The hypermobility syndrome. Musculoskeletal complaints associated with generalized joint hypermobility.

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Ann. rheum. Dis. (1967), 26, 419

THE HYPERMOBILITY SYNDROME*

MUSCULOSKELETAL COMPLAINTS ASSOCIATED WITH

GENERALIZED JOINT HYPERMOBILITY

BY

J. A. KIRK, B. M. ANSELL, AND E. G. L. BYWATERS

From the M.R.C. Rheumatism Research Unit, Taplow, and the Department of

Medicine,

Hammersmith Hospital, London

This paper is concernedwith generalized joint laxity

occurring as an isolated finding in otherwise normal

subjects. We have used the name " Hypermobility

Syndrome " for the situation in which this joint

laxity is associated with musculoskeletal complaints.

The range of joint motion varies considerably

between individuals and with age, race, and body

build. Where the joints are unduly lax and the range

of motion is in excess of the accepted normal in most

of the joints examined, we regard the subject as

having generalized hypermobility. This is not

uncommon in the general population. In their

sample of 285 English schoolchildren, and

Wilkinson (1964) found excessive motion in at least

four joint pairs in 7 per cent. and Sutro (1947) had

shown that three or more joint pairs were hypermobile

in 4 per cent. of 435 adult orthopaedic outpatients.

Information on this condition as a cause of

musculoskeletal complaints is scanty. In the first

detailed report, Key (1927) described a family in

which the father and several sons were hypermobile

because of generalized ligamentous laxity. Relatively

little disability resulted except that recurrent

patellar dislocation occurred in a son and the father

had developed osteo-arthritic changes in the knees,

spine, and fingers by the age of 50 with a resulting

reduction in mobility. The first case of congenital

hypermobility of joints as an isolated phenomenon

producing chronic recurrent symptoms to be

recognized by one of us (E.G.L.B., 1950) has

unfortunately been lost to follow up.

Rowatt Brown and Rose (1966) have recently

drawn attention to ligamentous laxity as one of the

causes of precocious osteo-arthritis.

Most reports have noted a strong familial tendency

(Finkelstein, 1916; Key, 1927), the inheritance being

apparently dominant with a variable degree of

expression (Sturkie, 1941).

*Read at a meeting of Heberden Society on June 17, 1967.

Massie and Howorth (1951) recognized the

aetiological importance of generalized joint laxity

in the pathogenesis of congenital dislocation of the

hip. In their studies of recurrent patellar and

shoulder dislocation and congenital hip dislocation,

and Sweetnam (1958, 1960) and and

Wilkinson (1964) showed a close association with

familial joint laxity, particularly where the dislocation

also occurred in close relatives.

Hass and Hass (1958) described a severe degree of

joint laxity in five infants leading to postural foot

deformities, scoliosis, and hip and elbow dislocations.

Naming the condition arthrochalasis multiplex

congenita, these authors recognized the entity

of joint hypermobility without skin abnormality as

an independent articular disorder from the Ehlers-

Danlos syndrome.

One of the few previous reports of isolated hypermobility

as a cause of recurrent joint pain and effusion

was that of Sutro (1947) who described thirteen

young adults with pain and effusions in the knees or

ankles developing in the course of military training.

The family histories were negative and the majority

were unaware of being hypermobile. As these

patients were soon discharged from the army, the

outcome of their complaints was not known.

Generalized joint laxity is also a feature of the hereditary

connective tissue disorders, Marfan's syndrome,

the Ehlers-Danlos syndrome, and osteogenesis

imperfecta (McKusick, 1966). In the

Achard syndrome it is prominent in the hands and

feet in association with arachnodactyly (Parish,

1960). Rheumatoid and other inflammatory polyarthritides

may cause widespread acquired hypermobility,

as may neurological disorders such as

poliomyelitis, tabes dorsalis, and myotonia congenita

(Hass and Hass, 1958). " Flail joints " of neurological

origin may result in episodes of traumatic

synovitis and secondary osteo-arthritis-like changes.

