The work of the musculoskeletal system directly depends on the condition of the connective structures that are located next to the joints: capsules, ligaments and tendons. They are distinguished by a special strength and provide a person with normal movement, but at the same time they have flexibility and elasticity. It is these qualities of structures that help maintain tissue integrity under tension under load. Joint hypermobility syndrome in children is a condition in which the range of motion in the joint is exceeded in comparison with physiological settings.
Causes of the violation
Joint hypermobility syndrome (in ICD 10 - code M35.7) most often appears in those people who have strong extensibility of ligament-tendon fibers transmitted from parents. As a result of an inherited disorder, proteoglycan, collagen, glycoprotein, and enzymes that provide their metabolism are significantly altered. Violations in the synthesis, maturation and decay of components of the connective tissue lead to severe extensibility of the joints.
All the described processes can affect the body of a pregnant woman from the outside. In most cases, such changes occur in the early stages, when the embryo is just beginning to develop and organs and systems are formed in it. The following negative factors act on the connective tissue of the fetus:
- pollution coming from the environment;
- poor nutrition (lack of vitamins, minerals and nutrients);
- infectious lesions of a woman;
- severe stress, anxiety and stress on the nervous system.
Acquired Form
From all this it follows that hypermobility syndrome is a congenital disease. But it is important to distinguish it from other hereditary diseases in which some changes occur in the structure of connective tissue (Marfan or Ehlers-Danlos syndrome). It is also important to remember about natural flexibility, which does not apply to the pathological form. Many people do not even realize that they have such a difference, considering it quite normal from childhood.
The acquired form of joint mobility in most cases is diagnosed by dancers or athletes, but it occurs as a result of training and has a local character, spreading mainly on the lower limb. Difficulties with joint mobility are an unusual lesion, but it is difficult to determine through diagnosis.
Features of the development of disorders in children
Previously, hypermobility of the joints was attributed to a peculiar structure of the musculoskeletal system. Parents always tried to take a very plastic child at an early age to a special section. It was believed that such a skeleton structure ensures the rapid achievement of good sports results. Now, hypermobility of the joints in a child refers to a form of deviation.
With active sports, the joints of children and adults with such a violation experience strong loads that significantly exceed the allowed ones. In people with normal joints, such a load leads to various injuries - sprains or dislocations. After proper treatment, many athletes quickly resume training. With hypermobility, everything happens differently. Even a non-hazardous injury can greatly change the structure of cartilage, bone tissue, tendons and ligaments, as well as lead to osteoarthritis.
Prohibited Sports
A sick child is not allowed to engage in the following sports:
- gymnastics and acrobatics;
- running, biathlon;
- hockey, football;
- long jumps;
- sambo and karate.
The treating specialists recommend that parents of especially plastic children do not immediately send them to sports facilities. Such a child must undergo a full examination in the hospital. If he has found hypermobility of the joints, then he will have to abandon all sports dangerous to him.
The clinical picture of the syndrome
Joint hypermobility is referred to as a systemic non-inflammatory lesion of the musculoskeletal system. Such a condition has so many symptoms that it may seem that the patient is suffering from a completely different disease. Such patients are often diagnosed incorrectly.
Special diagnostic measures in a medical institution help to specify the boundaries of hypermobility and to distinguish this lesion from other diseases with similar symptoms. In determining the main symptoms of the disease, it is important to consider the articular and extra-articular forms of the manifestation of the disease.
Articular manifestation
The first signs of damage in this case appear for the first time in childhood or adolescence, when the child is actively involved in sports and various physical activities. Most often, they are not considered as a consequence of pathological changes in the structure of tissues and are quite familiar, for this reason the disease is determined quite late.
At the first stage of the development of joint hypermobility syndrome in adults and children, quiet clicks or a crunch in the joints are observed, such sounds occur arbitrarily or with a change in physical activity. Over time, sounds can pass by themselves. But other, more severe signs are added to the symptoms, which help accurately identify joint hypermobility syndrome in children and adults:
- pain (myalgia or arthralgia);
- recurrent dislocations and subluxations;
- scoliosis;
- flat feet of varying degrees.
Joint pain appears after sports or at the end of the day. In most cases, it spreads to the legs (hypermobility syndrome of the hip joints in children), in addition to the shoulders, elbows and lower back. Permanent myofascial pain can occur in the shoulder girdle. At an early age, a child with this syndrome gets tired too quickly and asks again in his arms.
