Hypermobility

Joint flexibility is normal. It is important not to over-medicalise hypermobility, or create unnecessary fear, as   around 10 % of our population is hypermobile, but most have no symptoms of difficulties. Most children are flexible, some more so than others. The majority of children will become less supple as they get older but a small percentage will remain very flexible. This is more common if their parents have remained flexible. Hypermobility should not be diagnosed under the age of 6 years.

A diagnosis of hypermobile Ehlers-Danos should only be made by a paediatric rheumatologist. Joint hypermobility is now classified using the idea of a spectrum However, it is not validated in children. Use this as a guide:

Action: Key assessment points

• Beighton score for children over 6 years of age  (see table below)
• Check skin for elasticity, scaring, stretch marks
• pGALS screen (to rule out inflammatory arthropathy)

Action: Initial GP management

• Reassure parents. Hypermobility is common and normal in childhood. Must not be diagnosed <6 years
• Provide APCP advice sheet on ‘Hypermobility’
• Give exercise advice – it is important for flexible children to have good muscle strength, to provide stability around their joints. Good core stability is essential. Start with low-impact sports (e.g. swimming, cycling etc.)
• Young children may not wish to walk far and may want to be carried or use a push chair. Provide advice about encouraging regular and varied chunks of activity. Recommend limiting the use of a push chair.

Action: Refer to Paediatric Physiotherapy

• Reduced mobility / function
• Weakness or tightness in muscle groups
• Persistent muscle or joint pain
• Back Pain (consider spondylosi, spondylolisthesis)
• Recurrent joint subluxations / dislocations

Action: Refer to Community Paediatricians

• Abnormal neurology
• Regression or delay of developmental milestones / motor skills
• Motor Co-ordination Problems / DCD

Action: Refer to Paediatric Orthopaedics

• 1^st  joint dislocation (if not previously seen via ED)
• Recurrent painful joint dislocations
• Exclude serious orthopaedic pathology / red flags