Joint hypermobility syndrome is characterized by joints that move beyond normal ranges and can lead to pain, often inherited alongside Ehlers-Danlos syndrome (EDS), which affects collagen synthesis and leads to various physical manifestations. Management strategies for these conditions include medications, physiotherapy, and potentially surgery, while benign joint hypermobility syndrome typically requires minimal intervention. Marfan syndrome, another connective tissue disorder, presents with unique physical features and also necessitates a tailored treatment approach to manage its systemic effects.

1. Joint Hyper
mobility Syndromes
-By Dr. Rima Jani (PT)
(B.P.T., M.P.T. Pediatric Science)

2. INTRODUCTION
The joint hypermobility syndrome is a condition that
features joints that easily move beyond the normal
range expected for that particular joint.
Hypermobile joints tend to be inherited.
Symptoms of the joint hypermobility
syndrome include : pain in the knees, fingers, hips,
and elbows.

5. Ehler Danlos Syndrome

6. EDS [Ehler Danlos Syndrome] is a disorder of collagen
synthesis, primarily type V collagen.
Incidence of 1:10,000.
It’s a group of inherited disorders that mostly affect
the skin, joints and blood vessels.
It is characterized by joint hypermobility, skin hyper
extensibility, and tissue fragility.
INTRODUCTION

7. Classification
Formerly divided into 14 distinct variations, there are
now 7 accepted general classification types of EDS.
However, the Classic and Hypermobility type
account for 90% of all cases and involve mostly
orthopedic complaints.

8. Clinical Features
Overly flexible joints that can dislocate,
Skin that's translucent, elastic and bruises easily.
In some cases : dilation and even rupture of major
blood vessels.

9. Management
Treatment helps manage symptoms and monitor for
complications.
It includes:
 Medications,
 Physiotherapy &
 Surgery

10. Benign joint hypermobility syndrome
(BJHS)
It is also characterized by generalized joint laxity
with musculoskeletal complaints.
It is called “benign” owing to the absence of a
specific genetic, musculoskeletal or rheumatic
disorder.
Often, joint hypermobility causes no symptoms
and requires no treatment.

11. Management
Intervention focus and strategies will depend on the
patient’s age and severity of joint involvement.
Most programs should include a combination of the
following four areas:
Targeted Therapeutic Exercise,
Self-care & Home Management,
Functional Training for recreation, school, or work &
Orthoses or Adaptive Equipment.

12. Marfan Syndrome
Marfan syndrome is an inherited disorder that affects
connective tissue — the fibers that support and anchor
your organs and other structures in your body.
It affects the heart, eyes, blood vessels and bones.
People with Marfan syndrome are tall and thin with
long arms, legs, fingers and toes.
Incidence : Fewer than 1 million cases per year

13. Clinical Features
Tall and slender build.
Disproportionately long arms, legs and fingers.
A breastbone that protrudes outward or dips inward.
A high, arched palate and crowded teeth.
Heart murmurs.
Extreme nearsightedness.
An abnormally curved spine.
Flat feet.

15. Management
Treatment includes medication to keep blood
pressure low,
Glasses or contact lenses and
Surgery
Physiotherapy for pain management and
stabilization exercises.

16. Management of Hypermobility Syndrome
Therapeutic exercises
Orthoses
Adaptive Equipment

17. Therapeutic Exercises
A combination of strengthening and stabilization
exercises.
Glenohumeral joint and scapular stabilization and
strengthening are important to combat recurrent
subluxations.
This reduction in subluxations also improves proximal
stability to facilitate functional use of the hand and
arm without recurrent pain.

18. Scapular stabilization Exercises

19. Scapular stabilization Exercises

20. Shoulder Exercises

21. Foot & Ankle Strengthening Exercises
Foot and ankle strengthening will promote stability
and preserve foot function.
Full hind foot ROM should be achieved, as Achilles
tightness usually develops

22. Foot & Ankle Exercises

23. Ankle & Foot exercises

24. Ankle & Foot exercises

25. Abdominal & Trunk Strengthening
for overall proximal and lumbar stabilization is
frequently necessary as low back pain is a common
complaint.

26. Abdominal & Trunk Strengthening

27. Wrist & Hand Exercises
Wrist and hand work
should focus on small
intrinsic muscle
strengthening without
joint hyperextension to
facilitate hand use in fine
motor tasks especially for
school and work.

28. Wrist & Hand Exercises

29. The foot and ankle should be protected as early as possible
to prevent structural deformity associated with excessive
pronation.
Children with EDS and BJHS do well with custom and semi-
customized shoe orthotics for mild-to-moderate foot
hypermobility and light weight supramalleolar orthoses in
severe cases.
Orthoses

30. Adaptive Equipment
Primary equipment and device needs are related to
the hands, ankles, and feet.
These children benefit from wider grip pens and
pencils or regular ones with grip-widening foam
attached to them.

31. Adaptive Equipment
Some children benefit from early
use of computer or laptop use for
note taking.
More widespread academic use of
electronic tablets may provide
even more hand symptom relief.

32. THANK YOU…