Dangerous complications
With excessive activity, joints and closely spaced tissues are damaged. People prone to hypermobility are at risk for the following conditions:
- ligament tears and various sprains;
- bursitis and tenosynovitis;
- post-traumatic arthritis;
- tunnel syndromes.
Against the background of general weakness, the patient may feel instability in the joints, which appears with a decrease in the stabilizing role of the capsule and ligamentous apparatus. Most often this occurs in the ankles and knees, which are heavily loaded every day. In the future, hypermobility syndrome may lead to degenerative joint diseases, for example, osteoarthritis.
Joint mobility assessment
When evaluating the movement of joints, a specialist first of all determines their volume. If it is higher than normal, then we can safely talk about the presence of hypermobility in the patient. When evaluating, they mainly rely on the following clinical tests:
- the thumb is held toward the forearm;
- extends elbow or knee joint (angle not more than 10 degrees);
- the patient should touch the floor with his hands, without bending his legs at the knees;
- the metacarpophalangeal joints are unbent (the angle should not exceed 90 degrees);
- the hip is taken away to the side (an angle of about 30 degrees).
This helps to accurately establish the high flexibility of the joints, which is important in identifying disorders in the ligaments, tendons and capsules. It is important to remember that the sooner such signs are detected, the less dangerous the consequences will be for the human musculoskeletal system.
Joint symptoms of joint hypermobility syndrome in children from birth are a good example of connective dysplasia. But not only they make up the general symptoms of the disease.
Extraarticular symptoms
Since hypermobility has a systemic form, extraarticular manifestations are characteristic of it. Connective tissue is important for human organs and systems, so dysplasia can adversely affect all functions and even lead to significant disorders in the overall structure. In most cases, pathological disorders extend to the skeletal system. In addition to joint disorders, the doctor may notice some external features: high palate, lag in the development of the upper jaw or lower, curvature of the chest, excess of the length of the fingers on the legs or arms.
There are other signs of hypermobility:
- strong extensibility of the skin, increased chance of injury and damage;
- mitral valve prolapse;
- varicose veins in the legs;
- prolapse of the kidneys, intestines, uterus, stomach;
- different forms of hernia (inguinal, navel hernia);
- squint, epicant.
Often people suffering from hypermobility complain of fatigue, general weakness of the body, anxiety, aggression, headaches, and sleep problems.
Disease treatment
After making an accurate diagnosis, the doctor needs to choose an effective method of treatment. The choice of a method for treating joint hypermobility in children and adults will depend on the cause of its appearance, the main symptoms and the intensity of pain.
Moreover, it is very important that the patient understands that such a lesion cannot lead to disability, and that with the right treatment, all negative symptoms will quickly disappear.
To improve his condition, the patient must exclude from his daily life any stress that leads to the appearance of pain or any discomfort in the joints.
With a high intensity of pain in individual joints, specialized elastic fixators are used, which are also called orthoses (elbow pieces or knee pads can be purchased).
With especially severe pain, it is allowed to use medications. In most cases, analgesics (analgin, Dexalgin and Ketanov) are used to eliminate pain. For many patients, doctors prescribe special ointments with a warming effect and ointments with non-steroidal anti-inflammatory components in the composition.
Physiotherapeutic procedures will bring no less benefit: laser therapy, paraffin treatment, therapeutic mud.
The main ones in the treatment of hypermobility syndrome are considered special exercises and gymnastics. When they are performed, joints, ligaments and muscles receive the necessary stability and strength.
Exercise therapy with hypermobility of joints in children helps to fully bend and unbend joints. Physiotherapy exercises also help to tighten all muscles. With hypermobility of joints, exercises can be power and static, they are performed at a slow pace and without special weighting agents. Stretching exercises are strictly prohibited, as they only worsen the condition of the joints.
Accurate diagnosis
Inspection of the patient's appearance and listening to his main complaints helps to diagnose the doctor. A child can talk about frequent injuries, the appearance of bruises on the body after a minor external exposure.
To distinguish hypermobility syndrome from osteoarthritis, arthritis, coxarthrosis, special instrumental diagnostics are necessary:
- Ultrasound
- radiography;
- magnetic resonance or computed tomography.
It is only necessary to proceed to treatment if there is a joint disorder provoked by hypermobility of the limbs. In other situations, it is recommended that the child or adult strengthen muscles and ligaments: to do therapeutic exercises, to swim or just to walk.
Relief
The following orthopedic products help significantly relieve pressure on the joints:
- elastic bandages;
- posture correctors;
- inserts between the fingers.
The results obtained after research will help to accurately understand the severity of damage to the tendon-ligamentous apparatus, as well as the number of complications received.