Joint hypermobility

Prof. Dr. Faiq Isho Gorial

Consultant rheumatologist

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Objectives
• Definition
• Prevalence
• Causes
• Diagnostic criteria
• Treatment

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Definition
Joint hypermobility (JHM)

A hyper mobile joint is a joint whose range of motion is above normal

regarding age, sex, and race .

Benign joint hypermobility syndrome ( BJHS)

musculoskeletal symptoms + the hyper mobile + absence of systemic
rheumatologic disease.

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Epidemiology
•JHM prevalence is up to 35% for men and 57% for women.

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Common causes of JHM

1) Congenital: Bone shape or the depth of the joint sockets. Muscle

tone or strength. A poor sense of proprioception
2) Familial: Family history of hypermobility
3) Protein deficiency elastin
4) Hormonal: Female sex hormones alter collagen proteins.
5) Connective tissue disorders, such as Ehlers-Danlos Syndrome (EDS) and
Marfan syndrome.

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Diagnosis
• Joint hypermobility (JHM) Can
be diagnosed as a score of
Beighton scale 4 out of 9 or
greater.

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Treatment

1.Relieving pain
2.Strengthening exercises of the joint by certain exercises or
physical therapy

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Neuropathic Joints (Charcot Joints)

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Objectives
• Definition
• Etiology
• Clinical presentation
• Differential diagnosis
• Investigations
• Association
• Treatment
• Complications
• Prognosis

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Definition
• It is arthropathy due to neurological causes

• Caused by loss of sensation in the joint so that it is severely

damaged and disrupted.

• Triggered by a combination of mechanical, vascular and

biological factors and eventually lead to destruction of the foot .

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 Causes
• Any pathology that leads to loss of sensation in a joint may lead
to a Charcot joint

• The most common cause is diabetic neuropathy

• In the upper limb the classical cause is syringomyelia.

• In the lower limb were most often the result of tabes and
leprosy dorsalis but that is much rarer these days.

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Clinical presentation

• Acute Charcot arthropathy : warmth, swelling or deformity and loss of

function

• Consider acute Charcot arthropathy even when deformity is not present or

pain is not reported.

• Pain is present in 75%

• Presence of pain does not exclude a Charcot joint.

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• Examination: skin over the joint is hot and red with an effusion of the joint, may
also be osteomyelitis, instability.

• Neurological examination should be performed to identify the extent of sensory

loss and whether there is any motor loss too.

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 Differential diagnosis

• Severe trauma

• Osteomyelitis may well co-exist with a Charcot joint.

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Investigations
1. A plain X-ray may show considerable disruption of the joint but in early
disease, the picture will resemble osteoarthritis.

2. MRI or radionucleotide imaging may be valuable to differentiate soft tissue

infection from osteomyelitis.

3. Ix for cause of the neuropathy, eg.HbA1C testing to assess the control of the
diabetes.

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A ssociated diseases
1. Diabetes, tabes dorsalis, syringomyelia and leprosy

2. Alcoholism

3. Vitamin B1 deficiency and B12 deficiency

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Management
General measures
• Patient education about the risk of damaging a joint that is
devoid of pain
• Rx underlying disease may need to be treated to prevent
further progression of that disease
• The affected joint is initially immobilised in a cast. The cast is
usually on for three to six months.
• Consulting podiatrist.

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Pharmacological
Bisphosphonates may be of value to help heal the bones, particularly if caught

in the acute phase.

Surgical
• Surgery is indicated for patients with severe or unstable deformities that, if
untreated, will result in major amputations .

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Complications
•Fractures can occur without pain and the absence of treatment leads to
deformity.

•Neuropathic ulcer may occur and introduce infection.

• Soft tissue infection or osteomyelitis may occur. Severe damage may require
amputation

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 Prognosis

• Charcot neuroarthropathy is a progressive, destructive condition

• Early diagnosis and management are imperative to avoid rapid progression .

• A good prognosis therefore depends on early recognition of the problem and effective
management, which includes patient education .

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 Thank you

THANK YOU
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