The Effect of the Hypermobility Syndrome on Knee Joint Proprioception

Abstract

Proprioceptive sensory feedback is utilized by the central nervous system for conscious appreciation of the position and movement of the body and limbs. In patients with the hypermobility syndrome (HMS), it has been suggested that there is alteration of proprioceptive acuity. Proprioceptive performance of the knee joint was investigated in 10 female subjects who suffered from HMS using a threshold detection paradigm (accurate determination of the onset and direction of knee joint displacement at constant angular velocity). Compared to age- and sex-matched controls, HMS subjects showed significantly higher detection levels at starting knee flexion angles of 30 degrees P < 0.001) and 5 degrees (P < 0.001). Control subjects showed no significant difference in threshold acuity between the sexes (at 5 degrees P = 0.63, at 30 degrees P = 0.48). The increased acuity in proprioception observed towards full extension in the control population (P < 0.001) was absent in the HMS subjects (P = 0.596). Findings reported here suggest that HMS subjects have poorer proprioceptive feedback than controls. Reduced sensory feedback may lead to biomechanically unsound limb positions being adopted. Such a mechanism may allow acceleration of degenerative joint conditions, and may account for the increased prevalence of such conditions seen with HMS subjects.

Articular hypermobility is a protective factor for hand osteoarthritis

“…Proprioceptive acuity is abnormal in hypermobile joints, at both the PIP joint (18) and the knee joint (19). Position sense at the PIP joint was found to be significantly impaired in the setting of hypermobility; this is the same joint group in which we found a protective effect of hypermobility for OA.…”

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

“…In patients diagnosed with joint hypermobility, studies have shown a higher correlation with ACL tear [28] and shoulder instability [4]. Joint hypermobility has also been associated with a disturbance in proprioception [20]. The combination of decreased proprioception in addition to abnormal biomechanical stresses believed to result from increased joint mobility [38] is theorized to contribute to the development of arthritis.…”

Incidence of Joint Hypermobility Syndrome in a Military Population: Impact of Gender and Race

“…In addition to joint laxity, patients with JHS have reduced joint receptor activation and therefore a disturbance in proprioception [27]. Hall et al [19] demonstrated proprioceptive performance in the subjects with JHS was considerably poorer in the midrange of motion compared with their age-and gender-matched control subjects. They hypothesized that this may be secondary to decreased feedback from joints and suggested neuromuscular training for these patients as a potential way to decrease future degenerative joint disease.…”

“…They hypothesized that this may be secondary to decreased feedback from joints and suggested neuromuscular training for these patients as a potential way to decrease future degenerative joint disease. These findings suggest a need to identify those with JHS who are at high risk for musculoskeletal injuries and institute programs in neuromuscular training to decrease their risk of long-term disability and osteoarthritis, both in the military and civilian populations [19].…”

“…Recent studies have associated hypermobility with recurrent sprains and dislocations, arthralgias [2], premature osteoarthritis [23], mitral valve prolapse [8,43], and chronic fatigue syndrome [28]. Patients with hypermobility often need specific multidisciplinary rehabilitation after injuries because of reduced power and stamina of striated muscle in addition to pain and impaired proprioception [18,19,27]. The identification of risk factors for JHS may be helpful to implement preventive measures against injury for athletes and individuals with physically demanding jobs.…”