Causes of weak ligaments in a child. Joint hypermobility in children and adults: how dangerous is this disease? What treatment is prescribed

27.04.2024

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Joint hypermobility in children and adults: how dangerous is this disease?

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Signs of weak joints in children - pain in the knees and feet, and sometimes jaw pain.

Human lower jaw: 1 - alveolar process; 2 - body of the lower jaw; 3 - chin hole; 4 - mandibular canal; 5 - angle of the lower jaw; 6 - branches of the lower jaw; 7 - articular processes; 8 - coronoid processes; 9 - mandibular foramen.

If a child’s jaw hurts, then it may well be that the joints are rather weak. The exercise that doctors recommend is very simple - sit up straight and lower your lower jaw (opening and closing your mouth) straight down and no more than 2 cm. Repeat 10-15 times, and if there is pain, you can do more. But omit no more than 2 cm, to there was no extra load - this is the basis for treating all joints. This is to relieve pain, and then for recovery and strengthening you need training with a load, but only when the pain stops. A healthy person will not feel any worse with such exercises, and if there is a problem with the joints, it will help.

The reasons are the toxic influence of environmental factors on the developing child's body (lack of calcium in water and soil, imbalance in the ratio of microelements in food).

If the joint ceases to function normally, then this indicates either overload (during sports training, for example), or a lack of chondroitin and glucosamine in the joint, as the main components. The first and second (load and disadvantage) are interrelated.

In general, joints are a weak point for any person. They are capricious and require careful handling.

Fish fat.

Treatment. Pathogenetic and symptomatic: vitamin D, oral calcium medications, methods of physical influence on the musculoskeletal system, the use of balneofactors. For childhood arthritis, it is recommended to reduce the load on the joints and use drugs that eliminate pain, reduce muscle contraction, and improve the nutrition of cartilage. Plus physiotherapy (ultrasound, Bernard currents), spa treatment (mud, hydrogen sulfide and radon sources), exercise therapy, massage.

It's good for your joints to do exercises with low weights and high repetitions. This will increase the production of growth hormone and, as a result, heal the joints. Pressure and stretch resistance exercises are needed.

Fish and foods with calcium are very useful.

Fish oil is very good for joints. Take a teaspoon 3 times a day.

A small child's joints are cracking

Children's joints are very fragile. Even a slight crunch or clicking noise made by a child's joints can greatly frighten parents.

Some children actually hear cracking sounds in their joints during certain movements. The reason is immaturity of the ligamentous-muscular system. The connective tissue of a child’s joints is not as dense as in adults and is more elastic. The muscular system is much less developed, which is why the joints crack. As the joints grow (as the child gets older), the crunching goes away., so there's nothing wrong with that.

But if only one joint cracks, and the crunch does not go away with age, this may be a harbinger of joint pathology or the beginning of any diseases of the musculoskeletal system.

Sometimes cracking joints is an anatomical feature; it can be corrected with proper nutrition.

Nutrition for joints

Calcium, phosphorus, vitamin D and manganese are very necessary. You need to drink enough fluids throughout the day, because... water stimulates the production of intra-articular fluid.

The body strengthens gradually, so all changes are a matter of more than one month.

Collagen hydrolyzate.

General recommendations for joints: less monosaccharides (cookies, pasta, baked goods made from white flour), more polysaccharides (potatoes and other vegetables, fruits, oat and whole grain bread). Ears, pork tails (jellied meat), cottage cheese, milk, hard cheeses, and chicken eggs are useful.

Ears and tails are a source of naturally occurring collagen. And collagen is a constituent protein of connective tissue. Connective tissue - muscles, ligaments, bones, cartilage, joints, blood vessels, parenchyma of internal organs, skin, nails, hair, dentin of teeth. And joints.

Collagen hydrolyzate can be obtained by cooking - this is what we call jellied meat.

Manganese is a carrier of oxygen from the blood to the cells of the body; it is especially important for the nutrition of cartilage and intervertebral discs, because they do not have direct blood circulation. If there is a lack of manganese, the ossification processes in the skeleton are disrupted - the joints are deformed, the tubular bones become thicker and shorter.

Products that are good for joints:

contain calcium: milk, hard cheeses (preferably fat content up to 30%), cottage cheese, legumes, herbs, vegetables, raisins, dried apricots, carrots, beets, potatoes, bananas;
contain phosphorus: fish, cereals, meat, liver, peaches, apricots, raisins;
contain vitamin D: seafood, sea fish, fish oil;
contain manganese: egg yolk, seaweed, rose hips, apples, plums, rowan.

Aspic.

For calcium, it is best to: boil the eggs, peel the film from the shell, and crush them. Take a teaspoon up to three times a day with a drink. The taste is not very pleasant, but it helps a lot with calcium deficiency.

