What is joint hypermobility syndrome?
The joint hypermobility syndrome is a condition that features joints that easily move beyond the normal range expected for that particular joint. Joint hypermobility syndrome is considered a benign condition. Hypermobile joints are sometimes referred to as “loose joints,” and those affected are referred to as being “double jointed.”
Hypermobile joints tend to be inherited in specific genes passed on by parents to their children. It is felt that these certain genes predispose to the development of hypermobile joints. As a result, there is a tendency of the condition to run in families (familial). Genes that are responsible for the production of collagen, an important protein that helps to glue tissues together, are suspected of playing a role.
How common is joint hypermobility syndrome?
Joint hypermobility syndrome is common. It is estimated that 10%-15% of normal children have hypermobile joints or joints that can move beyond the normal range of motion. Please discuss with your doctor for further information.
What are the symptoms of joint hypermobility syndrome?
The common symptoms of joint hypermobility syndrome are:
- Pain and stiffness in the joints and muscles
- Clicking joints
- Joints that dislocate (come out of the correct position) easily
- Fatigue (extreme tiredness)
- Recurrent injuries – such as sprains
- Digestive problems – such as constipation and irritable bowel syndrome (ibs)
- Dizziness and fainting
- Thin or stretchy skin
Signs of the syndrome are the ability to place the palms of the hands on the floor with the knees fully extended, hyperextension of the knee or elbow beyond 10 degrees, and the ability to touch the thumb to the forearm.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
You should contact your doctor if you have any of the following:
- Often get pain or stiffness in your joints or muscles
- Keep getting sprains and strains
- Keep dislocating your joints (joints “Pop out”)
- Have poor balance or co-ordination
- Have thin, stretchy skin
- Have digestive problems like diarrhoea or constipation
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes joint hypermobility syndrome?
There are four factors that may contribute to joint hypermobility.
- The structure of your collagen. Collagen is a type of protein found throughout your body – for example, in skin and ligaments. Ligaments are tough bands of connective tissue (fibres that support other tissues and organs in your body) that link two bones together at a joint. They strengthen the joint and limit its movement in certain directions. If the structure of your collagen is altered, it may not be as strong, and the tissues that contain collagen will be fragile. This can lead to weakened or easily stretched ligaments. Changes in the structure of your collagen are likely to be caused by changes to your genes. Genes are units of genetic material that you inherit from your parents. They contain instructions that tell your body how to work. If the instructions within the genes change, it can alter the structure of your collagen.
- The shape of the ends of your bones. A joint is the junction between two bones. The shape of the bones determines how far you can move your limbs. For example, your limbs will be more flexible if the socket that the bone moves around in, such as the shoulder or hip socket, is shallow.
- Your muscle tone. Children with joint hypermobility may have a degree of hypotonia (low muscle tone), which makes the muscles “floppy” and could mean the child is able to bend their joints more than usual.
- Your sense of your joint movements (proprioception). You should be able to sense the position and movement of your joints. For example, even with your eyes shut, you should know whether your arm is bent or straight. The medical term for this sense is “proprioception”. However, some people with joint hypermobility have an abnormal sense of joint movement and are able to sense when a joint is overstretched, giving them a wider range of movement.
- Other conditions. In a small number of cases, joint hypermobility is associated with a more serious underlying condition. These are often inherited conditions, which parents pass to their children. Some conditions that can cause joint hypermobility are described below:
- Ehlers-Danlos syndrome. Ehlers-Danlos syndrome (EDS) is the name for a group of uncommon conditions that affect connective tissues. There are four main types of EDS, most of which can affect the joints in some way.
- Hypermobile EDS, previously known as EDS type III, is a form of the condition many experts now consider to be the same thing as joint hypermobility syndrome (JHS). This is the most common type of EDS and is estimated to affect around one in every 100 to 200 people.
- Marfan syndrome. Like EDS, Marfan syndrome affects the body’s connective tissues. The condition can cause hypermobile joints in addition to a number of typical characteristics, such as being tall and having abnormally long and slender limbs, fingers and toes. It can also cause potentially serious problems affecting the heart and eyes.
- Osteogenesis imperfecta. Osteogenesis imperfecta is a rare condition sometimes known as “brittle bone disease” because it causes fragile bones. Some forms of the condition can also cause joint hypermobility, along with a range of other problems.
What increases my risk for joint hypermobility syndrome?
There are many risk factors for joint hypermobility syndrome, such as:
- A history of Ehlers-Danlos syndrome, Down syndrome, Marfan syndrome.
- Young age.
- Female gender.
- Ethnic backgrounds (not white people)
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is joint hypermobility syndrome diagnosed?
If your doctor thinks that you may have joint hypermobility, the Beighton score is often used as a quick test to assess the range of movement in some of your joints. However, this cannot be used to confirm a diagnosis, because it is important to look at all the joints.
Your GP may also carry out blood tests and X-rays to rule out other conditions associated with joint pains, such as rheumatoid arthritis.
If you have other symptoms in addition to hypermobile joints, your GP may carry out a further assessment of your condition using the Brighton criteria, which can help determine if you have joint hypermobility syndrome (JHS).
The Beighton score
The Beighton score consists of a series of five tests, the results of which can add up to a total of nine points.
The score is worked out as follows:
- One point if you can place your palms on the ground while standing with your legs straight
- One point for each elbow that bends backwards
- One point for each knee that bends backwards
- One point for each thumb that touches the forearm when bent backwards
- One point for each little finger that bends backwards beyond 90 degrees
If your Beighton score is four or more, it is likely that you have joint hypermobility.
The Brighton criteria
The Brighton criteria take into account your Beighton score, but also consider other symptoms, such as joint pain and dislocated joints, and how long you have had them. There are major and minor Brighton criteria.