Several rare diseases may show this feature,

419

ANNALS OF THE RHEUMATIC DISEASES

including the disorders of amino acid metabolism,

homocystinuria (Schimke, McKusick, Huang, and

Pollack, 1965) and hyperlysinaemia (Ghadimi,

Binnington, and Pecora, 1965). Levine (1958) noted

that hyperextensibility of the finger joints is common

in children with rheumatic fever and Callegarini

(1957) showed the same with joint range measurements.

The purpose of this paper is to describe a group of

patients with joint laxity and musculoskeletal

complaints, drawing attention to the hypermobility

syndrome as an explanation for a variety of otherwise

unexplained rheumatic complaints encountered

in clinical practice.

Material and Methods

A series of 24 patients has been seen since 1960 at the

Rheumatology Clinics of the Canadian Red Cross

Memorial Hospital, Taplow; Hammersmith Hospital,

London; Wrexham Park Hospital, Slough; and wood

Hospital, Ascot. These patients had musculoskeletal

complaints which the examiners at the time

considered were due to generalized joint laxity.

They were recalled for further study of the course and

nature of the complaints and for a search for any other

physical characteristics common to the group. The

patients were re-examined after an average period of 2

years by one of us (J.K.) and a full history was elicited,

including a detailed account of the musculoskeletal

symptoms. Family history of abnormal physique, joint

dislocation, or other hypermobility associations was

sought. The physical examination was made with particular

regard to any of the stigmata of heritable connective

tissue disorder, such as high arched palate, ocular and

cardiac lesions, hyper-elastic skin, or arachnodactyly.

The height, span, and pubis/heel dimensions were measured

and the body build assessed. Relevant x rays and

laboratory investigations were reviewed and where hand

x rays were available, the Metacarpal Index (Sinclair,

Kitchin, and , 1960) was calculated by the method

of Eldridge (1964) and compared with age-matched

controls from population survey material (by courtesy of

Dr. J. S. Lawrence).

The following subjects were studied for comparison:

(1) Nine first-degree relatives of hypermobile patients,

ncluding a non-identical twin and his mother.

(2) Sixteen age-matched controls.

(3) Fifteen hospital patients convalescing from

rheumatic fever.

Using a goniometer, the maximum movement of the

following joint groups was measured and recorded

according to the Neutral Zero Method as described by

Cave and (1936):

(1) Active horizontal motion of the arms behind the

coronal plane.

(2) Active hyperextension of the elbows.

(3) Active dorsiflexion of the wrists.

(4) Passive dorsiflexion of the third metacarpophalangeal

joints.

(5) Passive approximation of the thumbs toward the

forearms with the wrists in flexion.

(6) Supine hip flexion.

(7) Combined hip abduction in the supine position.

(8) Passive hyperextension of the knees.

In addition, the extent of passive ankle dorsiflexion and

foot eversion was compared with the normal.

Analysis.-The results of the joint range measurements

were analysed in two separate ways:

I. The criteria of joint hypermobility defined by

and Wilkinson (1964) were applied. The following

joint movements are considered and if more than three of

the five joint pairs are positive, then generalized hypermobility

is present.

(a) Passive opposition of the thumb to the flexor

aspect of the forearm.

( Passive hyperextension of the fingers so they lie

parallel with the extensor aspect of the forearm.

© Ability to hyperextend the elbow more than 100.

(d) Ability to hyperextend the knee more than 10°.

(e) An excess range of passive dorsiflexion of the

ankle and eversion of the foot.

IL. For each subject the measurements were compared

with a generally accepted normal range in two age groups:

Joint Group

(1) Shoulders

(2) Elbows

(3) Wrists

(4) MCP

(5) Thumbs

(6) Hip flexion

(7) Hip total abduction

(8) Knees

Feet and ankles

Age 5-14 Age 15+

30° 250

50 00

900 80°

700 600

1750 1750

950 900

900 850

50 00

Subjective assessment.

A scoring system was devised in which each measurement

in excess of the normal counts one point toward a

maximum of 17. This second system seems superior to

the first in that it includes the shoulders and hips, makes

some allowance for age, and gives a fairer representation

to the less severely hypermobile patients. The measurement

of joint motion is subject to considerable technical

error. This was reduced by one examiner making all

the measurements and by the goniometer being read after

it had been removed from the joint being measured.

