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Ankle instability
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
As described for a LAS, anterior drawer and talar tilt tests for ATFL and CFL integrity are important, but are more subjective and less accurate compared to when used to examine for acute injury. Patients should also be screened for joint hypermobility syndrome.
Soft Tissue Surgery of the Knee
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Stephen Key, Jonathan Miles, Richard Carrington
A careful assessment of patients with recurrent patellar instability is required to identify the underlying pathoanatomy and confirm the surgical target. The mainstays of surgical treatment, which are discussed here, are medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle transfer, but other abnormalities that should be sought and may require surgical correction include trochlear dysplasia, coronal malalignment and torsional malalignment. Combined procedures may be warranted. The problem may be compounded by generalised hypermobility disorders. Additionally, poor strength of the quadriceps, glutei and core muscles leads to dynamic alignment problems, particularly evident on attempted single-leg squatting, that should be targeted with intensive physiotherapy. Isolated lateral release is not indicated for patellar instability and may even exacerbate the problem.
Orthopaedics and Fractures
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Women are more lax jointed than men and there is wide ethnic variation. The quick clinical test for joint laxity developed by Beighton is helpful. A child who scores five or more is hypermobile and when hypermobility becomes symptomatic, the ‘hypermobility syndrome’ is said to exist. Symptoms in children include joint and back pains, occasionally subluxations or frank dislocations, ligament muscle and tendon injuries after mild trauma and fasciitis.
Hypermobility of the spine: Ehlers Danlos and neurosurgery, the route forward in the UK?
Published in British Journal of Neurosurgery, 2023
Andrew Brodbelt, Jake Timothy, Nicholas Haden, Joshi George
Three pathophysiological mechanisms for the symptoms due to craniocervical instability in hEDS have been proposed. In the series described above, 71% of the HDCT group were said to have pannus of 3mm or more and basilar invagination, supporting a direct compressive mechanism on the brainstem.3 A second proposition is that hypermobility at the craniocervical junction increases strain on the brain stem, associated tracts, and the axons.4 Stretching of axons affects synaptic firing rates and amplitude, NMDA expression, mitochondrial function, and can eventually lead to apoptosis. Fixation is postulated as reducing the strain and microtrauma of hypermobility.4 The final hypothesis relates to the myodural bridge that attaches the craniocervical dura to the adjacent musculature. This is said to support and limit movement of the spinal cord and adjacent brain stem, and when deficient, as in EDS patients, leads to excessive pathological spinal cord motion. This has been postulated as precipitating significant symptoms without the need for the hypermobility described in the diagnostic measurements described above.5
Occupational Therapy Interventions for Clients with Ehlers-Danlos Syndrome (EDS) in the Presence of Postural Orthostatic Tachycardia Syndrome (POTS)
Published in Occupational Therapy In Health Care, 2022
David Levine, Brittany Work, Susan McDonald, Nicole Harty, Carolee Mabe, Alison Powell, Graceline Sanford
Ehlers-Danlos syndromes (EDS) are a group of genetic, connective tissue disorders that are heritable and can result in abnormal collagen synthesis, which may lead to skin hyperextensibility and tissue fragility, depending on the type (Malfait et al., 2017). Generalized joint hypermobility is commonly seen in individuals with some types of EDS (Gazit et al., 2016). Individuals with hypermobile EDS (hEDS), the most common type, can experience musculoskeletal problems such as joint dislocations, joint subluxations, and associated soft tissue injuries (Rombaut et al., 2010). Similar to EDS, the hypermobility spectrum disorders (HSD) are a group of conditions involving joint hypermobility and other articular and extra-articular symptoms (Malfait et al., 2017). HSD tends to be diagnosed after other conditions, such as hEDS, have been ruled out (Malfait et al., 2017). Common features seen in individuals with hypermobility conditions include chronic pain, micro and macrotrauma to joints and soft tissue, disturbed proprioception, bladder and pelvic dysfunction, and gastrointestinal disorders (Castori & Hakim, 2017).
Do asymptomatic generalised hypermobility and knee hyperextension influence jump landing biomechanics?
Published in European Journal of Physiotherapy, 2021
Ivana Hanzlíková, Kim Hébert-Losier
Joint hypermobility is characterised by increased joint movement beyond normal ranges expected in a given population [1]. The term generalised joint hypermobility is used when multiple joints (usually five or more) are affected [1]. Unlike joint hypermobility, generalised joint hypermobility is usually a congenital inherited disorder [1,2], but may be acquire by inflammation, degenerative, and endocrine processes [1]. Overall, the prevalence of generalised hypermobility reported to exist in the general population ranges from 2 [3] to 57% [4], with most studies reporting a prevalence from 10 to 20% [5] with females and children more often affected [6]. A recent framework for the classification of joint hypermobility [1] suggests dividing hypermobile individuals into 3 groups: individuals with asymptomatic joint hypermobility, individuals with a well-defined syndrome associated with joint hypermobility, and individuals with symptomatic joint hypermobility.