Гипермобильность суставов: от повышенной гибкости до спектра расстройств.

Joints that stretch further than normal

Hypermobility, also known as double jointedness, describes joints that stretch farther than normal. For example, some hypermobile people can bend their thumbs backwards to their wrists and bend their knee joints backwards, put their leg behind the head or perform other contortionist "tricks". It can affect one or more joints throughout the body. Hypermobile joints are common and occur in about 10 to 25% of the population, but in a minority of people, pain and other symptoms are present. This may be a sign of hypermobility spectrum disorder (HSD). Hypermobile joints are a feature of genetic connective tissue disorders such as hypermobility spectrum disorder or Ehlers–Danlos syndromes (EDS). Until new diagnostic criteria were introduced, hypermobility syndrome was sometimes considered identical to hypermobile Ehlers–Danlos syndrome (hEDS), formerly called EDS Type 3. As no genetic test can distinguish the two conditions and because of the similarity of the diagnostic criteria and recommended treatments, many experts recommend they be recognized as the same condition until further research is undertaken. In 2016 the diagnostic criteria for hEDS were re written to be more restrictive, with the intent of narrowing the pool of hEDS patients in the hope of making it easier to identify a common genetic mutation, hEDS being the only EDS variant without a diagnostic DNA test. At the same time, joint hypermobility syndrome was renamed as hypermobility spectrum disorder and redefined as a hypermobility disorder that does not meet the diagnostic criteria for hEDS, other types of Ehlers–Danlos Syndrome, or other heritable Connective Tissue Disorder (such as Marfan's, Loeys–Dietz, or osteogenesis imperfecta).

Those with hypermobile joints are more likely to have ADHD, autism, dyspraxia, fibromyalgia, hereditary connective tissue disorders, mitral valve prolapse, and anxiety disorders such as panic disorder.

Joint hypermobility syndrome shares symptoms with other conditions such as Marfan syndrome, Ehlers Danlos Syndrome, and osteogenesis imperfecta. Experts in connective tissue disorders formally agreed that severe forms of Hypermobility Syndrome and mild forms of Ehlers Danlos Syndrome Hypermobility Type are the same disorder. Generalized hypermobility is a common feature in all these hereditary connective tissue disorders and many features overlap, but often features are present that enable differentiating these disorders. The inheritance pattern of Ehlers Danlos syndrome varies by type. The arthrochalasia, classic, hypermobility and vascular forms usually have an autosomal dominant pattern of inheritance. Autosomal dominant inheritance occurs when one copy of a gene in each cell is sufficient to cause a disorder. In some cases, an affected person inherits the mutation from one affected parent. Other cases result from new (sporadic) gene mutations. Such cases can occur in people with no history of the disorder in their family. The dermatosparaxis and kyphoscoliosis types of EDS and some cases of the classic and hypermobility forms, are inherited in an autosomal recessive pattern. In autosomal recessive inheritance, two copies of the gene in each cell are altered. Most often, both parents of an individual with an autosomal recessive disorder are carriers of one copy of the altered gene but do not show signs and symptoms of the disorder.

As of July 2000, hypermobility was diagnosed using the Beighton criteria. In 2017, the criteria changed, but still involve the Beighton score. The Beighton criteria do not replace the Beighton score but instead use the previous score in conjunction with other symptoms and criteria. HMS is diagnosed in the presence of either two major criteria, one major and two minor criteria, or four minor criteria. The criteria are:

It is important that hypermobile individuals remain fit – even more so than the average individual – to prevent recurrent injuries. Regular exercise and exercise that is supervised by a physician and physical therapist can reduce symptoms because strong muscles increase dynamic joint stability. Low impact exercise such as closed kinetic chain exercises are usually recommended as they are less likely to cause injury when compared to high impact exercise or contact sports. Heat and cold treatment can help temporarily to relieve the pain of aching joints and muscles but does not address the underlying problems.

Medication is not the primary treatment for hypermobility, but can be used as an adjunct treatment for related joint pain. Nonsteroidal anti inflammatory drugs are the primary medications of choice. Narcotics are not recommended for primary or long term treatment and are reserved for short term use after acute injury.

For some people with hypermobility, lifestyle changes decrease symptom severity. In general, activity that increases pain is to be avoided. For example:
Typing can reduce pain from writing. Voice control software or a more ergonomic keyboard can reduce pain from typing. Bent knees or sitting can reduce pain from standing. Unwanted symptoms are frequently reduced by some forms of yoga and weightlifting. Use of low impact elliptical trainer machines can replace high impact running. Pain free swimming may require a kickboard or extra care to avoid hyperextending elbow and other joints. Weakened ligaments and muscles contribute to poor posture, which may contribute to other medical conditions. Isometric exercise avoids hyperextension and contributes to strength.

Bracing can be helpful for temporarily protecting unstable joints.

Hypermobile joints occur in about 10 to 25% of the population.