Body proportions were considered to be abnormal in an

adult if the span differed from the height by 3 in. or the

lower segment from the upper segment by 2 in. Sinclair

and others (1960) suggested that these were suitable

limits outside which the diagnosis of the Marfan's

syndrome should be considered.

Results

Table I (opposite) shows hypermobility in patients

and controls according to age.

The age at onset of complaints ranged from 3 to

58 years, symptoms commencing in threequarters of

the patients before the age of 15. The adults in this

series were all female whereas the sexes were equally

represented in children. The oldest male with the

420

HYPERMOBILITY SYNDROME 421

TABLE I

PROPORTION OF SUBJECTS WITH HYPERMOBILITY

Subjects Age Number of Patients with eight or more Number of Patients with

's

(yrs) Hypermobile Joints Score 3 or More

Hypermobile Patients with Symptoms .. 5-14 7/11 8/11

15+ 11/13 1/13

First-degree Relatives .5-14 3/4 4/4

15 + 2/5 1/5

Controls.5-14 1/7 2/7

15+ 0/9 0/9

Rheumatic Fever Patien.ts. 5-14 2/12 0/12

15+ 0/3 0/3

combination of joint laxity and symptoms was of hereditary connective tissue

disorder, such as high

sixteen when symptoms ceased altogether. Symp- palate, hyper-elastic skin, or

easy bruising, detected.

tomless hypermobility was found in one 5-year-old Further evidence against this

condition being a

control and two children with rheumatic fever but forme fruste of

Marfan's syndrome

lay in the finding

in none of the adults. of normal body proportions on measurement and

Table II shows that the mean joint score in the normal metacarpal indices.

The combination of

hypermobility group was 9 (ranged 6 to 15), but a abnormal span and lower

segment length occurred

higher joint score did not always accompany severe in only one

patient, a hypermobile

youth who had a

complaints or a more widespread pattern of symp- normal metacarpal index (7

4) with no other clinical

toms. features of Marfan's syndrome. A raised meta-

An unexpected finding was that rheumatic fever carpal index may be more

reliable evidence towards

patients had a higher average joint score than the the diagnosis of Marfan's

syndrome than an abnormal

subjects. However, the observations of normal upper/lower segment

ratio according

to

Callegarini (1957) were not confirmed, in that the Eldridge (1964). Here the

metacarpal indices were

extensibility of the metacarpopha'angeal joint (600) all within the normal

range and showed the usual

was not significantly greater than that of age- increase with age (Table

III).

matched controls (57°). TABLE III

The relatives (five mothers, three brothers, and a AVERAGE METACARPAL INDEX

son) were also significantly hypermobile and two

were found to have symptoms attributable to this. Age (yrs)

The son experienced joint pains after exertion and Series 5-14 15+

one mother had evidence of mild generalized osteoarthritis

developing at the age of 44. This further Nopermalbeglatients 74 8 0

examination confirmed that the hypermobility was

an isolated finding. In no patient was other evidence Upper limit of normal:

Males 8-8; Females 9 4 (Eldridge, 1964).

TABLE It

MEAN HYPERMOBILITY

Subjects Age Average Number of Average Score per

(yrs) Hypermobile Joints per Patient Patient

Hypermobile Patients with Symptoms .5-14 8-7 3 0

15+ 100 2-6

First-degree Relatives. 5-14 8 3 3 0

15+ 7-4 1*6

Controls .5-14 3 8 1*4

15+ 1-8 0-2

Rheumatic Fever Patients.5-14 5 9 1-4

15+ 30 03

D

ANNALS OF THE RHEUMATIC DISEASES

The physical appearance of the hypermobile

patients was otherwise normal; they were not

particularly tall or slender but several were noted to

have poor muscular development.

In general the erythrocyte sedimentation rate was

not raised, except transiently to about 30 mm./hr

(Westergren) during some episodes of traumatic

synovitis. Neither was joint dislocation a prominent

feature. One woman described recurrent shoulder

dislocation with slight trauma in her youth and the

daughter of another had congenital hip dislocation.

