls accounts for about 80% of the pathology. Most researchers believe that the disease is genetically conditioned. Cases of family morbidity account for about a third of cases. At the heart of the pathogenesis is usually a violation of the exchange of collagen structures.

Treatment is mainly osteopathic. Most often 2-3 sessions are enough to eliminate pathology. After such sessions, the amplitude of movements comes to normal, eliminates excess muscle tension, normalizes metabolic processes in surrounding tissues.

The most common complication of excessive mobility of the pelvic joints is dislocation and subluxation of the hip. This is often a congenital anomaly that is much more common in children who were in the pelvic position during childbirth.

Also, hypermobility can be due to the bone itself, a violation of the elasticity or integrity of the ligamentous apparatus, pathological phenomena. Sometimes normal development of bone and its location in the horizontal plane is disrupted.

Pathology is important in a timely manner to identify and begin treatment. Then many serious complications can be avoided. In this case, as early warning signs are considered such early manifestations as the shortening of one leg in a child against the background of the normal size of the other leg. Anxious signs are: the appearance of an additional fold on the thigh, full symmetry of the gluteal folds and buttocks, as well as the presence of extraneous sound when the knee is sideways.

Treatment is reduced mainly to physiotherapy exercises, the use of certain techniques of active passive gymnastics, timely massage. In rare cases, medication is required. It is mainly aimed at eliminating symptoms.

Hypermobility of the shoulder joint

Often there is increased mobility of the shoulder joint. The cause is a violation of protein metabolism and a decrease in the tone of the skeletal muscles, which provides mobility of the joint. The weakness of the ligamentous apparatus is also noted. In the anamnesis painful joints, increased sensitivity to physical exertion, frequent injuries. Especially often there is a dislocation of the joint. At the same time there is an increased amplitude of movements in the joint, excessive volume of movements.

In this case, there are joint manifestations of this pathology, and extra-articular. The first form of pathology is characterized by increased mobility of the joints.

The extra-articular form of pathology is characterized by the presence of an inflammatory process in other, nearby areas. In this case, often increased mobility is accompanied by arthralgia and myalgia. At the same time, there may be a feeling of pain, severity, pressure in the joint region, but no other pathology is found during palpation. Visualization of pathology in most cases also fails. At the same time, a characteristic feature is that pain is intensified during massage, but after some time after passing the full course of treatment, the condition improves. Often the degree of pain syndrome depends on the emotional state of a person, general health, concomitant pathologies. Can occur in acute or chronic form, accompanied by frequent dislocations and subluxations.

Also one of the signs of the pathology of the shoulder joint is the pain that arises in the joint itself, gradually spreading to the entire shoulder, scapula and sternum zone. This process is accompanied by increased skin extensibility and its excessive flexibility and vulnerability. Especially dangerous is this pathology for people suffering from impaired cardiac activity and normal blood circulation.

Hypermobility of the elbow joint

This condition can be congenital or acquired. Most often, congenital anomalies are genetically determined, or caused by pathologies of intrauterine development, birth trauma. There are cases of family hypermobility.

Acquired most often result from injury, damage, excessive training. This is the main professional disease for dancers, dancers, athletes. Especially intensively, this pathology develops in individuals who initially have high rates of natural flexibility. Also, excessive mobility of joints can develop against the backdrop of diseases of the musculoskeletal system, other diseases. Mobility significantly increases when pregnant.

The main complaint of patients, besides high amplitude of movements, is pain and discomfort in the area of the damaged joint. At the heart of pathogenesis is a violation of metabolic processes in the joint, as well as a violation of the normal synthesis of collagen structures.

Diagnosis is most often based on a clinical picture. Also, if necessary, designate laboratory and instrumental studies. Usually it is enough to conduct a general physical examination to make a diagnosis, to conduct several tests on the mobility and flexibility of the joints.

Treatment is predominantly complex, including physiotherapy, physiotherapy, massage, and medication. Surgical methods are used extremely rarely, they are considered ineffective.

