Presentation is loading. Please wait.

Presentation is loading. Please wait.

HYPERMOBILITY SYNDROME/EDS III LORRAINE FRIEL EXTENDED SCOPE PRACTITIONER CENTRE FOR RHEUMATIC DISEASES GLASGOW ROYAL INFIRMARY.

Similar presentations


Presentation on theme: "HYPERMOBILITY SYNDROME/EDS III LORRAINE FRIEL EXTENDED SCOPE PRACTITIONER CENTRE FOR RHEUMATIC DISEASES GLASGOW ROYAL INFIRMARY."— Presentation transcript:

1 HYPERMOBILITY SYNDROME/EDS III LORRAINE FRIEL EXTENDED SCOPE PRACTITIONER CENTRE FOR RHEUMATIC DISEASES GLASGOW ROYAL INFIRMARY

2 HYPERMOBILITY & HYPERMOBILITY SYNDROME Range of movement in excess of the accepted normal range of motion at a joint, taking into account the age, gender and ethnic background of the individual (Grahame 2010) Range of movement in excess of the accepted normal range of motion at a joint, taking into account the age, gender and ethnic background of the individual (Grahame 2010) Musculoskeletal symptoms in the presence of generalised joint hypermobility but in the absence of other defined rheumatic diseases (Kirk et al 1967) Musculoskeletal symptoms in the presence of generalised joint hypermobility but in the absence of other defined rheumatic diseases (Kirk et al 1967)

3 What is joint hypermobility syndrome? Pereception of JHS as a mild or trivial condition with lax joints, pain, joint dislocation/subluxation, possible OA in later life. Pereception of JHS as a mild or trivial condition with lax joints, pain, joint dislocation/subluxation, possible OA in later life. This has changed….. Now considered an inherited, genetically determined multisystemic disorder of connective tissues rendering them more vulnerable to injury and mechanical failure.

4 WHAT IS HMS? A family of related genetically based conditions. The protein affected varies and the degree of difference varies A family of related genetically based conditions. The protein affected varies and the degree of difference varies Marfans Syndrome Marfans Syndrome Ehlers-danlos Ehlers-danlos Benign Joint Hypermobility syndrome Benign Joint Hypermobility syndrome

5 Presentation Chronic pain and kinesiophobia Chronic pain and kinesiophobia Joint laxity,subluxations/dislocations Joint laxity,subluxations/dislocations Vulnerability to injury Vulnerability to injury Rest at EOR/”lock” joints and poor posture habits Rest at EOR/”lock” joints and poor posture habits Dysfunctional movement patterns Dysfunctional movement patterns Poor healing and slower recovery Poor healing and slower recovery Easy bruising and tendency towards bleeding Easy bruising and tendency towards bleeding

6 Non articular presentation Fatigue Fatigue Deconditioning Deconditioning Autonomic dysfunction Autonomic dysfunction Pelvic organ prolapse Pelvic organ prolapse Urinary incontinence Urinary incontinence Psychological Psychological POTS POTS

7 Examination Observation – skin, postural alignment Observation – skin, postural alignment Range of movement Range of movement Functional activities Functional activities Muscle testing Muscle testing Neurological testing Neurological testing Passive movement Passive movement Ligament integrity Ligament integrity Balance/proprioception Balance/proprioception

8 Good postural alignment Muscular and skeletal balance which protects the supporting structures against injury and progressive deformity Muscular and skeletal balance which protects the supporting structures against injury and progressive deformity Muscles function most efficiently Muscles function most efficiently Optimum positions for thoracic and abdominal organs Optimum positions for thoracic and abdominal organs

9 Habitual postures Frequently rest at EOR and poor postural alignment Frequently rest at EOR and poor postural alignment Stress and strain in HM collagenous tissues Stress and strain in HM collagenous tissues Decreased muscle use leading to stiffness, weakness, deconditioning, fatigue Decreased muscle use leading to stiffness, weakness, deconditioning, fatigue