Musculoskeletal complaints varied widely in their

duration, severity, and distribution (Table IV).

TABLE IV

MUSCULOSKELETAL COMPLAINTS IN 24 HYPERMOBILE

PATIENTS

Complaint No. of Cases

Muscle pains... 2

Muscle and widespread joint pains ..

Isolated painless knee effusion 2

Joint pains (including four with knee effusions and

one with an elbow effusion)...19

Total.24

At one end of the scale were children with pains in

one joint or muscle group for a year followed by

complete recovery. At the other end were women

with lifelong widespread joint pains sometimes with

effusion, who developed degenerative joint changes

in their 30s. In 21 of the 24 patients, pain was

associated with over-use, more often following than

accompanying it. Stiffness was a variable feature

and damp weather was often incriminated as a

factor. One third of the subjects considered themselves

double-jointed. Whereas hypermobility is

usually most prominent in the hands and wrists,

symptoms predominated in the lower limbs (Table

V).

TABLE V

SITES OF JOINT PAIN IN NINETEEN PATIENTS

Site No. of Cases

Widespread.5

Knees.11

Hands (4 DJD thumb bases

2 wrists

2 MCP andPIP). 8

Neck (3 with DJD).5

Ankles... 4

Back 3 lumbago and sciatica

I coccydynia 4

Feet 2 painful flattened longitudinal arch

I DJD first MTP .. 3

Table VI shows the wide range of associated

conditions encountered in the hypermobile patients.

TABLE VI

ADDITIONAL MUSCULOSKELETAL COMPLAINTS

Complaints No. of Cases

Degenerative joint disease.5

Dislocation (bilateral shoulders) I

Miscellaneous Supraspinatus tendinitis. .. 2

Bicipital tendinitis .. 2

Tennis elbow

Golfer's elbow

Painful Achilles tendon .. 1

Cramplike muscle pains in the thighs, calves, and

insteps occurred as the sole complaint in two

children over several years, and gradually lessened

as they approached puberty.

Case 1, a 10 year-old schoolboy, experienced nocturnal

attacks of cramplike pains in the calves and instep

between the ages of 3 and 9 years. At one time these

occurred several times a week often after strenuous

activity at school. At the time of examination, he had

been free of pain for a year. He was hypermobile (nine

lax joints out of seventeen with a score of 4), both

knees and elbows hyperextended by 200 and the thumbs

could be made to touch the forearms, but the feet and

ankles were not lax. He was slender with normal height,

541 in., span 56 in., lower segment 28 in., metacarpal

index 7*9.

Family.-The patient's non-identical twin brother was

slightly smaller and lighter but also with normal proportions,

height 53 in., span 52 in., lower segment 28 in,

metacarpal index 7-6. He denied any musculoskeletal

symptoms, although ten out of seventeen joints were

hypermobile and the score was 3. Both knees

and ankes hyperextended by 100.

His 32-year-old mother had complained for several

years of aching in the joints following over-use. Typing

would bring on wrist pain and a long walk caused pain in

the knees and ankles which she said would swell for a day

or so. Her body proportions were normal, height 65 in.,

span 65 in., lower segment 33 in., and measurement

showed her to be mildly hypermobile in seven out of

seventeen joints. The elbows and knees hyperextended

by 50 and the wrists dorsiflexed to 800.

Two children aged 9 and 10 experienced episodes

of pain in the front and medial aspects of the ankle

joints without swelling after vigorous physical

education at school. There was little discomfort

during the activity but the pain at night was severe

and they woke crying. In both cases the symptoms

persisted for a year and then subsided completely,

although the knees and ankles remained hypermobile.

Observed joint effusions had occurred in seven

patients, involving the knee in six, being bilateral in

422

HYPERMOBILITY SYNDROME

one and usually recurrent. In two cases chronic knee

effusion was the sole complaint, but generally the

knee was the site of pain after over-use as well and

sometimes other joints were involved. Knee pain

was usually felt at the medial or lower border of the

patella, occasionally posteriorly.

In two children chronic knee effusions still

persisted 2 years after the onset and the affected

knees lost their ability to hyperextend; both were

unusually active in sport and recreation and the

complaints coincided with a period of rapid growth

and weight gain.

