Hypermobility is the term used to describe the ability to move joints beyond the normal range of movement. Joint hypermobility is common, with studies estimating a prevalence of up to 25% of the population.

Hypermobility syndrome occurs when patients experience symptoms secondary to their flexible joints – it occurs in a minority of people with hypermobility (around 5%) and symptoms range from joint pain to dislocation and injury.

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Joint hypermobility by itself can be benign – in some sports, it can be beneficial (eg. ballet, ice-skating).

When the hypermobility causes pain, it becomes joint hypermobility syndrome. Patients can present with pain or stiffness in the joints or muscles, frequent sprains, dislocations of the joints, poor balance, thin stretchy skin and gastrointestinal issues such as diarrhoea or constipation.

Diagnosis

The Beighton score is used to assess the joints and a score of 5 points indicates hypermobility. It requires the performance of five manoeuvres, four passive bilateral movements and one active unilateral movement:

  1. hyperextension of the knees >10°
  2. hyperextension of the elbows >10°
  3. passive opposition of the thumb to the flexor aspect of the forearm
  4. passive extension of the little finger beyond 90 degrees
  5. forward trunk flexion so that the patient can place the palms of the hands on the floor

A diagnosis of joint hypermobility syndrome requires the presence of arthralgia for more than 3 months, previous dislocation or subluxation, abnormal skin, Marfanoid habitus, eye signs or hernia/prolapse.

In patients with hypermobility, increased skin fragility and joint dislocation, it is important to consider heritable connective tissue diseases such as Marfan and Ehlers–Danlos syndromes.

Differential Diagnosis

Different conditions can mimic symptoms of joint hypermobility syndrome, including: