Joint Hypermobility Syndrome

What is joint hypermobility syndrome?

Joint hypermobility syndrome is a connective tissue disorder. Thick bands of tissue (ligaments) hold your joints together and keep them from moving too much or too far out of range. In people with joint hypermobility syndrome, those ligaments are loose or weak. If you have joints that are more flexible than normal and it causes you pain, you may have joint hypermobility syndrome.

What is the difference between joint hypermobility and joint hypermobility syndrome?

Joint hypermobility is very common. Hypermobility means your joints can move beyond the normal range of motion. You may also hear the term double-jointed. This means your joints are very flexible. The most commonly affected joints are your elbows, wrists, fingers and knees.

In most people, hypermobility doesn’t cause any pain or medical issues. However, for some people, hypermobility causes joint pain, joint and ligament injuries, tiredness (fatigue), bowel issues and other symptoms. Joint hypermobility syndrome is most common in children and young people. It affects people assigned female at birth (AFAB) and people of Asian and Afro-Caribbean descent more often. It usually gets better with age.

Is joint hypermobility syndrome the same as Ehlers-Danlos syndrome?

Joint hypermobility syndrome can be a sign of a more serious underlying genetic condition. These conditions are called Heritable Disorders of Connective Tissue (HDCT). Rare medical conditions associated with joint hypermobility syndrome include:

• Ehlers-Danlos syndrome: A group of conditions that affect your cartilage, bone, fat and blood. A defect in collagen — the protein that adds flexibility and strength to your connective tissue — causes this syndrome.
• Marfan syndrome: A condition that affects your connective tissue. A defect in the gene responsible for building fibrillin and elastic fibers — a major part of your connective tissue — causes this syndrome.
• Down syndrome: A genetic disorder that affects the way your brain and body develop. People with Down syndrome are born with an extra chromosome.

What are the symptoms of joint hypermobility syndrome?

The most common symptom of joint hypermobility syndrome is pain in your joints and muscles. Other symptoms may include:

• Frequent joint and ligament injuries, including dislocations and sprains.
• Joint and muscle stiffness.
• Tiredness (fatigue).
• Clumsiness/poor balance.
• Bladder and bowel issues.
• Dizziness and fainting.
• Thin, stretchy skin.

What causes joint hypermobility syndrome?

The exact cause of joint hypermobility syndrome isn’t known. However, the disorder tends to run in families. The genes that are involved in the creation of collagen are believed to play a role. Collagen is the protein that adds flexibility and strength to your joints, ligaments and tendons. People with joint hypermobility syndrome have loose joints because they have weak ligaments. They have weak ligaments because of the defect in their collagen.

What tests can my healthcare provider use to diagnose joint hypermobility syndrome?

Your healthcare provider may perform a physical exam to see the range of motion in your joints. They may also order blood tests to check for possible genetic conditions.

Your healthcare provider may use a test or questionnaire to measure the flexibility of your joints. The Beighton score measures your joint flexibility on a nine-point scale. You receive one point for each of the following:

• Being able to bend forward and place your hands flat on the floor without bending your knees.
• Being able to bend your elbows backward (one point each).
• Being able to bend your knees backward (one point each).
• Being able to bend your thumbs backward to touch your forearms (one point each).
• Being able to bend your little fingers backward beyond 90 degrees (one point each).

If you scored four or more points and have had pain in four or more joints for at least three months, you may have joint hypermobility syndrome.

Your healthcare provider may also ask you the five-point hypermobility questionnaire. The five questions asked are:

1. Can you now (or could you ever) place your hands flat on the floor without bending your knees?
2. Can you now (or could you ever) bend your thumb to touch your forearm?
3. As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?
4. As a child or teenager, did your shoulder or kneecap dislocate on more than one occasion?
5. Do you consider yourself double-jointed?

If you answered “yes” to two or more questions, you may have joint hypermobility syndrome.

How is joint hypermobility syndrome treated?

There’s no cure presently for joint hypermobility syndrome. Treatment involves protecting your joints and managing your pain. You can protect your joints by strengthening your muscles through exercise. Other recommendations include:

• Maintain good posture.
• Stand with your knees slightly bent and avoid extreme ranges of motion.
• Wear shoes with good arch support.
• Use orthotics to help correct flat feet.
• See a physical therapist to help reduce pain, increase muscle strength and improve your posture and balance.

For mild pain, your healthcare provider may recommend an over-the-counter pain reliever such as acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®) or naproxen (Aleve®). For more severe pain, your healthcare provider may prescribe stronger pain medication or provide additional resources to help manage your pain.

How can I prevent joint hypermobility syndrome?

Joint hypermobility syndrome is a genetic disorder that usually runs in families. Therefore, it can’t be prevented.

What can I expect if I have joint hypermobility syndrome?

Joint hypermobility syndrome is most commonly found in children and adolescents. As you get older, symptoms tend to decrease. For some people, symptoms are mild. For others, pain can be severe. It’s important to work with your healthcare provider on ways to protect your joints and manage your pain.

What is the joint hypermobility syndrome diet?

Researchers have found there may be a link between hypermobility and gastrointestinal issues such as irritable bowel syndrome (IBS). The symptoms of IBS are commonly found in joint hypermobility syndrome. Therefore, your healthcare provider may recommend an exclusion diet to test for an intolerance to certain food products. If whatever’s causing the intolerance is removed, your symptoms may resolve.

The three most common exclusion diets are:

• Gluten-free diet: Gluten is removed from your diet to see if you have a gluten allergy.
• Lactose-free diet: Lactose is removed from your diet to see if you’re intolerant to dairy products.
• Low-FODMAP diet: A group of five sugars found in certain foods is removed from your diet. These sugars are lactose, fructose, fructans, galactans and polyols. FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides and polyols.

How do I take care of myself?

If you have joint hypermobility syndrome, it’s important to maintain a healthy lifestyle and protect your joints. You can improve joint and muscle strength by:

• Getting regular exercise.
• Taking regular breaks while exercising.
• Eating a healthy diet.
• Wearing supportive shoes.
• Easing joint pain and stiffness with warm baths.
• Not overextending your joints on purpose.

A note from Cleveland Clinic

Joint hypermobility syndrome is a connective tissue disorder. Many people are double-jointed or have very flexible joints. But when you have very flexible joints along with pain and other symptoms, it may be joint hypermobility syndrome. Joint hypermobility syndrome is diagnosed through a physical exam as well as a test or questionnaire on your flexibility. While there’s no cure, symptoms can be managed by keeping your joints strong and taking medication. Talk to your healthcare provider if you have severe symptoms. They can help you manage this condition.