Case 2, a schoolgirl aged 12, developed a painful

effusion into the right knee following unaccustomed high

jumping during a sports meeting. The left knee had

ached after use for the preceding few months. She

had been taking penicillin prophylaxis after an attack of

rheumatic fever without cardiac damage 7 years earlier.

The effusion still persisted 2 years later in spite of being

twice aspirated and once injected with intra-articular

corticosteroid. Percutaneous needle biopsy of the

synovium showed normal synovial histology. Examination

showed her to be strikingly hypermobile in thirteen

joints with a score of 4. Both ankles and the left

knee were lax but the affected knee did not hyperextend.

Her physical appearance was normal, height 66 in., span

66 in., lower segment 33 in., metacarpal index 7 * 9. The

enythrocyte sedimentation rate was 10 mm./hr

(Westergren). She is an extremely active girl and an

ardent ballet dancer which may account for the

persistence of the effusion.

Some older female patients had multiple musculoskeletal

complaints extending over many years,

culminating in the development of degenerative

joint changes at a premature age.

Case 3, a 45-year-old housewife, was the most strikingly

hypermobile patient examined. She was slender with

long arms, height 63 in., span 66 in., lower segment

32 in., and an asthenic build. Fifteen joints were lax

with a score of 4. The knees hyperextended by

200 and the elbows 150. She could touch elbows behind

her back and while standing touch the floor with her

wrists. The enythrocyte sedimentation rate was normal

and metacarpal index 8 * 4. All her life she was considered

double-jointed. Since the age of 20 one knee had been

painful and stiff after prolonged sitting and had once been

the site of an effusion. The fingers became stiff and painful

after knitting. Since the age of 33 years her neck movements

had been painful and limited, the cervical x ray

showing disc narrowing (C5, 6, 7) and degenerative

changes. She was referred to the clinic because of

recurrent " golfer's elbow " . Her daughter was born with

congenital dislocation of one hip.

Of the 24 hypermobile patients, five adult females

showed clinical and radiological signs of degenerative

joint disease. As shown in Table VII, the most

common sites were the thumb bases and cervical

spine and the age at onset of symptoms ranged from

33 to 56 years. Each of these five patients had in

addition a history of joint pain or effusion in earlier

life, but in two the complaints were so mild that it

was symptoms from degenerative joint disease which

first caused them to seek medical attention.

TABLE VII

DEVELOPMENT OF SYMPTOMS DUE TO OSTEO-ARTHRITIS

IN FIVE HYPERMOBILE PATIENTS

No. of Cases Site Age at Onset (yrs)

4 Carpometacarpal joints 56, 53, 41, 38

3 Cervical spine 54, 39, 33

2 Patello-femoral 54, 45

1 Elbow .. 38

1 First MTP 36

1 Mild generalized 52

Case 4, a 57-year-old female secretary, had developed

effusions of one knee on five occasions in the previous

10 years, each following strenuous gardening or work

involving kneeling. In between effusions she had pains

at the lower end of each patella on exercise and on

descending stairs. She attended the clinic when the

thumb bases became painful at the age of 56. She was a

tall slender woman, height 67 in., span 68 in., lower

segment 34 in., metacarpal index 7-3. Thirteen joints

were lax and the score 4. From her earliest recollection

she had been proud of being double-jointed, she

would bend her thumbs onto the forearm or squat on

the floor and then lie flat with ease until about the age

of 30. Until her teens she was an active ballet dancer

and wished to turn professional but became too tall for it.

Her mother had generalized osteo-arthritis and by

description was probably hypermobile. Clinical and

radiological examination confirmed the presence of

patello-femoral and carpo-metacarpal osteo-arthritis.

Notwithstanding she could still bend her thumb forward

parallel to the forearm.

Discussion

The isolated joint hypermobility in these patients

is considered to be the result of generalized familial

ligamentous laxity. This study supports the opinion

that this condition represents the extreme of a wide

normal variation in joint mobility. Another view

is that isolated ligamentous laxity is a mild mesenchymal

developmental disorder which lies at oni

end of a spectrum of heredofamilial connective

tissue disease with the fully-developed picture of

Marfan's syndrome and the Ehlers-Danlos syndrome

at the other (Brown and Rose, 1666).

