Thursday, April 16, 2009

What You Need to Know - Scholarly Articles, Batch #1

R. Grahame (UCL Hospitals) HMS and Pregnancy
• Symptoms of HMS during pregnancy include,
o Joint and spinal pains increase
o Tendency to premature labour and delivery
o Tendency to rapid labour
o Resistance to effects of local anaesthetics can cause problems during the epidural
o Healing of tear or episiotomy may be impaired and/or prolonged
o Pelvic floor problems (especially uterine prolapse), therefore post-natal exercise is very important
o 50% chance child will have HMS

Larson, Baum, Mudholkar 1981
• “Hypermobility was a predominantly female characteristic”
• Joint laxity declines naturally with age, but “not to a statistically significant degree”
• In men, joint laxity started to decline in mid-twenties, in women it continued through mid-forties

Bridges, Smith, Reid
• Most patients with hypermobility had common musculoskeletal problems as the main reason for their referral (usual to a rheumatologist)
• “Results show that joint hypermobility is common, familial, found in association with common rheumatic disorders, and statistically associated with osteoarthritis”
• “The findings support the hypothesis that joint hypermobility predisposes to musculoskeletal disorders, especially osteoarthritis”

R Graham (UCL Hospitals) Pain and Hypermobility Syndrome 2009
• “At the present time we simply do not know for certain whether or not HMS is a less severe type of Ehlers-Danlos Syndrome III.”
• “Usually unexpected exercise or a change of job or lifestyle provokes the onset of pain. Whenever symptoms commence … the term ‘Hypermobility Syndrome’ is used … hypermobile people without pain are just called hypermobile people.”
• “So how is it that people with hypermobility can be literally fine for decades, only to be laid low from widespread pain, often out of the blue, which may make its unwelcome appearance during childhood, adolescence, or adult life?”
o A hypermobile person has an inbuilt weakness if their “strength-providing” collagen. Injuries occur “whenever there is a mismatch between the physical demands on one hand, and the strength of the parts being asked to perform on the other… If one only knew one’s strength (or lack of it), one should be able, in theory at least, to stay within the safety margin and thereby protect oneself from injury.”
• “Neither susceptibility to injury or overuse … explains all the pain that is felt in HMS.”
o Pain is a subjective experience, and “the severity of the pain we feel is greatly influenced by our state of mind.”
o “Lack of understanding of the condition is widespread, and this, coupled with failure to receive adequate treatment for relief of symptoms, leads to frustration, resentment, anger, and ultimately depression.”
o HMS and fibromyalgia occur together quite often, and “fibromyalgia should be regarded as a signal emanating from a distressed HMS person.”
• There may be two clues to explaining the burden of pain bourn by HMS patients
o First, people with HMS have diminished proprioception, that is to say, “people with HMS are not quite as good as other people in knowing exactly where their fingers or arms, etc. are in space. This could lead to a further increase in the risk of injury.”
o Secondly, “patients with HMS for some reason do not appear to experience the full anaesthetic affect of lignocaine injections when these are given for dental purposes, minor surgery or for epidural anaesthesia.”
o The above “suggest that people with HMS … may also have a fault in the way their pain signals are picked up for onward transmission to the brain, where they reach consciousness.”

Howes, Isdale (New Zealand)
• They studies 102 cases of backache – 59 men, 43 women. Out of the 59 men, none had hypermobility, but rather had disc lesions, spondyiolysis, etc. One half of the 43 women suffered from those same ailments, while the majority of the remainder suffered from HMS
• “It is suggested that this is an important differential diagnosis of backache in women”

No comments:

Post a Comment