REVIEW OF RECENT JOURNAL ARTICLE
DR DOUGLAS R KENNEDY
BOULDER CO

Journal of musculoskeletal pain
volume 18, number three, 2010
the official Journal Journal of the international Myopain Society

review: title: An overlooked diagnosis in rheumatology: benign joint hypermobility syndrome.
Authors: Omer Faruk Sendur, Bengu Beydag, Odabasi, Yasemin Turan

Abstract
objectives: in this paper we aim to present the new developments in the clinical findings and treatment of benign joint hypermobility syndrome, in the light of recent studies, in an effort to give a better understanding of provider review for the doctors involved.

Findings: hypermobility is a clinical fine independent of any rheumatic disease is characterized by movement of joints beyond the normal range of motion. It is associated with some system pathologies in which the main findings are correlated with the musculoskeletal system and can be easily confused with some hereditary connective tissue disorders. Clinical signs of this benign joint hypermobility syndrome are considered in a range from joint instability to various problems, such as varicose veins and low bone mineral density.

Conclusions: the clinical effects of the JHS are poorly understood by general practitioners and, furthermore, it may be misdiagnosed or neglected by rheumatologists to. For this reason, the clinical signs of the syndrome should be while recognizing patients should be informed about the syndrome.

The symptoms that the authors found to be associated with this benign joint hypermobility syndrome include the following:
knee pain, back pain, foot pain, headache, growing pains, Polly arthralgia, joint swelling, stiffness, flulike symptoms, anxiety, sleep disturbance, poor coordination, clumsiness, dyspraxia, dyslexia, learning difficulties, easy bruising, muscular cramps, clicky joints, palpitations, fatigue, weight walking as a child, stress incontinence, and paresthesias.

Clinical findings of benign joint hypermobility syndrome:
joint stability disorders of proprioception, poor response to anesthetics, autonomic disturbances, low bone density, pes planus or flat feet, sprains, meniscus caring, fracture, scoliosis, costochondritis, sacred iliac joint just instability. Additionally Reynard's phenomena, skin fragility and skin laxity, paper scarring, vascular findings, neuropathies, knee pain, traumatic arthritis, Baker's cyst, temporal mint tubular joint dysfunction, congenital hip dislocation.

The clinician should be looking for some signs such as: the thumb passably touching the interior of the forearms, dorsi flexion of the small finger past 90∞, the ability of the patient to hyperextended elbow greater than 10∞, hyperextension of the knee beyond 10∞, and being able to touch the floor with the palms of the hands while standing with their knees extended and bending forward.

The authors developed a five-point hypermobility questionnaire. The following questions when asked can give a good indication of the need for further study and investigation.
1. Can you now or could you ever placed her hands flat on the floor without bending your knees
2. Can you now or could you ever been jerked him to touch her forearm?
3. As a child, did you amuse your friends by contorting your body and strange shapes or could you do the splits?
4. As a child or teenager, did your kneecap or shoulder dislocate on more than one occasion?
5. Do you consider yourself "double-jointed"?

It should be noted that if the patient answers in the affirmative on two or more of the five questions, the authors believe that they do have hypermobility syndrome. Statistically when a patient answers yes to two or more of the questions, the sensitivity is 85% in the specificity is 90%.

TREATMENT:
the authors believe that epic education is probably the most important thing a doctor can do. It's important for the patient to understand the importance of ergonomics and body mechanics. This will help lower the incidence of back pain. The patients are also told to avoid aggressive sports, but to participate in mild sports and jobs that require movement. Taping and splints can be helpful as well.

Medication: the authors report that medication may or may not be helpful.

Physical treatment modalities: there's not enough evidence who regards to physical therapy in the syndrome.

Spinal manipulations: the authors did not address spinal manipulation in this study. It is my opinion that if a patient has hypermobility syndrome they should not, I repeat, they should NOT be manipulated with high velocity thrust. Gentle mobilizations may be useful to help balance the spine.

Douglas R Kennedy, DC, Cert.Acup.
Kennedy chiropractic and acupuncture
Boulder, CO 80301, 80302, 80303.
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