Hypermobility can be:
- Localised – single area affected and often acquired following trauma, joint disease or surgery
- Generalised – affects more than 5 joints in more than one limb
Prevalence of hypermobility varies greatly depending on the literature.
Management of hypermobility should generally be in Primary Care
Hypermobility may be a red flag symptom of a more severe disease with underlying multi-organ involvement.
Symptoms of hypermobility
- Chronic Pain
- Impaired proprioception
- Risk of trauma
- Pain often worse at end of the day/ after activity
Musculoskeletal: P GALS examination (paediatric Gait, Arms, Legs, Spine)
- Flat feet and over pronation of ankles can contribute to pain.
- Link to pGALS examination – click here
- Beighton score is not validated for use in children, but forms part of diagnostic criteria for EDS 3 (Ehlers-Danlos Syndrome type 3).The Beighton score is a set of manoeuvres used to look for evidence of joint hypermobility. There are 9 points in total, and a score of 4 or more is considered a sign of there likely being generalised joint hypermobility.
Skin: elasticity (ideal places abdominal wall, dorsum feet), atrophic scars, velvety skin, hernias
Mouth: high arched palate, dental crowding
General systemic examination: it is normal for children to be flexible and the degree of flexibility does not always correlate clinically.
- With no other concerning clinical features or significant symptoms, consider psychosocial compounding factors.
- Girls are more flexible than boys
- Flexibility decreases with age.
- It is normal for toddlers to be flexible and this should not be a reason for delayed motor milestones or pain.
- Encourage physical activity
- Avoid over use of analgesia
- Orthotics may offer some benefit if flat feet or over pronated ankles
- Simple measures such as rucksacks to distribute weight in school bags
Red Flag symptoms
- Morning stiffness easing through the day/ activity
- Joint swelling, joint restriction
- Recurrent dislocations
- Cutaneous changes- atrophic scars, skin hyper extensibility, velvety skin, recurrent hernias, unexplained prolapse
- Mouth- high arched palate, dental crowding
- Constitutional symptoms which may suggest malignancy or systemic disease.
When to Refer To Paediatric Rheumatologist:
- Any red flag symptoms
- No improvement with physiotherapy and orthotics
- Evidence of joint restriction.
Hypermobility in Children. W Coles et al. Paediatric and Child Health. 2017 28 (2)
Guidance for Management of Symptomatic Hypermobility in Children and Young People – A Guide for Professionals managing Children and Young People with this condition. British Society Rheumatology.