Saturday, January 2, 2016

Family Medicine: Hypermobile Patients More Prevalent/ Pathology Than Expected

I am finding more hypermobile patients than would be expected for a practice like mine.  The chronic pain patients with spinal problems and sacroiliac pain are often responding positively to probing questions about Ehlers Danlos Syndrome.  "Are you double jointed?  Did you used to entertain your friends with contorting your body or stretching your skin?  Could you stand flatfooted with knees straight and put your palms flat on the floor?  Do your elbows and knees go "more than straight?"  Do your thumbs with wrists flexed touch the forearms?  Do your little fingers extend a good distance beyond 90 degrees?
This blog (click twice) has photos of what to look for and more for the Beighton Score and Brighton Criteria for assessing joint hypermobility and Ehlers Danlos Syndrome.

I have mentioned Ehlers Danlos Syndrome many times on my broadcasts (See the hyperlink to BlogTalk Radio to the right side of this post for the Dr. Synonymous Show).

These patients, known to have a flaw in the making of connective tissue such as collagen and/ or elastin, also have a tendency toward gastrointestinal problems with constipation, and are known to have as few bowel movements as once a week in them or their families.

A lot of them have chronic pain.  Many have other deficiencies such as methylation problems with their B Vitamins.

Inquiring about the joint issues in the Beighton Score with my patients on chronic pain medications yielded about two patients with hypermobility syndromes each week for five months.  A few with nagging spinal problems met the criteria.  Many have a long history of problems consistent with the Ehlers Danlos Syndrome diagnosis, while some have hypermobility but it never caused problems.  The latter group would be thought of as having "Benign Joint Hypermobility Syndrome".

Do you have a family of gymnasts, divers, cheerleaders who do back flips, skaters, etc.?

Long thought to affect one in 5,000 persons, the joint hypermobility syndrome(s) may be found in 1 in 500 persons or more.

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