The major Brighton criteria are:
- Having a Beighton score of four or more – either now or in the past
- Having joint pain for longer than three months in four or more joints
The minor Brighton criteria are:
- Having a Beighton score of one to three, or having a Beighton score of zero to three if you are over 50 years of age
- Having joint pain for longer than three months up to three joints, back pain for longer than three months, or spondylosis (spinal arthritis) or spondylolisthesis (where a bone from the lower spine slips out of position)
- Dislocation or partial dislocation of more than one joint, or the same joint more than once
- Having three or more injuries to your soft tissues – such as tenosynovitis (inflammation of the protective layer surrounding a tendon) or bursitis (inflammation of a fluid-filled sac in a joint)
- Having particular physical characteristics called marfanoid habitus – this includes being tall and slim and having long, slim fingers
- Having abnormal skin – such as thin and stretchy skin
- Having eye-related symptoms – such as droopy eyelids or short-sightedness
- Having swollen and enlarged veins (varicose veins), a hernia (when an internal part of the body pushes through a weakness in the surrounding tissue wall) or – in women – pelvic organ prolapse (where the organs inside the pelvis slip down from their normal position)
According to the Brighton criteria, JHS may be diagnosed if you have:
- Two major criteria
- One major criteria and two minor criteria
- Four minor criteria
- Two minor criteria and a close relative, such as a parent, who has been diagnosed with JHS
How is joint hypermobility syndrome treated?
Often joint hypermobility causes no symptoms and requires no treatment. Many individuals with joint hypermobility syndrome improve in adulthood. Treatments are customized for each individual based on their particular manifestations. Joint pains can be relieved by medications for pain or inflammation. Proper physical fitness exercise should be designed to avoid injury to joints
- Physiotherapy may help people with hypermobile joints in a number of ways. For example, it may help to reduce pain, improve muscle strength and fitness, improve posture, improve your sense of your body’s position and movement (proprioception), and correct the movement of individual joints. It’s helpful to have a physiotherapist with knowledge of JHS, as some physiotherapy treatments can make symptoms worse. A wide range of physiotherapy techniques can be used. You may be advised to follow an exercise programme that includes strength and balance training, special stretching techniques and advice about pacing. Pacing involves balancing periods of activity with periods of rest. It means not overdoing it or pushing yourself beyond your limits, because if you do it could slow your long-term progress.
- Occupational therapy aims to help you overcome difficulties in your everyday life caused by having JHS. This may involve teaching you alternative ways of carrying out a certain task. For example, an occupational therapist can give you advice about reducing the strain on your joints while using a computer or getting dressed. Equipment may also be provided to make certain tasks easier. For example, special grips can make holding a pen easier and help improve handwriting. An occupational therapist can also suggest ways to adapt your home to make moving around easier. For example, if using stairs is a problem, fitting special grab rails may be recommended.
- For some people with JHS, flat feet can be a problem. If someone has flat feet, that person has no arch in the inner part of their feet, which can put a strain on nearby muscles and ligaments (tissue that connects bones together at a joint). If you have problems with your feet, a podiatrist (a foot specialist) can recommend treatments such as special insoles to support your feet.
- Medication can be used to manage the pain associated with JHS. Painkillers available over the counter from pharmacies, such as paracetamol, can sometimes help. Your GP can also prescribe a medicine that contains both paracetamol and codeine, which is a stronger type of painkiller. Liquid paracetamol may be helpful for children with JHS. Alternatively, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help in some cases. Painkillers and NSAIDs are also available as gels or sprays that can be applied directly onto painful joints. Make sure you check the patient information leaflet that comes with your medicine before taking any over-the-counter medication, to make sure it is suitable for you. Some people with JHS may find pain medication is not effective for them. There have been reports of local anaesthetic used during surgical procedures not having an effect on people with JHS. If you are having a procedure that requires anaesthesia, such as dental treatment, you may want to discuss the issue with your doctor or dentist beforehand.
- Pain management. If painkillers are not effective in reducing your pain, you may benefit from being referred to a pain specialist at a pain clinic. Staff at the clinic will be able to provide further advice and treatment. For example, some people with JHS benefit from a pain management programme that incorporates a type of psychological therapy called cognitive behavioural therapy (CBT) when painkillers are not working. Pain specialists can also provide stronger painkillers or medication used to specifically treat nerve (neuropathic) pain.
- Treating specific problems. If you have any related conditions, these will often be treated in the same way as people without JHS.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage joint hypermobility syndrome?
The following lifestyles and home remedies might help you cope with joint hypermobility syndrome:
- Ensuring you have a generally healthy lifestyle – including having a healthy diet and maintaining a healthy weight; this will help improve the strength of your joints and reduce the strain on them
- Adopting sleep hygiene measures if you have trouble sleeping – such as establishing fixed times for going to bed and waking up, trying to relax before going to bed, and maintaining a comfortable sleeping environment
- Staying as active as you can, but sticking to “Low-impact” Exercises, such as swimming or cycling to reduce strain on your joints
- Wearing comfortable and supportive footwear to support your ankles
- Applying heat – such as a hot water bottle or heat-rub cream – to soothe sore joints
- If you have an injury from over-stretching, it helps to rest the joint and elevate it (for example, by propping it up on some pillows); you can also apply ice wrapped in a damp towel to the injured area
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Hypermobility Syndrome (Joint Hypermobility Syndrome). https://www.medicinenet.com/hypermobility_syndrome/article.htm. Accessed February 27, 2019.
Joint hypermobility. https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/joint-hypermobility. Accessed February 27, 2019.
Joint hypermobility syndrome. https://www.nhs.uk/conditions/joint-hypermobility-syndrome/. Accessed February 27, 2019.
Review Date: February 27, 2019 | Last Modified: February 27, 2019