Chest Pain From Hypermobility Responding to Physical Therapy in an Adolescent

Abstract

Hypermobility syndrome usually causes pain in limbs from extension type injuries. The authors report on a 16-yr-old female adolescent with incapacitating chest pain secondary to extreme hypermobility of the chest. This pain led the patient to see multiple specialists without improvement or diagnosis. Physical examination results revealed a very hypermobile patient who was able to internally rotate her shoulders inward until her elbows touched. This unusual hyperextension maneuver was achieved by holding the shoulders in anteversion with her hands on her hips (see figures in the article). Currently, there is no literature reporting hypermobility as a cause for chronic chest pain. Pain medication including opioids did not reduce the patient's chronic chest pain. Specific physical therapy to strengthen core and chest wall muscles in addition to working on proper breathing techniques with the diaphragm decreased pain and resulted in a resolution of this condition. We report that hypermobility can cause significant chest pain and may require creative physical therapy to strengthen the specific musculature.

Hypermobility prevalence, measurements, and outcomes in childhood, adolescence, and emerging adulthood: a systematic review

“…Physical health 4. Mental health Pacey, 2013 [ 88 ] Transcutaneous electrical nerve stimulation 5–14 Incontinence symptoms Salem, 2010 [ 97 ] Rehabilitation Strengthening and stability training 16 Chest pain Nash, 2017 [ 79 ] Strengthening and stability training 10 Elbow stability, strength and function Karademir, 2022 [ 68 ] Orthopedic aids Neoprene Wrist/hand splints 14 None Frohlich, 2012 [ 53 ] Foot orthotics 5–15 1. Gait synchrony 2.…”

“…Five studies offered patients physical interventions, which included either physiotherapy, strengthening, and movement training or a combination, often accompanied by education about GJH. All studies found improvement in pain, injury, and/or strength post-intervention [ 23 , 56 , 79 ]. One study compared knee strengthening exercises either in full ROM or only in a non-hyperextended ROM for children with GJH.…”

“…Two studies were case studies looking to rehabilitate children with a specific complaint and underlying GJH, both offered a strengthening and stability training program and reported patients’ full recovery [ 68 , 79 ].…”

The effect of generalized joint hypermobility on functional capacity, pulmonary function, respiratory muscle strength, and chest expansion in healthy young adults

“…The increased range of motion caused by hypermobility and chronic joint laxity may also cause hyperextension injuries to the supporting ligaments and soft tissue. Particularly in people who are already hypermobile, forces from repeated muscle contractions can strain the ligaments of the chest wall, leading to fatigue and pain (12).…”