Hypermobility and Hypomobility Flashcards
Hypermobility
-an increased degree of motion at a joint
-can occur at one joint (often trauma related) or several joints, or can be generalized throughout the body
-it can range from mild joint laxity to extreme mobility or even joint instability
- hypermobility and compensatory weakness can be created in the body by soft tissue tightness and
hypomobility in another place - in the spine, a hypermobile joint may be found next to a hypomobile joint
-while hypermobility itself does not necessarily mean pain and dysfunction, people with joint laxity may be at risk for musculoskeletal symptoms and injuries including sprain, tendinitis, OA ( joint over use in over range ) and entrapment neuropathies. ( Shift to 1 side too much → compress on the nerves )
Hypermobility Syndrome
-occurs in up to 5% of those with hypermobility
-symptoms include muscle and joint pain, overuse syndromes such as tendinitis, abdominal muscle weakness, hyper-extensible skin and mitral valve prolapse - don’t close
Predisposition for Hypermobility
-certain pathologies and conditions predispose people to hypermobility
RA • Rheumatoid Arthritis, an autoimmune disorder characterized by inflammation and destruction of
connective tissue results in hypermobility of the affected joints
ED • Ehlers-Danlos syndromes are a group of inherited disorders characterized by joint hypermobility, sometimes dislocation, skin hyper-extensibility, increased bruising and tissue fragility
MaS • Marfan s Syndrome, is an inherited disorder with fragmentation of elastin, leading to joint hypermobility (dislocation is not common), elongated bones, aortal widening, mitral valve prolapse and changes in the eye, specifically the lens
Causes of Hypermobility
• Compensation:
-due to hypomobility or postural dysfunction elsewhere in the body
• Increased flexibility:
-due to body type, occupation or activity
• Hormonal influences:
-during pregnancy
• Joint trauma:
-such as sprain or dislocations
• Pathologies and conditions:
-causing joint laxity
Symptoms of Hypermobility
-joint will have greater than normal range of motion
-may be painful if the ligaments crossing the joint are intact but overstretched or if intra-articular adhesions are stretched
-may be painless if ligaments are ruptured
-joint capsule is lax
-muscles crossing the affected joint may be hypertonic
*Contraindications
-do not mobilize a hypermobile joint
-do not stretch muscles that cross a hypermobile joint past the accepted range for that joint
- PROM CVS W RA
Assessment
- Observations:
-a full postural assessment may reveal areas of imbalance
- Palpation:
-may reveal tenderness in the muscles crossing the hypermobile joint
- Testing:
-AF ROM and PR ROM are greater than normal at a hypermobile joint
-end feel is encountered at a point later than normally expected
Massage Treatment
-no specific techniques are used on hypermobile joints
-if hypermobility is combined with compensatory hypomobility at another joint proximal or distal to th hypermobile joint, joint play is used on the hypomobile joint
-trigger points may be present in muscles that cross a hypermobile joint
Self care
-strengthen all muscles crossing the hypermobile joint
-patient should begin with isometric exercises, progressing to isotonic exercises when the muscles are able to support the joint in a physiologically normal position
-patient is referred to a physician or chiropractor if an undiagnosed pathology is suspected as the underlying cause of the hypomobility
Hypomobility
-a loss of motion at joint, including the loss of normal joint play movements
-can occur at one joint or several joints, or can be generalized throughout the body
-joints on the dominant side of the body tend to be more hypomobile than those on the non-dominant side
Minor Intervertebral Derangement
-in the spine is an isolated, painful, hypomobile vertebra
-it has a mechanical, postural or traumatic cause
-static and mobility x-rays of the affected vertebra reveal nothing abnormal
-palpation and vertebral mobility tests reveal the painful, hypomobile segment
Causes of Hypomobility
• Compensation:
-due to hypermobility or postural dysfunction elsewhere in the body
• Decreased flexibility:
-due to body type or occupation
• Intra-articular and extra-articular adhesions:
-following joint trauma, surgery, immobilization
• Surgical fixation:
-by pins, screws, or shortening of ligaments or muscles that cross the affected joint
• Pathologies and conditions:
-causing contractures
Symptoms of Hypomobility
-joint will have reduced range of motion and reduced joint play movements
-stiffness and pain (not always)
-joint capsule may be fibrosed and there may be intra-articular adhesions
-shortened fascia, scar tissue or contractures may be present in muscles crossing the affected joint
-nerve roots, IVDs, peripheral nerves, blood vessels and menisci may be entrapped or compressed
-proper nutrition is decreased to the articular surfaces
-myofascial pain syndromes, including TPs, in the muscles that cross the affected joint
Contraindications
-do not attempt to mobilize a hypomobile joint that has been surgically repaired with metal appliances
-where the ligaments have been surgically shortened, do not restore full ROM of the affected joint in the direction that will stretch the repaired ligament
Assessment
- Observations:
- a full postural assessment may reveal areas of imbalance
- Testing:
-AF ROM and PR ROM are reduced from normal ranges
-end feel is encountered before it is normally expected; may be bony or capsular, depending on the cause observations
