By: Joseph Brence, DPT
Benign joint hypermobility syndrome (BJHS) is a disorder in which musculoskeletal symptoms occur in hypermobile individuals in the absence of a rheumtological diagnosis. Individuals with BJHS often have hypermobility and pain of multiple joints. It is thought that the pain is due to stresses put on joint surfaces as well as strains of surrounding soft tissue. Below are some things to look for in indivuals who may possibly presenting with this disorder:
- Joint pain with joint hypermobility
- Report of being “double-jointed”
- Onset can occur at any time but there is a higher incidence of onset in children and females
- Pain for prolonged amounts of time
- Weight-bearing joints such as the knee and hip are most commonly effected
- Pain occurs later in the day
- Possible hx of shoulder or patellar dislocations, easy bruising, ligament/tendon ruptures, congenital hip dysplasia and TMJ
- Due to the disorder being autosomal dominant, 1st degree relatives also often have similar complaints
- Due to this being a connective tissue disorder, scoliosis, pes planus, genu valgum, lordosis, varicose veins, rectal/genital prolapse, thin skin may also be present
A Beighton score is necessary for screening these individuals and will help in making a diagnosis. A diagnosis should be one of exclusion and should rule out similar connective tissue and rheumatological disorders. A Beighton score is seen above and outlined below:
Can the patient:
- passively extend 5th MCP to > 90deg L R
- passively oppose thumb to ipsilateral forearm L R
- hyperextend elbow > 10deg L R
- hyperextend knee > 10 deg L R
- put hands on the floor while bending at waist without bending knees Yes or No
- Total Possible Score is 9 points a score of 4 or greater indicates generalized laxity.
Treatment of these patients should consist of medical management with a physician for proper pain relieving medications, open and closed chain strengthening and proprioceptive activities which will reduce stresses placed on ankle soft-tissue from hyper-mobility.
Simpson MR. Benign Joint Hypermobility Syndrome: Evaluation, Diagnosis and Management. JAOA. 2006:106;531-36.
Remvig L, Jensen DV, Ward RC. Epidemiology of General Joint Hypermobility and Basis for the Proposed Criteria for Benign Joint Hypermobility Syndrome: Review of the Literature. J of Reumatol. 2007:34;804-9.