Hypermobility of the temporomandibular joint

Patients suffering from this disease, make numerous complaints. Most of them are caused by morphological and structural changes of the joint itself. Patients often have excessive mobility in the joint area, which is accompanied by pain, discomfort. This condition is especially strengthened during conversation, chewing, swallowing. In case of suspicion of hypermobility, you need to see a doctor. An orthopedic dentist will help. It is important to get complex treatment as soon as possible, since a dangerous complication is a violation of the normal structure and localization of the chewing musculature. Also, muscle tone decreases. The process can be accompanied by a violation of the trophism of the masticatory muscles, a violation of the functional state of facial muscles. Inflammation, an infectious process, often develops. In this case, the danger lies in the fact that the dislocation of the joint can develop.

Complications and consequences

Hypermobility can have complications, for example, in a person with this pathology, dislocations, subluxations, sprains of joints and ligaments often occur. Such people are more likely than others to suffer sprains and injuries. With excessive mobility of the knee or ankle, disability can develop, because when a person leans on the leg, it turns, which can result in a dislocation, severe trauma, muscle weakness. The extreme stage of muscle weakness is myositis, atrophy, which lead to partial or complete paralysis.

[28], [29], [30], [31], [32], [33], [34], [35]

Diagnostics of the hypermobility of the joints

In order to diagnose such a condition as hypermobility, it is necessary to consult a qualified specialist who specializes in the treatment of joints, limbs, muscles. You can apply to the district therapist, who then sends a consultation to the right specialist.

In order to make a diagnosis, usually an anamnesis is enough. First the doctor collects an anamnesis of life, which already can tell a lot about a person, about his lifestyle. From this, based on the analysis of the data, the doctor can draw a conclusion about the possible accompanying pathologies, the reasons for this condition. Often, identifying the cause, the doctor removes it, and this is enough to completely cure the person.

During the admission the doctor also collects an anamnesis of the disease, that is, finds out what exactly bothers the person, gets a detailed description of the symptoms, learns how long it began to bother the disease, what were his first signs, whether there is a similar condition in relatives and parents. It is also important to find out whether there are factors that increase mobility, or on the contrary, reduce it? Is there any pain, what is its nature, features of manifestation, severity.

Then, with the help of classical methods of research - palpation, percussion, the doctor conducts an examination - probes, listens for possible pathologies. Also, special diagnostic tests are conducted, which help to accurately determine the cause and degree of development of pathology. As diagnostic tests, various physical exercises are used that demonstrate the flexibility of the joints, their mobility. Usually, based on these tests, you can draw a line between the pathological, and the natural condition, to identify existing injuries and damage.

Most often, the following tests are used: ask the patient to reach with his thumb to the inside of the forearm. With normal flexibility, a person will not be able to perform this exercise.

After that, ask to touch the little finger of the outer part of the hand. This exercise is also able to perform only a person who has excessive flexibility of the joints.

At the third stage the person gets up, and tries to reach out to the floor with his hands. In this case, the knees can not be bent. And finally, the fourth test marks the condition and position of elbows and limbs with the full straightening of the arms and legs. With hypermobility, elbows and knees will bend in the opposite direction.

Usually such research is enough to make a diagnosis. Additional methods may be required only if there is a suspicion of any additional pathology, for example, an inflammatory or degenerative process, a violation of connective or epithelial tissue.

[36], [37], [38], [39], [40], [41]

Analyzes

Firstly, clinical tests (standard) are prescribed. This is a clinical blood test, urine. They give an approximate idea of the direction of the main processes in the body, make it possible to suspect pathologies and develop the most effective program for further diagnosis, which will help to identify pathological processes and take the necessary measures.

A clinical blood test can show the presence of an inflammatory process, a viral or bacterial infection, allergic reactions. The greatest diagnostic value is given by such indicators as the level of leukocytes, leukocyte formula. In the inflammatory process, the ESR increases dramatically, the number of lymphocytes and the total number of leukocytes increase. There is a shift of the leukocyte formula to the left.

Urine analysis may be required, since urine is a biological fluid that contains the final products of metabolism. A negative sign, indicating the development of inflammatory processes in the body and inflammation of the connective and epithelial tissue, is the presence of glucose, or protein in the urine.

