The Hypermobile Athlete Melody Hrubes MD Director NonOperative
![The Hypermobile Athlete Melody Hrubes, MD Director, Non-Operative Sports Medicine, New York Region Rothman The Hypermobile Athlete Melody Hrubes, MD Director, Non-Operative Sports Medicine, New York Region Rothman](https://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-1.jpg)
The Hypermobile Athlete Melody Hrubes, MD Director, Non-Operative Sports Medicine, New York Region Rothman Orthopaedics New York
![Presenter Disclosure Information Neither I, Melody Hrubes, or any immediate members of my family, Presenter Disclosure Information Neither I, Melody Hrubes, or any immediate members of my family,](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-2.jpg)
Presenter Disclosure Information Neither I, Melody Hrubes, or any immediate members of my family, have an financial relationships to disclose.
![Hypermobility Hypermobility](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-3.jpg)
Hypermobility
![Hypermobility Hypermobility](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-4.jpg)
Hypermobility
![Joint Hypermobility Syndrome • More prevalent in musicians than general population • Prevalence in Joint Hypermobility Syndrome • More prevalent in musicians than general population • Prevalence in](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-5.jpg)
Joint Hypermobility Syndrome • More prevalent in musicians than general population • Prevalence in classical ballet dancers 60 -90% Mc. Cormack M, Briggs J, Hakim A, et al. Joint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers. J Rheumatol. 2004; 31(1): 173 -178.
![Joint Hypermobility Syndrome • Declining prevalence of joint hypermobility from student to professional • Joint Hypermobility Syndrome • Declining prevalence of joint hypermobility from student to professional •](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-6.jpg)
Joint Hypermobility Syndrome • Declining prevalence of joint hypermobility from student to professional • Declining prevalence from corps de ballet to principal dancer (Mc. Cormack e al. , 2004)
![Joint Hypermobility Syndrome • Joint laxity may lead to an increased injury risk (Hamilton Joint Hypermobility Syndrome • Joint laxity may lead to an increased injury risk (Hamilton](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-7.jpg)
Joint Hypermobility Syndrome • Joint laxity may lead to an increased injury risk (Hamilton et al. , 1992) • Or it may not (Klemp and Chalton, 1989) • Increases rehabilitation time (Coollinge et al, 2009)
![Increased Stress on Secondary Stabilizers Increased Stress on Secondary Stabilizers](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-8.jpg)
Increased Stress on Secondary Stabilizers
![Hypermobility History • Persistent pain/headache • Joint subluxations/dislocations • Fatigue/sleep disorder • GI complaints Hypermobility History • Persistent pain/headache • Joint subluxations/dislocations • Fatigue/sleep disorder • GI complaints](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-9.jpg)
Hypermobility History • Persistent pain/headache • Joint subluxations/dislocations • Fatigue/sleep disorder • GI complaints • Rectal or uterine prolapse
![Hypermobility History • Mood disorders • Abnormal scarring/bruising • Slow healing • Abnormal reactions Hypermobility History • Mood disorders • Abnormal scarring/bruising • Slow healing • Abnormal reactions](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-10.jpg)
Hypermobility History • Mood disorders • Abnormal scarring/bruising • Slow healing • Abnormal reactions to local anesthetics
![Hypermobility History Hypermobility History](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-11.jpg)
Hypermobility History
![Hypermobility Physical Exam • Focused MSK • Genu valgus • Pes planus Hypermobility Physical Exam • Focused MSK • Genu valgus • Pes planus](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-12.jpg)
Hypermobility Physical Exam • Focused MSK • Genu valgus • Pes planus
![Hypermobility Physical Exam • • Scoliosis Varicose veins Thin skin “Party tricks” Hypermobility Physical Exam • • Scoliosis Varicose veins Thin skin “Party tricks”](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-13.jpg)
Hypermobility Physical Exam • • Scoliosis Varicose veins Thin skin “Party tricks”
![Beighton Scale Beighton Scale](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-14.jpg)
Beighton Scale
![Revised Beighton Criteria Major Criteria 1. Beighton score ≥ 4/9 2. Arthralgia for > Revised Beighton Criteria Major Criteria 1. Beighton score ≥ 4/9 2. Arthralgia for >](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-15.jpg)
Revised Beighton Criteria Major Criteria 1. Beighton score ≥ 4/9 2. Arthralgia for > 3 months in ≥ 4 joints Minor Criteria 1. Beighton 1, 2, or 3/9 2. Arthralgia for > 3 months in ≥ 1 -3 joints, back pain for ≥ 3 months 3. Dislocation or subluxation in >1 joint, or in 1 joint >1 x 4. Soft tissue rheumatism ≥ 3 locations 5. Marfanoid habitus 6. Abnormal skin 7. Eye abnormalities 8. Varicose veins , hernia, or uterine/rectal prolapse
![Revised Beighton Criteria • Two major criteria • One major and 2 minor criteria Revised Beighton Criteria • Two major criteria • One major and 2 minor criteria](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-16.jpg)
Revised Beighton Criteria • Two major criteria • One major and 2 minor criteria • Four minor criteria • Joint Hypermobility Syndrome (JHS) is excluded in those patients with MFS or EDS
![Lower Limb Assessment Scale (LLAS) Ferrari J, Parslow C. , Lim E. , Hayward Lower Limb Assessment Scale (LLAS) Ferrari J, Parslow C. , Lim E. , Hayward](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-17.jpg)