10 Poor postural alignment Faulty relationship produces stress and strain on supporting structures Faulty relationship produces stress and strain on supporting structures Less efficient balance Less efficient balance

11 Active movement Look well Move well Subjective and objective often at odds Check ‘normal’ range for that patient

12 Assess muscle function Breathing Breathing Transversus abdominus Transversus abdominus Deep multifidus Deep multifidus Pelvis floor Pelvis floor Timing, atrophy, loss of tonic function, loss of co-ordination, asymmetry, length Timing, atrophy, loss of tonic function, loss of co-ordination, asymmetry, length Overactivity in globa, muscles – quads, latissimus, pects, obliques, erector spinae Overactivity in globa, muscles – quads, latissimus, pects, obliques, erector spinae

13 Muscle strategy High load strategy for low load task High load strategy for low load task Produces excessive compression, loss of mobility, loss of shock absorbtion Produces excessive compression, loss of mobility, loss of shock absorbtion Tendency to rely on ‘ankle strategy’ to maintain balance Tendency to rely on ‘ankle strategy’ to maintain balance

14 Functional movement testing One leg stand One leg stand Standing knee bend Standing knee bend Walking Walking Heel raise Heel raise Sit to stand Sit to stand

15 Management Time – listen to story, answer questions, identify needs/expectations, address fears/barriers Time – listen to story, answer questions, identify needs/expectations, address fears/barriers Communication – greater benefit and cost effectiveness when patients who expressed apreference received their preferred treatment Communication – greater benefit and cost effectiveness when patients who expressed apreference received their preferred treatment Reassurance – finally have diagnosis, not life threatening, can be proactive Reassurance – finally have diagnosis, not life threatening, can be proactive

16 Prioritise treatment Try to avoid chasing the pain Try to avoid chasing the pain Patients expectations Patients expectations Short and long term goals Short and long term goals Achievable Achievable Enjoyable Enjoyable

17 Treatments Supports Supports Tape Tape Pre-exercising readiness – breathing, relaxation, pain relieving modalities, manual therapy, posture re education Pre-exercising readiness – breathing, relaxation, pain relieving modalities, manual therapy, posture re education

18 Correct movement dysfunction Start in non weight bearing, pain free positions Start in non weight bearing, pain free positions Closed chain Closed chain Improve joint positioning and awareness Improve joint positioning and awareness

19 Joint stability and control Challenge stability Improve balance and coordination Incorporate into weightbearing and functional positions Incorporate into weightbearing and functional positions Introduce unpredictability using balance boards, wobble cushions, gym ball Introduce unpredictability using balance boards, wobble cushions, gym ball

20 Stretching Often advised not to stretch –danger of overstretching/damage Often advised not to stretch –danger of overstretching/damage Reassure and educate – good to stretch Maintain muscle length, joint range, stretch out old injuries and muscle spasm Maintain muscle length, joint range, stretch out old injuries and muscle spasm No stretching beyond their hypermobile range No stretching beyond their hypermobile range

21 Education Be positive Be positive Joint care – avoidance of unhelpful postures and activities Joint care – avoidance of unhelpful postures and activities Pacing Pacing Discuss lifestyle modifications – occupation, family life, sport, pregnancy and other health issues Discuss lifestyle modifications – occupation, family life, sport, pregnancy and other health issues

22 General fitness Encourage lifelong commitment to exercise and maintenance of good general fitness Encourage lifelong commitment to exercise and maintenance of good general fitness Encourage normal activities and return to sport Encourage normal activities and return to sport Pilates, yoga, exercise in water, walking Pilates, yoga, exercise in water, walking

23 Main aim of treatment Increase function Increase function Decrease disability Decrease disability Self management Self management Treatment often takes longer(many affected areas, longer healing time, mismanaged in past) Complete resolution rarely occurs

24 Contacts/resources


Download ppt "HYPERMOBILITY SYNDROME/EDS III LORRAINE FRIEL EXTENDED SCOPE PRACTITIONER CENTRE FOR RHEUMATIC DISEASES GLASGOW ROYAL INFIRMARY."

Similar presentations


Ads by Google