Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain

Kumar, Bharat; Lenert, Petar

doi:10.1016/j.amjmed.2017.02.013

Cited by 109 publications

(123 citation statements)

References 47 publications

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“…Our estimated point prevalence of G‐HSD in 24.2% of women with chronic myofascial pelvic pain is higher than current estimates of approximately 3% to 20% for JHS in the general population . In our patient population, the presence of G‐HSD was associated with a higher likelihood of comorbid dyspareunia, low back pain, hip pain, SUI, and IBS, but not provoked vestibulodynia or prior diagnosis of fibromyalgia.…”

Section: Discussioncontrasting

confidence: 56%

“…Joint hypermobility alone is thought to be very common in the general population, affecting approximately 6% to 57% of individuals to some degree; however, this includes all individuals on the joint hypermobility spectrum, even those with single hypermobile joints . The prevalence of JHS, or chronic musculoskeletal pain due to joint hypermobility, is not firmly established with estimates ranging from 3% to 20% of women in the general population …”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis of JHS or HSD may, in turn, expedite the appropriate diagnosis and management of the associated conditions of chronic pain and pelvic floor dysfunction including incontinence and prolapse. Many of these patients would benefit from an individualized physical therapy treatment plan to focus on neuromuscular reeducation and joint stability . Likewise, an awareness of the condition may offer patients with pelvic pain, who often suffer for quite some time before obtaining a diagnosis, some reassurance as to the cause of their symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The true prevalence of G‐HSD in the general population is unknown, as no prevalence studies have been conducted since the 2017 nomenclature change. In prior literature looking at the prevalence of JHS, prevalence estimates range from as 3% to 20% of women in the general population …”

Section: Introductionmentioning

confidence: 99%

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Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Hastings

Forster

Witzeman

2019

PM&R

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Background Female chronic pelvic pain is estimated to affect up to 24% of adult women, many of whom have a component of myofascial pelvic pain. Although an association of joint hypermobility and pelvic pain has been hypothesized, limited data are available that estimate the prevalence of joint hypermobility in this population. Objective To estimate the prevalence of generalized hypermobility spectrum disorder (G‐HSD) among female patients with chronic myofascial pelvic pain and examine the association between G‐HSD and other frequent pelvic pain‐associated complaints. Study Design Retrospective case control. Setting Tertiary referral center within a university‐affiliated public health system. Patients Adult women who were diagnosed with myofascial pelvic pain during a 1‐year period (n = 77 with G‐HSD and n = 241 without G‐HSD). Methods Data were abstracted via chart review of patients meeting inclusion criteria. Outcomes The primary outcome of this study was the prevalence of G‐HSD among patients with persistent myofascial pelvic pain. Secondary outcomes included the prevalence of dyspareunia, provoked vestibulodynia, stress urinary incontinence, irritable bowel syndrome, hip pain, low back pain, and fibromyalgia in patients with persistent myofascial pelvic pain with and without G‐HSD. Results Twenty‐four percent (N = 77; 95% CI: 19.6, 29.4) of myofascial pelvic pain patients also met criteria for G‐HSD. After adjusting for confounders, the odds in favor of having G‐HSD was 3.55 higher (95% CI: 1.50, 8.40) (P = .004) in females with dyspareunia; 7.46 higher (95% CI: 2.41, 23.1) (P < .001) with low back pain; 3.76 higher (95% CI: 1.35, 10.5) (P = .02) with stress urinary incontinence; 4.72 higher (95% CI: 2.00, 11.2) (P < .001) with irritable bowel syndrome; and 3.12 higher (95% CI: 1.36, 7.13) (P = .007) with hip pain. There was no significant association identified between provoked vestibulodynia or fibromyalgia and G‐HSD. Conclusion The estimated prevalence of G‐HSD is higher in chronic myofascial pelvic pain patients than in the general population with statistically significant associations with several comorbid conditions. Characterizing these associations is the first step in developing effective, evidence‐based screening recommendations. Level of Evidence III

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Hastings

Forster

Witzeman

2019

PM&R

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“…Hypermobility of the sacroiliac joint is difficult to quantify in patients with sacroiliac joint pain. Whether due to adaptive biomechanical changes or actual ligamentous laxity, uneven stresses are created on the joint and surrounding stabilizing tissues . Lumbopelvic pain due to ligament hyperlaxity can be a congenital or an acquired condition.…”

Section: Introductionmentioning

confidence: 99%

Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients

Enix

Mayer

2019

PM&R

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Sacroiliac joint dysfunction is complex with numerous etiologies. Proper stabilization of the sacroiliac joint allows for effective transfer of loads between the trunk and the lower extremities during static and dynamic activities, while maintaining a freely nutating motion. A loss of integrity of the stabilizing soft‐tissue structures inhibits the ability to transmit axial loads and creates uneven stresses on the joint and surrounding tissues. Hypermobility of the sacroiliac joint can be caused by ligamentous instability or secondary to adaptive biomechanical changes and increased stresses affecting the joints of the pelvis. This article examines the current evidence related to the loss of stability on sacroiliac joint pain and dysfunction. A review of exercise goals for the hypermobile joint is included.

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Inspiratory muscle strength training improves lung function in patients with the hypermobile Ehlers–Danlos syndrome: A randomized controlled trial

Reychler

Liistro

Pierard

et al. 2018

American J of Med Genetics Pt A

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As exertional inspiratory dyspnea is a common disabling complaint in hypermobile Ehlers-Danlos syndrome (hEDS) often also known as joint hypermobility syndrome (JHS), we investigated inspiratory muscle (IM) strength in patients with hEDS, and we assessed the effects of IM training (IMT) on IM strength, lung function, and exercise capacity. A prospective evaluation of IM strength followed by a randomized controlled trial of IMT was performed in women with hEDS. Sniff nasal inspiratory pressure (SNIP) was used to routinely measure IM strength and IMT was carried out using a pressure threshold device. IM strength (main outcome), cardiopulmonary function, exercise capacity, and emotional distress of both the treated and control groups were evaluated at the start and at the end of the 6-week training period. IM strength was reduced (<80% of predicted) in 77% of patients (80/104). Lung function was normal, although 24% of patients had a higher forced expiratory vital capacity (FVC) than normal and 12% of patients had a higher total lung capacity (TLC) than normal.Both the IMT and control groups (n = 20) had similar baseline characteristics. Significant changes were noted only in the IMT group after IMT. At the end of the program, IMT improved SNIP (20%) (before: 41 AE 17 cm H 2 O [28, 53] vs. after: 49 AE 18 cm H 2 O [34;65]), six-minute walking distance (6MWD) (60 m) (455 AE 107 m [379,532] vs. 515 AE 127 m [408, 621]), and forced expiratory volume in one second (FEV1) (285 mL) (94 AE 14% pred [84,104] vs. 103 AE 11% pred [94, 112]). IM strength is significantly reduced in patients with hEDS. IMT improved IM strength, lung function, and exercise capacity. Our findings suggest that IMT should be added to usual care.

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Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain

Cited by 109 publications

References 47 publications

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients

Inspiratory muscle strength training improves lung function in patients with the hypermobile Ehlers–Danlos syndrome: A randomized controlled trial

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