Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner

<p>Abstract</p> <p>Background</p> <p>Generalized joint hypermobility (JHM) refers to increased joint mobility with simultaneous absence of any other systemic disease. JHM involves proprioception impairment, increased frequency of pain within joints and tendency to injure soft tissues while performing physical activities. Children with idiopathic scoliosis (IS) often undergo intensive physiotherapy requiring good physical capacities. Further, some physiotherapy methods apply techniques that increase joint mobility and thus may be contraindicated.</p> <p>The aim of this paper was to assess JHM prevalence in children with idiopathic scoliosis and to analyze the relationship between JHM prevalence and the clinical and radiological parameters of scoliosis. The methods of assessment of generalized joint hypermobility were also described.</p> <p>Materials and methods</p> <p>This case-control study included 70 subjects with IS, aged 9-18 years (mean 13.2 ± 2.2), Cobb angle range 10°-53° (mean 24.3 ± 11.7), 34 presenting single curve thoracic scoliosis and 36 double curve thoracic and lumbar scoliosis. The control group included 58 children and adolescents aged 9-18 years (mean 12.6 ± 2.1) selected at random. The presence of JHM was determined using Beighton scale complemented with the questionnaire by Hakim and Grahame. The relationship between JHM and the following variables was evaluated: curve severity, axial rotation of the apical vertebra, number of curvatures (single versus double), number of vertebrae within the curvature (long versus short curves), treatment type (physiotherapy versus bracing) and age.</p> <p>Statistical analysis was performed with Statistica 8.1 (StatSoft, USA). The Kolmogorov-Smirnov test, U Mann-Whitney test, Chi²test, Pearson and Spermann correlation rank were conducted. The value <it>p </it>= 0.05 was adopted as the level of significance.</p> <p>Results</p> <p>JHM was diagnosed in more than half of the subjects with idiopathic scoliosis (51.4%), whilst in the control group it was diagnosed in only 19% of cases (<it>p </it>= 0.00015). A significantly higher JHM prevalence was observed in both girls (<it>p </it>= 0.0054) and boys (<it>p </it>= 0.017) with IS in comparison with the corresponding controls. No significant relation was found between JHM prevalence and scoliosis angular value (<it>p </it>= 0.35), apical vertebra rotation (<it>p </it>= 0.86), the number of vertebrae within curvature (<it>p </it>= 0.8), the type of applied treatment (<it>p </it>= 0.55) and the age of subjects (<it>p </it>= 0.79). JHM prevalence was found to be higher in children with single curve scoliosis than in children with double curve scoliosis (<it>p </it>= 0.03).</p> <p>Conclusions</p> <p>JHM occurs more frequently in children with IS than in healthy sex and age matched controls. No relation of JHM with radiological parameters, treatment type and age was found. Systematically searched in IS children, JHM should be taken into account when physiotherapy is planned.</p

Physiotherapy Intervention for Joint Hypermobility in Three Cases with Heritable Connective Tissue Disorders

peer reviewedIntroduction: In Joint Hypermobility Syndromes, chronic pain is the most disabling symptom. Its origin can be multiple (i.e. subluxations, sprains, pathologies of tendons, ligaments, peripheral nerves, multiple operations). The goal of this article was intended to discuss appropriate physiotherapy in hyperlax patients. Patients and Method: The recovery process was analyzed in three cases (Marfan Syndrome, Ehlers-Danlos Syndrome and Osteogenesis Imperfecta). Hypermobility was assessed using the Brighton scale, pain using the Visual Analogue Scale and quality of life using the Medical Outcome Study Short Form-36. Bone density was evaluated by QDR X-ray absorptiometry. We emphasized that it was important to avoid stretching and to train the patient within a controlled range of motion. Submaximal eccentric exercises within a safe range of motion were incorporated to increase the active control of the joint positioning. Thus, in one patient, isokinetic rehabilitation was successfully undertaken. Each treatment had to be adapted to the individual patient and had to include specific home exercises. Conclusion: In each case, physiotherapy gave good results in relation to pain, quality of life and stability of rehabilitated joints. Safety must be assured and specific evaluations such osteodensitometry, cardiac explorations and interventions of bracing, proprioceptive and functional strengthening can be very helpful

Prevalência de hipermobilidade articular em crianças pré-escolares

A hipermobilidade articular é a capacidade de realizar movimentos em amplitudes maiores que a normal. O presente estudo teve como objetivo estabelecer a prevalência de hipermobilidade articular em crianças pré-escolares da Rede Municipal de Educação de Londrina/PR. O estudo foi do tipo transversal com amostra constituída de 366 crianças, de 5 e 6 anos de idade. Verificou-se que, das crianças pré-escolares avaliadas, 198 (54,1%) apresentaram hipermobilidade articular, sendo 96 (59,6%) do sexo feminino e 102 (49,8%) do masculino. A hipermobilidade articular foi encontrada com maior frequência nas articulações de cotovelo e joelho, onde ocorreu a hiperextensão. Não houve diferença estatisticamente significante entre os grupos masculino e feminino em relação à hipermobilidade articular (&#967;²=3,539, p=0,072). Pode-se concluir que a hipermobilidade articular nas crianças pré-escolares foi achado comum, compatível com a faixa etária da população avaliada no estudo