Prof Rodney Grahame & Dr Alan Hakim
Department of Rheumatology, University College Hospitals, London
1. Do you have HMS?
We have been working on a 5-part questionnaire to identify hypermobility. If you answer yes to at least 2 of the 5 questions then there is an 80-90% chance you are hypermobile. We hope it will become a simple aide memoire for doctors and allied health practitioners, encouraging them to think about hypermobility as the cause for musculoskeletal problems.
The questions are:
- Can you now (or could you ever) place your hands flat on the floor without bending your knees?
- Can you now (or could you ever) bend your thumb back to touch your forearm?
- As a child did you amuse your friends by contorting your body into strange shapes or could you do the splits?
- As a child or teenager did your shoulder or knee cap dislocate on more than one occassion?
- Do you consider yourself to be double-jointed?
Ref: Hakim AJ, Graham R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain.
International Journal of Clinical Practice 2003; volume 57: p163-166
2. HMS and local anaesthesia
In our survey of questions for the 5-part questionnaire we also asked about local anaesthetics as there has been work published suggesting that patients with joint hypermobility syndromes may be more resistent to them. We found that people with Benign Joint Hypermobility Syndrome are three times more likely than non-hypermobile individuals to have noticed that either local anaesthetic did not work at all or that they needed to be given more than usual to gain any benefit. We do not know the mechanism behind this but clearly it is an important message to get accross to colleagues in both hospital and general practice as well as dentistry.
3. Vascular problems and HMS
There has been some interesting work done recently looking at the many other non-musculoskeletal symptoms experienced by those with benign joint hypermobility syndrome. In particular people often complain of vascular problems of feeling faint, actual fainting or palpitations. A lot of people also experience gastrointestinal symptoms such as heartburn and irregular bowel habit. In our clinic we found that up to 60% of our patients have these kinds of symptoms on top of the more classic ones of widespread pain, anxiety and fatigue.
Dr Gazit and colleagues from Israel have done some important work that suggests that these kinds of vascular symptoms may be the result of poor functioning of the autonomic nervous system. This is a part of the nervous system that we do not have specific control over. It is responsible, in part, for maintaining our blood pressure and pulse when we move from lying to standing, or increase our level of activity. For some people the autonomic nervous system does not work as well as it should and their blood pressure falls and their pulse rises when they stand up. This makes them feel dizzy and experience 'palpitations', possibly even chest tightness and shortness of breath. Prof Grahame and I, with colleagues from the National Hospital for Neurological Diseases, Queen Square, are looking at this in more detail at present.
Ref. Hakim AJ, Grahame R. Symptoms of autonomic nervous system dysfunction in the benign joint hypermobility syndrome. Rheumatology (Oxford) 2003; Volume 42 supplement: Abstract number 47.
4. Other projects that are underway or about to start are:
- A study looking at the association between hypermobility and complications of pregnancy, particularly rapid delivery and tissue damage in labour.
- A study exploring the benefits and complications of conservative and surgical management of orthopeadic problems in the shoulder and knee in patients with benign joint hypermobility syndrome.
5. Finally a book on the Hypermobility Syndrome...
...'Hypermobility Syndrome - Recognition and Management for Physiotherapists' by Prof Grahame and Rosemary Keer was published on 3 June 2003. Although it is written for physiotherapists, it would still be very accessible to the 'un-medical'.
(Editors note: 'Hypermobility Syndrome - Recognition and Management for Physiotherapists' by Prof Grahame and Rosemary Keer is available from Amazon for £32.39)
Latest Research in Scotland - Prof W FerrellProfessor William Ferrell was awarded a grant from the Arthritis Research Campaign to compare the differences in muscle reflexes and the sensations originating from proprioceptors - sensory nerve endings which feed back information about muscles and tendons to the brain in individuals with HMS.