Inflammatory and degenerative processes may be accompanied by leukocyturia. This is a condition in which the number of white blood cells in the urine sharply increases.

If there is a suspicion of an inflammatory process of bacterial origin, there is a need for a bacteriological study. Standard methods of bacteriological inoculation are used, in which the culture is sown, then it is incubated, which makes it possible to isolate the causative agent of the disease and to determine its quantitative and qualitative characteristics. Also, an antibiotic sensitivity test can be performed, which makes it possible to select the optimal treatment and determine the most sensitive antibiotic and its required dosage. The object of investigation is blood, urine, inflammatory exudate, synovial (joint) fluid.

In order to obtain a synovial fluid, a puncture is performed with further collection of biological material. If there is a suspicion of hyperplasia and the development of a malignant or benign neoplasm, a biopsy may be required to take a tissue sample. Then a cytoscopy is performed, during which the obtained material is stained, subjected to various biochemical markers, determines the morphology and cytological structure of the cell. For the histological analysis, sowing is carried out on special nutrient media intended for tissue growth. By the nature and direction of growth determine the main characteristics of the tumor, make appropriate conclusions.

In addition, it may be necessary to analyze the quantitative and qualitative content of vitamins in the blood and tissues of the body. Specialized biochemical tests, in particular, a test for the content of proteins, proteins, individual amino acids, microorganisms in the blood, their quantitative and qualitative characteristics, and also the ratio may be required.

Often with hypermobility, ifobsenno, if it is accompanied by pain, discomfort in the joints, appoint rheumatic tests. In addition, it is desirable to undergo these tests for prophylactic purposes, at least once a year. They allow us to identify many inflammatory, degenerative, necrotic, autoimmune processes in the early stages. Basically, assess the indices of C-reactive protein, rheumatoid factor, antistreptolysins, seromucoids. It is important to determine not only their number, but also the ratio. Also, with this analysis, you can monitor the treatment process, if necessary, make certain adjustments.

Rheumatoid factor is an indicator of an acute pathological process in the body. A healthy person does not have a rheumatoid factor. Its presence in the blood is a sign of an inflammatory disease of any etiology and localization. This often occurs with rheumatoid arthritis, hepatitis, mononucleosis, autoimmune diseases.

Antistreptolysin aslo is a factor aimed at lysis (elimination) of streptococcal infection. That is, its growth occurs with an elevated content of streptococci. Can indicate the development of the inflammatory process in the joint bag, soft tissues.

The determination of the level of seromucoids in hypermobility can play a very important role. The importance of this method is that it makes it possible to identify the disease long before it manifests itself clinically, accordingly, measures can be taken to prevent it.

The amount of seromucoids increases against the background of inflammation. This has an important diagnostic value in many pathological conditions, sluggish current inflammations, which practically do not bother the person and are difficult to detect by clinical methods.

C reactive protein is one of the indicators of an acute inflammatory process. An increase in the amount of this protein in the plasma indicates the development of inflammation. If, on the background of ongoing treatment, the level decreases - this indicates the effectiveness of treatment. It should be noted that the protein shows only the acute stage of the disease. If the disease has passed into a chronic form, the amount of protein becomes normal.

If, based on the available data, it is not possible to fully establish the cause or clinical picture, an immunogram may additionally be prescribed that reveals the main indicators of the immune system.

[42], [43], [44], [45]

Instrumental diagnostics

It is used if, during the diagnostic examination, the doctor failed to establish an accurate diagnosis, and also if the doctor has a suspicion of inflammation of the soft tissues, the articular bag, the development of other associated pathologies. Most often, an X-ray examination, computer and magnetic resonance imaging.

With the help of an X-ray, you can enlighten the bones, see damage, trauma or pathology in the bones. This method is especially effective if you want to visualize fractures of bones, displacement and pinched nerves, bone spurs, and even arthritis.

With the help of CT and MRI techniques, soft tissues can be considered. Thus muscles, ligaments, tendons, and even cartilages and surrounding soft tissues are well visualized.