Lower Limb Assessment Scale (LLAS) Ferrari J, Parslow C. , Lim E. , Hayward A. Joint hypermobility: The use of a new assessment tool to measure lower limb hypermobility Clin Exp Rheum 2005; 23: 413 -420 • Movement of joints in several planes of motion • 15 minutes • Scored out of 12
![Lower Limb Assessment Scale (LLAS) • Compared it to Beighton scale • LLAS = Lower Limb Assessment Scale (LLAS) • Compared it to Beighton scale • LLAS =](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-18.jpg)
Lower Limb Assessment Scale (LLAS) • Compared it to Beighton scale • LLAS = 7 – Sensitivity 94% – False positive rate 7. 5% • LLAS = 8/12 – Sensitivity 70% – False positive rate 0. 4%
![Upper Limb Hypermobility Assessment Tool (ULHAT) • Nicholson L, Chan C. The Upper Limb Upper Limb Hypermobility Assessment Tool (ULHAT) • Nicholson L, Chan C. The Upper Limb](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-19.jpg)
Upper Limb Hypermobility Assessment Tool (ULHAT) • Nicholson L, Chan C. The Upper Limb Hypermobility Assessment Tool: A novel validated measure of adult joint mobility. Muscul Sci Prac. 25(2019)38 -45. • Upper limb hypermobility did not vary with age or ethnicity • Greater in females (p<0. 001)
![Upper Limb Hypermobility Assessment Tool (ULHAT) • Designed as analogue to • ULHAT = Upper Limb Hypermobility Assessment Tool (ULHAT) • Designed as analogue to • ULHAT =](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-20.jpg)
Upper Limb Hypermobility Assessment Tool (ULHAT) • Designed as analogue to • ULHAT = 7 12 point LLAS – Sensitivity 0. 84 – Specificity 0. 77 • Performed on both – False positive ratio 5. 4 upper limbs • Multiple directions
![Hypermobility Further Testing • complete blood cell count • erythrocyte sedimentation rate • rheumatoid Hypermobility Further Testing • complete blood cell count • erythrocyte sedimentation rate • rheumatoid](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-21.jpg)
Hypermobility Further Testing • complete blood cell count • erythrocyte sedimentation rate • rheumatoid factor • antinuclear antibody test • serum complement (C 3, C 4, CH 50) levels • serum immunoglobulin (Ig. G, Ig. M, Ig. A) levels.
![Treatment Strategies • Prioritize strength and control • straight instead of locked in hyperextension Treatment Strategies • Prioritize strength and control • straight instead of locked in hyperextension](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-22.jpg)
Treatment Strategies • Prioritize strength and control • straight instead of locked in hyperextension • approximate closed chain
![Treatment Strategies Avoid static stretching and overstretching – dynamic vs static – release vs. Treatment Strategies Avoid static stretching and overstretching – dynamic vs static – release vs.](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-23.jpg)
Treatment Strategies Avoid static stretching and overstretching – dynamic vs static – release vs. lengthening
![Treatment Strategies • Improve endurance – Mitigate risk of overuse injuries – Easily fatigued Treatment Strategies • Improve endurance – Mitigate risk of overuse injuries – Easily fatigued](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-24.jpg)
Treatment Strategies • Improve endurance – Mitigate risk of overuse injuries – Easily fatigued leads to easily injured
![Treatment Strategies • Proprioception • Hypermobility leads to proprioceptive dysfunction Treatment Strategies • Proprioception • Hypermobility leads to proprioceptive dysfunction](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-25.jpg)
Treatment Strategies • Proprioception • Hypermobility leads to proprioceptive dysfunction
![Treatment Strategies Treatment Strategies](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-26.jpg)
Treatment Strategies
![Treatment Strategies • Modifications to playing biomechanics or choreography Treatment Strategies • Modifications to playing biomechanics or choreography](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-27.jpg)
Treatment Strategies • Modifications to playing biomechanics or choreography
![Treatment Strategies • Brace when appropriate – wrist – finger – spine Treatment Strategies • Brace when appropriate – wrist – finger – spine](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-28.jpg)
Treatment Strategies • Brace when appropriate – wrist – finger – spine
![Treatment Strategies Treatment Strategies](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-29.jpg)
Treatment Strategies
![Mental Health Anxiety OCD Depression Selfcriticism/Perfectionism • Disordered eating patterns • • Mental Health Anxiety OCD Depression Selfcriticism/Perfectionism • Disordered eating patterns • •](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-30.jpg)
Mental Health Anxiety OCD Depression Selfcriticism/Perfectionism • Disordered eating patterns • •
![Further Management • Is this more than hypermobility? Could it be Marfan syndrome? Ehlers-Danlos? Further Management • Is this more than hypermobility? Could it be Marfan syndrome? Ehlers-Danlos?](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-31.jpg)
Further Management • Is this more than hypermobility? Could it be Marfan syndrome? Ehlers-Danlos? • Scoliosis • Cardiac work-up • PHONE A FRIEND
![Resources • Hypermobility Syndromes Association hypermobility. org • Linda Bluestien, MD hypermobilitymd. com • Resources • Hypermobility Syndromes Association hypermobility. org • Linda Bluestien, MD hypermobilitymd. com •](http://slidetodoc.com/presentation_image_h/0b19425f94629f04ebe0b8337dccc307/image-32.jpg)
Resources • Hypermobility Syndromes Association hypermobility. org • Linda Bluestien, MD hypermobilitymd. com • International Ehler’s Danlos Society. Ehlers. Danlos. com
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