Although hypermobility is relatively common

in the general population, depending on the criteria

chosen for diagnosis, reports of musculoskeletal

complaints are infrequent. However, as most

423

ANNALS Of JHE RHEUMATIC DISEASES

symptoms are mild and self-limiting so that subjects to the premature

development of degenerative joint

may not seek medical attention, the overall inci- - disease.

dence of complaints due to hypermobility is likely It is important to recognize

this syndrome, since a

to be much greater than hitherto recognized. In firm diagnosis and reassurance

may help the patient

this study many of the patients attended the clinic considerably and

save a great

deal of anxiety and

because of a family history of rheumatoid arthritis, medical time.

because an intercurrent sore throat raised the ques- DISCUSSION

tion of rheumatic fever, or through being members of DR. J. S. LAWRENCE

(Manchester): In our family study of

a medical family or hospital staff. At the present rheumatoid

arthritis, we examined

600 first-degree relatime

the diagnosis of this condition is essentially tives of patients with

arthritis and found that hyperclinical

combined with an awareness of the family mobility was present about 2j times

as often in these

history. The diagnosis and classification of the relatives as in the control

population sample. I do not

hereditary connective tissue disorders have as yet know whether we can draw

any conclusions from this,

not been facilitated by histological or biochemical

abrutthriittsisuggwehsitcshthiast ctohnerceerins eadgemnoetriec fwaictthorti

hnerchoenunmeacttoiivde studies incpoludingharidementaworksonhydroxypr tissue

structure than with any abnormality in the immu- and mucopolysaccharide

metabolism. nologically competent cells. Have you come across any

The management commences with reassurance as cases of rheumatoid arthritis

in the relatives of these

to the absence of serious disease. When an expla- patients?

nation of the complaints is given many patients do DR. KIRK: Dr. Ansell

tells me there was one.

not again seek medical attention. Activity which DR. H. L. F. CURREY

(London): I wonder if you could

precipitates symptoms should be avoided if possible comment on the racial

incidence of this laxity? There is

and, where the musculature is poor, which is a strong clinical impression that

hypermobility of joints

common, swimming is encouraged as regular is greater in people of African Negro

origin than in those

exercise. of European origin.

Most young subjects will grow out of their com- DR. KIRK: I think this is

quite true. These patients

plaints altogether. Others will develop premature were all born in Great

Britain and living locally. It is

degenerative joint disease particularly in the cervical my impression that

Indians and Pakistanis do have a

spine, thumb base, and patello-femoral articulation. greater degree of joint

laxity, and Prof. Bywaters has told

Inthsitsudy this complication did appearbefore me that he found the same among

the patients he saw in

hIn this study did not appear before Egypt.

the third decade. PROF. BYWATERS: I think this study is useful firstly

Summary because hypermobility is a factor which may possibly

enter into the genesis, severity, or progression of other

A reassessment was made of 24 patients who had joint diseases, and secondly

because in individual

presented with various musculoskeletal complaints patients it is always more

satisfactory for the clinician to

and who had been found to have generalized joint be able to give a positive

diagnosis. These patients often

laxity; the latter was thought to be responsible for masquerade under other

labels, rheumatoid arthritis,

their complaints. fibrositis, psychoneurosis, etc., which is unsatisfactory.

The ranges of joint movement, body proportions I recognized the first one in

about 1950; he was a young

and metacarpal indices were measured and comi doctor, whose symptoms had

been ascribed to many paned mehtacarpfalmindic werembeasurhedmand cern

different

categories by many different doctors. While not pared with other

family members,

rheumatic fever much can be done therapeutically, it is a great

psychopatients,

and normal controls. logical help to the patient (and the doctor also) to

recog-

Generalized familial joint laxity was found to nize the real origin of the

symptoms.

occur in this group of patients without any other DR. A. G. S. HILL

(Stoke Mandeville):

Was there any

features of hereditary connective tissue disorder. evidence of discomfort or

clicking in the temporo-

The wide range of associated symptoms is described. mandibular joint?

