{"id":4024,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/hypermobility\/"},"modified":"2023-11-30T11:56:56","modified_gmt":"2023-11-30T11:56:56","slug":"hypermobility","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/hypermobility\/","title":{"rendered":"Hypermobility"},"content":{"rendered":"\n<h3 class=\"wp-block-heading has-alert-red-color has-text-color has-link-color wp-elements-a6f841c6bda5b15b9546d16cd4041e18\"><strong>This page is currently under review &#8211; Nov 23<\/strong><\/h3>\n\n\n\n<p>Hypermobile Ehler&#8217;s Danlos Syndrome (hEDS) is a condition characterised by hypermobile joints, widespread musculoskeletal pain and other symptoms. It is also known as Ehler&#8217;s Danlos Syndrome type III. There are many other types of EDS but most are very rare. Patients with these subtypes also have joint hypermobility but with prominent skin manifestations including fragile, paper-thin skin which scars easily. If these skin features are present, referral to clinical genetics would be indicated.&nbsp; <\/p>\n\n\n\n<h3 class=\"wp-block-heading\">History <\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Generalised joint pains<\/li>\n\n\n\n<li>Hypermobile joints <\/li>\n\n\n\n<li>Back pain<\/li>\n\n\n\n<li>Dislocations (uncommon)<\/li>\n\n\n\n<li>Abdominal pain<\/li>\n\n\n\n<li>Palpitations and faintness on standing<\/li>\n\n\n\n<li>Easy bruising<\/li>\n\n\n\n<li>Stress incontinence<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Examination<\/h3>\n\n\n\n<p>Hypermobility can be diagnosed clinically by testing mobility of the hands, knees, elbows, back and wrists and calculating the modified Beighton Score (see below). <\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Test<\/strong><\/td><td><strong>Score<\/strong><\/td><\/tr><tr><td>Extend 5<sup>th<\/sup> (little) finger by &gt;90<sup>o<\/sup><\/td><td>1 point for each side<\/td><\/tr><tr><td>Extend thumb back to touch forearm or lie parallel to forearm<\/td><td>1 point for each side<\/td><\/tr><tr><td>Extend elbow by &gt;10<sup>o<\/sup><\/td><td>1 point for each side<\/td><\/tr><tr><td>Extend knee by &gt;10<sup>o<\/sup><\/td><td>1 point for each side<\/td><\/tr><tr><td>Bend over and touch floor with flat of hands with legs straight<\/td><td>1 point<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>A score of &gt;4 is considered to represent joint hypermobility (the maximum score is 9).<br>Some patients also exhibit signs of fibromyalgia with multiple tender spots on palpation<br>There may be a late systolic murmur suggestive of mitral valve prolapse.<br>The pulse may rise and blood pressure fall on sitting up or standing up. This is known as postural orthostatic tachycardia syndrome (POTS)<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>It is not necessary to refer patients with hypermobility to the rheumatology service if there are no symptoms. If there is joint pain and generalised pain referral would be indicated if you are unsure about the diagnosis of thought there was another cause of the pain. Referral to the pain clinic may be appropriate if the patient&#8217;s symptoms don&#8217;t respond to the measures outlined in Primary Care Management.<\/p>\n\n\n\n<p>Patients with prominent cardiac, GI and urinary symptoms may require evaluation by cardiology, gastroenterology or urology.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<p>Treatment is symptomatic.<\/p>\n\n\n\n<p><strong>Education:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Explain that they have hypermobile joints and that sometimes this is associated with joint pain due to laxity of the ligaments and soft tissues.<\/li>\n\n\n\n<li>Explain that there is no cure but some treatments can help control pain.<\/li>\n<\/ul>\n\n\n\n<p><strong>Drugs:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Analgesics<\/li>\n\n\n\n<li>NSAIDs<\/li>\n\n\n\n<li>Gabapentin<\/li>\n\n\n\n<li>Amitriptyline<\/li>\n\n\n\n<li>Fluoxetine<\/li>\n<\/ul>\n\n\n\n<p><strong>Physiotherapy:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Referral to physiotherapy help through muscle strengthening exercises to improve joint stability<\/li>\n<\/ul>\n\n\n\n<p><strong>Please see Resources and links tab for additional information<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>\u200b<a rel=\"noreferrer noopener\" href=\"https:\/\/www.ehlers-danlos.org\/\" target=\"_blank\">Ehler&#8217;s Danlos Support UK<\/a><\/p>\n\n\n\n<p><a rel=\"noreferrer noopener\" href=\"https:\/\/www.hypermobility.org\/\" data-type=\"link\" data-id=\"https:\/\/www.hypermobility.org\/\" target=\"_blank\">What is Hypermobility-Syndromes (hypermobility.org)<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This page is currently under review &ndash; Nov 23 Hypermobile Ehler&rsquo;s Danlos Syndrome (hEDS) is a condition characterised by hypermobile joints, widespread musculoskeletal pain and other symptoms. It is also known as Ehler&rsquo;s Danlos Syndrome type III. There are many other types of EDS but most are very rare. Patients with these subtypes also have<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[619],"class_list":["post-4024","page","type-page","status-publish","hentry","category-hypermobility"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/hypermobility\/\" rel=\"tag\">Hypermobility<\/a>","rttpg_excerpt":"This page is currently under review &ndash; Nov 23 Hypermobile Ehler&rsquo;s Danlos Syndrome (hEDS) is a condition characterised by hypermobile joints, widespread musculoskeletal pain and other symptoms. It is also known as Ehler&rsquo;s Danlos Syndrome type III. There are many other types of EDS but most are very rare. Patients with these subtypes also have","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4024","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4024"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4024\/revisions"}],"predecessor-version":[{"id":17598,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4024\/revisions\/17598"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4024"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4024"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}