Hypermobility Syndromes and limb pain

• Children may be hypermobile due to a connective tissue disorder or from benign hypermobility syndrome with no underlying connective tissue disease.
• Pain is caused by mechanical stress.
• Pain often occurs after excessive activity; may get a sterile joint effusion
• Usually occurs between ages 6 to 11, since under 5 years of age it is often normal to be hypermobile.
• Labs and x-rays are normal
• Criteria include (need 4 of 5):
  1. Hyperextension of the fingers so that they are parallel to the forearm
  2. Apposition of the thumb to the surface of the forearm
  3. Hyperextension of the elbow more than 10 degrees
  4. Hyperextension of the knees more than 10 degrees
  5. Hyperflexionof the trunk –touching the palms of the hands to the floor with the knees straight
• Arthralgia or arthritis from joint hypermobility is a diagnosis of exclusion
• Therapy consists of strengthening exercises, protection of the joints, and NSAIDS

CHLA Board Review 2005