If there is a suspicion of metabolic disturbances in the muscles, and if there is a suspicion of nerve damage, EMNG is used - the method of electromyoneurography. With the help of this method, it is possible to assess how much the nerve conduction and the excitability of muscle tissue are disturbed. It is estimated by the conductivity of the nerve impulse.

Differential diagnosis

Hypermobility often has to be differentiated with the natural flexibility of a person and other pathological conditions that have similar features. To make a differential diagnosis, it is necessary to differentiate the state from genetic and acquired pathologies. This is especially true with generalized joint loosening.

The first step towards successful differentiation is the need to differentiate from the pathologies of connective tissue. For this, a standard clinical trial is used. The most informative method is palpation. A standard physical examination is also mandatory. Various functional tests are used.

Some congenital anomalies can be recognized by a characteristic clinical picture.

A peculiar is the syndrome Ehlers-Danlos, which is a group of connective tissue diseases. Some symptoms border on the pathology of connective tissue and skin. The pathology of the skin can be quite diverse. Anomalies vary widely: from excessive softness to hyperelasticity, accompanied by ruptures and bruises. Gradually, this condition leads to the formation of scars, softening and increasing the elasticity and mobility of ligaments, muscles and bones.

Often this condition is accompanied by pain, effusion, dislocation of joints and bone structures. The main complication is the instability of the legs, in which a person can not rest on the lower limbs. Most often it is inherited.

It is extremely important to differentiate Ehlers-Danlos syndrome of the fourth stage from hypermobility, since this syndrome is a serious danger to the body and is a life-threatening condition. This syndrome is dangerous because it can lead to spontaneous rupture of blood vessels, in particular, arteries. There is also a rupture of the hollow veins and parenchymal organs. Especially dangerous is the condition for women during pregnancy, since there may be a rupture of the uterus. The condition is due to a defect in collagen synthesis.

In the second stage it is important to differentiate from the Marfan syndrome, which is a violation, the distinctive features of which are increased mobility, not only in the joints, but also in other organs. Also, a person has a peculiar appearance. A person suffering from this syndrome is abnormally high, has long, disproportionate limbs. The trunk with this is thin, the fingers are long. Also characteristic are eye anomalies, such as myopia, dislocation of the joints.

Disturbances are caused by a violation of fibrillin metabolism in the body. This is a special glycoprotein complex, which is an important component of connective tissue. This pathology is also extremely important to recognize in a timely manner, since it can act as a threat to human life. So, an aneurysm or aortic dissection, regurgitation of the aortic canal, prolapse of the mitral valve is a dangerous complication.

In general, this pathology is found in childhood. If you suspect a development of this syndrome, you need to undergo a comprehensive examination. Laboratory testing is mandatory. It is important to analyze the amino acid composition of blood plasma. It is important to exclude homocithinuria, metabolic disorders. Marfan's syndrome also needs additional differentiation. It is important to differentiate from homocystunuria. A distinctive feature of the second pathology is mental retardation.

Differentiation with osteogenesis is carried out. A distinctive feature of this disease is the excessive fineness of the sclera, as well as the presence of a blue hue in the color of the sclera. Bones acquire increased fragility, a person often fractures. There are lethal, and non-lethal forms of this disease. You can also distinguish by the low growth of a person. The lethal form is associated with the high fragility of bones, which is incompatible with life. Non-lethal forms are characterized by a lower severity of these symptoms, which do not represent a mortal danger. Complications of the heart and deafness may develop.

The syndrome of the Stickler differs from hypermobility in that, against the background of increased mobility of the joints, a person has peculiar facial features. The cheek bone undergoes changes, the bridge of the nose is pressed. Neurosensory hypoacusis may also develop. Most often manifested in infancy. Also, such children suffer from respiratory pathologies. In older children, arthritis develops as a concomitant disease, which usually tends to progress, and progresses to adolescence.

Williams syndrome is also much like hypermobility, but differs in that it develops against the backdrop of a delay in mental and physical development. Also it is diagnosed mainly in children. Associated pathologies are a violation of the heart, vessels. In adulthood, joint contracture can develop. A distinctive feature is a rough voice, low growth. A dangerous complication is aortic stenosis, vascular stenoses of the pathology of the heart.

