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Generalized Joint Hypermobility

Generalized Joint Hypermobility is Predictive of Hip Capsular Thickness

Generalized Joint Hypermobility (GJH) is diagnosed as increased mobility of small and large joints.1 The frequency of GJH is estimated between 10-20+%, and is more common in females and young children.1-4 Individuals with GJH are more prone to lumbar and peripheral injuries including: recurrent shoulder dislocations, patellar instability, ACL injuries, ankle instability, supraspinatus and biciptal tendonitis, tennis elbow and achilles tendonitis.1,3, 5-7 It has also beeen recognized as a risk factor for postural disorders especially lordotic posture, sway-back posture, and functional scoliosis.1,8,9 

It is assumed that joint hypermobility is an expression of laxity of connective tissue,10 specifically ligamentous insufficiency,11 which effects motor competence,12 muscle strength,13-15 and proprioception.1,8,9

Since GJH can cause detrimental effects, one recent cross-sectional study set out to examine the relationship between generalized joint hypermobility and hip capsular thickness.16 One hundred patients undergoing hip arthroscopy completed the Beighton test score (BTS)17 prior to the procedure.  A score of 4 was defined as hypermobile. Capsular thickness was measured arthroscopically using a calibrated probe.16 A statistically significant association was found between BTS and capsular thickness.  A BTS score of ≤4 is strongly predictive of having a capsular thickness of >10mm, while a BTS 4 correlates with a capsular thickness of 16 This suggests that hypermobility can be an indicator of hip joint degeneration. 

The aim of therapy for subjects with joint hypermobility should include: improving core stability, improving activity of muscles responsible for joint stabilization, inhibition of hyperactive muscles, improving proprioception and balance, education about ergonomic patterns concerning the avoidance of resting in harmful end-range postures, postural self-control, and physical fitness.1,8,9,11, 13-15


1. Czaprowski, D., Sitarski, D. Generalized Joint Hypermobility-Diagnosis and Physiotherapy. J Nov Physiother. 2016; 6:4.

2. Hakim, A., Grahame, R. Joint Hypermobility. Best Pract Res Clin Rheumatol. 2003; 17: 989-1004.

3. Kirk, JA., Ansell, BM., Bywaters, EG. The Hypermobility Syndrome: Musculoskeletal complaints associated with generalized joint hypermobility. Ann Rheum Dis. 1967; 26:419-25.

4. Grahame, R. Time to take hypermobility seriously (in adults and children). 2001; 40:485-7.

5. Bilsel, K., et al. Acetabular dysplasia may be related to global joint laxity. Int Orthop. 2016; 40:885-9.

6. Bin Abd Razak, HR., Bin Ali, N., Howe, TS. Generalized ligamentous laxity may be a predisposing factor for musculoskeletal injuries. J Sci Med Sport. 2014; 17: 474-8.

7. Vaishya, R., Hasija, R. Joint hypermobility and anterior cruciate ligament injury. J Orthop Surg. 2013; 21:182-4.

8. Czaprowski, D., Kotwick, T., Stolinski, L. Assessment of joint laxity in children and adolescents: a review of methods. Orthop Traumatol Rehabil. 2012; 14: 407-20.

9. Russek, LN. Examination and treatment of a patient with hypermobility syndrome. Phys Ther. 2000; 80:386-98.

10. Remorig, L., et al. Need for a consensus on the methods by which to measure joint mobility and the definition of norms for hypermobility that reflect age, gender and ethnic dependent variation. Rheumatology. 2011; 50:2.

11. Kerr, A. Macmillan CE., Ultey, WS. Physiotherapy for children with hypermobility syndrome. Physiotherapy. 2000; 86: 313-17.

12. Hanewinkel-van Kleef, YB et al.  Motor performance in children with Generalized Joint Hypermobility: the influence of muscle strength and exercise capacity. Pediatr Phys Ther. 2009; 21: 194-200.

13. Engelbert, RH., et al. Pediatric Generalized Joint Hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? Pediatrics. 2003; 111: e248-254.

14. Scheper, MC., et al. Gneralized Joint Hypermobility in professional dancers: a sign of talent or vulnerability? Rheumatology. 2013; 52: 651-8.

15. Scheper, MC. The functional consequences of Generalized Joint Hypermobility: a cross-sectional study. Physiotherapy. 2014; 15: 243.

16. Devitt, B., et al. Generalized Joint Hypermobility is predictive of hip capsular thickness. Orthop J Sports Med. 2017; 5: 4.

17.  The most commonly used clinical screening method  for GJH is the 9 point Beighton Scale consisting of: passive flexion of fifth digit beyond 90°, passive thumb abduction to front forearm, passive hyperextension of elbow joint above 10°, passive hyperextension of knee joint above 10°, forward flexion of the trunk in standing so that the palms of the hands lay flat on the ground. Each hypermobile joint gets one point.

      Beighton, P., Grahame, R., Bird, H. Hypermobility of Joints. 4th edtn. 2012. Springer, London, UK.