The hypermobility syndrome appears to predispose DR. KIRK: We received

no complaints

of this.

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Brown, A. Rowatt, and Rose, B. S. (1966). N. Z. med. J., 65,449

(Familial precocious

polyarticular

osteo-arthrosis of chondrodysplastic type).

Callegarini, U. (1957). Bull. St. Francis Hosp. (N. Y.), 14, 32 (Clinical

studyonthehyper-extensibility

of fingers in rheumatic children).

, C., and Sweetnam, R. (1958). J. Bone Jt Surg., 40B, 664 (Familial

joint laxity and recurrent

dislocation of the patella).

(1960). Ibid., 42B, 721 (Recurrent dislocation of the patella and of the

shoulder).

and Wilkinson, J. (1964). Ibid., 46B, 40 (Persistent joint laxity and

congenital

dislocation of

the hip).

424

HYPERMOBILITY SYNDROME

Cave, E. F., and , S. M. (1936). Ibid., 18, 455 (A method for measuring

and recording

joint function).

Eldridge, R. (1964). Arch. intern. Med., 113, 248 (The metacarpal index).

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Ghadimi, H., Binnington, V. I., and Pecora, P. (1965). New Engl. J. Med.,

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Hass, J., and Hass, R. (1958). J. Bone Jt Surg., 40A, 663

(Arthrochalasis multiplex

congenita).

Key, J. A. (1927). J. Amer. med. Ass., 88, 1710 (Hypermobility of joints as

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711 (Homocystinuria).

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29, 19 (The Marfan

syndrome).

Sturkie, P. D. (1941). J. Hered., 32, 232 (Hypermobile joints in all

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capsular and

ligamentous tissues; a cause for recurrent intra-articular effusions).

Le syndrome d'hypermobilite. Des sympt6mes locomoteurs

associes a l'hypermobilite articulaire generalisee.

RESUME

On r & -examina 24 malades presentant de differents

sympt6mes du systeme locomoteur chez qui on avait

trouve un relachement articulaire generalise et attribue

les sympt6mes a ce relachement. On determina

l'amplitude du mouvement articulaire, la conformation

corporelle et les indices metacarpiens et on compara ces

donnees avec celles obtenues chez d'autres membres de

la famille, chez des patients atteints de rhumatisme

articulaire aigu et chez des sujets normaux.

On trouva que le relachement articulaire g6n6ralis &

familial survient dans ce groupe de patients en l'absence

de tout signe de desordre hereditaire du tissu conjonctif.

On decrit un grand nombre des sympt6mes y associes.

Le syndrome d'hypermobilite semble predisposer ses

porteurs au developpement pr & coce d'une maladie

articulaire degenerative.

Il est important qu'on reconnaisse ce syndrome, car

un diagnostic ferme permet de rassurer le malade et

facilite la tache du medecin.

El sindrome de hipermovilidad. Sintomas locomotores

asociados con una hipermovilidad articular generalizada.

SUMARIO

Se volvieron a examinar 24 enfermos con varios

sintomas del sistema locomotor en los cuales se habia

encontrado una laxitud articular generalizada y atribuido

estos sintomas a ella. Se determinaron la amplitud del

movimiento articular, la conformaci6n del cuerpo y los

indicios metacarpianos y se compararon estos datos con

los obtenidos en otros miembros de la familla, en

enfermos con ruematismo poliarticular agudo y en

sujetos normales.

Se hall6 que la laxitud articular generalizada familiar

ocurre en este grupo de pacientes sin evidencia alguna de

trastorno hereditario del tejido conectivo. Se describen

los numerosos sintomas asociados. El sindrome de

hipermovilidad parece predisponer al desarrollo prematuro

de una enfermedad articular degenerativa.

El reconocimiento de este sindrome es importante, ya

que un diagn6stico firme conforta el paciente y facilita la

tarea del medico.

425

--

" Life- Like the flutter of wings... feel your hollow wings rushing... " (AFI-

Silver and Cold).

my Flight in life is a metamorphosis of growth and this flutter of wings is

within me awaiting to find a space to find it's flow...