Test for hypermobility of joints

The data are variable, and this should be taken into account when making a diagnosis. It is important to take into account anamnesis: individual characteristics of a person, age, sex, bone and muscle system of a person. It is also important and the physiological state of a person. For example, in young people, the score for this scale will normally be much higher than in older people. Also, during pregnancy, the rates of the norm may vary significantly.

It is important to consider that excessive flexibility in one or two joints, does not yet speak of pathology. It is possible to judge the presence of the disease in the presence of generalized flexibility that arises at the level of the whole organism.

The presence of genetic pathology can be said in the event that there is a combination of several characteristics. This is the basis for genetic analysis, on the basis of which it is already possible to draw certain conclusions.

Beiton scale

Thanks to it you can determine the severity of hypermobility. It is used for diagnosis at the level of the joints. The mobility is evaluated for each of them in points, then the result is summed and checked against the scale.

The Beaton scale includes 5 criteria, based on which the state is assessed. First, passive extension of the joints is evaluated. If a person can unbend it by 90 degrees, we can talk about hypermobility.

As a second indicator, the passive pressing of the thumb to the inner side of the forearm is considered. Normally, overextension in the elbow and knee joints should not exceed 10 degrees. The slope downward is also evaluated. In this case, the legs should be straight, the person should touch with the hands of the floor. Normally, the score should not exceed 4 points. Nevertheless, there are cases when girls show results over 4 points, and this is not considered a pathology. This is especially true for young girls aged 16 to 20 years, engaged in various sports.

[46], [47], [48], [49], [50]

Treatment of the hypermobility of the joints

At the heart of the treatment of hypermobility is pathogenetic treatment aimed at eliminating the pathological process in the body. Sometimes, in the early stages, an etiological treatment is used, which is based on the elimination of the cause, which resulted in a violation of the normal mobility of the joint. Pathogenetic treatment is resorted to if the diagnosis is clearly established and the clinical picture of pathology is clearly visible. The course of treatment is controlled by various laboratory and instrumental methods of investigation. Changing the results for the better, indicates the effectiveness of the treatment.

Prevention

At the heart of prevention is the observance of a healthy lifestyle. It is necessary to maintain the optimal level of physical activity. Sleep should be on a hard surface or using special orthopedic mattresses. It is important to perform physical exercises that strengthen dorsal muscles. Well in this regard, swimming, tennis lessons. It is necessary to take preventive courses of massage. If you are addicted to hypermobility, you should periodically drink the courses of muscle relaxants. At occurrence of the first signs, it is necessary to address as soon as possible to the doctor, to spend symptomatic therapy.

In order to identify pathology in the early stages, and to take timely measures, you need to undergo preventive medical examinations, take laboratory tests, especially rheumatic tests. They are recommended to be handed over at least once a year to persons over 25 years of age. This is especially true for people who have problems with the musculoskeletal system.

To prevent relapse, after the disease, it is necessary to strictly follow the doctor's recommendations, undergo a full rehabilitation course. It is necessary to understand that rehabilitation is lengthy. In addition, this pathology requires constant monitoring. It is necessary to take measures aimed at correcting existing deformities and preventing the formation of new ones. It is important to strengthen the muscles located along the spine.

[51], [52], [53], [54], [55]

Forecast

For many children, the prognosis is favorable -  hypermobility  usually disappears in adolescence. With adults, the situation is different. They have hypermobility, in most cases they need to be treated. If the treatment is started in time, the prognosis may be favorable. In the absence of adequate therapy, serious complications can arise: inflammatory, degenerative processes in the joints. Complications of the heart often develop, the central nervous system is disrupted.

Hypermobility of the joints and the army

Hypermobility can be the basis for postponing or unfit for service in the army only by the decision of the commission inspecting the draftee. It is impossible to answer this question unequivocally, since the problem is approached in a complex way: the degree of severity of the pathology, the limitations of the basic functions of the organism, the effect on performance, physical activity are taken into account.

[56], [57], [58], [59], [60], [61]