hypermobility spectrum disorders (HSD)

Last edited 06/2018

Hypermobility spectrum disorders (HSD) are a group of conditions related to joint hypermobility (JH).

HSD are intended to be diagnosed after other possible answers are excluded, such as any of the Ehlers-Danlos syndromes (EDS) including hypermobile EDS (hEDS), Marfan's syndrome or osteogenesis imperfecta

Joint hypermobility is a term to describe the capability of joints to move beyond normal limits

• can exist by itself or be a part of a more complex diagnosis
• localized joint hypermobility (LJH) - with joint hypermobility in a couple of joints (fewer than five
• generalized joint hypermobility (GJH) - with joint hypermobility in five or more joints
  • GJH is more often congenital and possibly inherited, although acquired forms of GJH exist (training such as dance, widespread inflammatory or degenerative diseases of the joints, musculoskeletal tissues, and nerves, and hypothyroidism and other endocrine disorders) (1)
• LJH is generally acquired
• hyperlaxity that is entirely the result of impaired collagen is likely to be aggravated by growth spurts and hormonal changes as in menarche and pregnancy and at the menopause
• severe localised laxity at a single joint, perhaps a mild osteochondrodystrophy, is more likely to be associated with premature osteoarthritis, which may also be caused by impaired proprioception

Joint hypermobility can be asymotomatic apart from the unusual mobility

Possible skeletal manifestations include:

• trauma e.g. recurrent dislocations and subluxations
• chronic pain - can develop
  • possible mechanisms include
    • hyperalgesia
    • an impaired connective tissue function
• disturbance of proprioception

Other associations with HSD include:

• anxiety disorders, orthostatic tachycardia, a variety of functional gastrointestinal disorders, and pelvic and bladder dysfunction

Management of hypermobility is mainly symptomatic, requiring a multidisciplinary team including physiotherapists, occupational therapists and podiatrists

• the Beighton score is used to assess joint hypermobility

Reference:

• The Ehlers-Danlos Society. What is HDS (Accessed June 11th 2018)
• ARC (February 2005). Topical Reviews - Heritable Collagen Disorders.