Magnesium is found in dates, prunes, raisins, dried apricots, beans, soybeans, buckwheat honey, oatmeal and buckwheat, nuts, bran, whole grain bread, dark chocolate, cocoa.

Selenium is interconnected with vitamin E - consumption of one requires proportional consumption of the other.

If you play sports, it is good to eat cottage cheese before training or in the morning.

Vitamin D prevents the leaching of calcium from bones: it is found in fish liver, butter, cottage cheese, cheese, dairy products and egg yolk.

Joints need vitamins B, C, E, A, K, as well as microelements. Vitamin F is a complex of polyunsaturated fatty acids that has an anti-inflammatory effect. Salads made from raw vegetables, seasoned with olive or other vegetable oil, are very good for joint health.

Collagen is a complex protein that forms the basis of all human connective tissue, which is approximately 25-35% of the total protein mass in the body.

A lot of polyunsaturated fatty acids are found in fatty sea fish: regular herring works well here; it is better to buy it frozen or lightly salted. Salted herring can be soaked in milk, and after that it can be given even to children from 2 years old.

Fruits and vegetables should be cooked as little as possible, and peeled and cut immediately before consumption to preserve vitamin C.

Collagen synthesis in the body is a complex biochemical process that involves a large number of vitamins and minerals. With age, or as a result of diseases or poor nutrition, the body’s process of synthesis of its own collagen slows down, which begins to negatively affect the condition of connective tissue - it ceases to be replenished and is destroyed. In this case, the use of collagen hydrolyzate can compensate for the lack of collagen and stimulate the body to produce its own protein.

Hyaluronic acid and joints

Hyaluronic acid (hyaluronate, hyaluronan) is a non-sulfonated glycosaminoglycan that is part of connective, epithelial and nervous tissues. It is one of the main components of the extracellular matrix and is found in many biological fluids (saliva, synovial fluid, etc.).

In the cavity of the joints there is a special synovial fluid, having a unique biological composition and properties. Its composition is similar to blood plasma, but it contains less proteins and contains hyaluronic acid, necessary for the fluid to be viscous and the joints to be constantly lubricated.

Hyaluronic acid is the main component of synovial fluid, responsible for its viscosity. Along with lubricin, hyaluronic acid is the main component of biological lubricant. Hyaluronic acid is an important component of articular cartilage.

The joints are covered with synovial membranes, which contain synovial fluid; and as soon as its composition deteriorates, the membranes cease to protect the joints from friction. The synthesis of hyaluronic acid in cells due to poor nutrition and negative influences slows down and even stops; In this case, the synovial fluid ceases to perform its function, and the tissues of the joints begin to quickly deteriorate. Then even children and young people develop arthrosis and arthritis.

Hyaluronic acid is part of many tissues (skin, cartilage, vitreous), and this is what determines its use in the treatment of diseases associated with these tissues (cataracts, osteoarthritis): synovial fluid endoprostheses; surgical environment for ophthalmic operations; preparations for mild tissue augmentation and wrinkle filling (including in the form of intradermal injections) in cosmetic surgery.

To ensure that the amount of hyaluronic acid in the cartilage and connective tissues, as well as in the interarticular fluid, does not decrease, it is necessary to consume foods containing mucopolysaccharides - these substances are vital for joints. An important property of these products is their gelling ability. These are seaweed, mussels, shrimp and other seafood, as well as ligaments, bones and cartilage of fish, birds and animals - it is from these products that aspic, jellies, and jellied meats are prepared. Often these useful parts are considered waste; chicken feet, fish heads, beef and pork bones are thrown away.

Try not to throw away such waste, but cook, for example, fish soup from a fish head - the fish soup will turn out to be very rich, tasty and healthy. The fish can be any, river or sea: catfish, perch, pike, salmon, halibut, salmon fish. Wash the heads (1-2 pieces) thoroughly, remove the gills, cut into several parts, put in a pan with cold water, cook over low heat for about an hour. It is good to cook with black pepper (6-7 peas) and bay leaf; You can also add fins and a tail. Next, add 2 chopped onions, carrots, bell pepper and tomato, dry seaweed (2 tsp), add sea salt to taste, cook for another 5-7 minutes. Place a slice of lemon on each plate of the finished fish soup and pour in a little lemon juice. Sprinkle with fresh herbs. Excellent fish soup for joints!

Running and joints

Multiple micro-concussions of the joints during running cause microtrauma to the articular surfaces, which is why professional runners always have problems with their joints. Therefore, track and field athletes spend a lot of time developing their running technique, when they try to minimize these harmful effects on the joint. And you need special shoes.

But walking is very beneficial for joints. Both sports and ordinary. So walk more.

Pharmacy products for joints

Pharmacies sell various products to strengthen joints. There are many medications whose purpose is to strengthen joints and maintain the elasticity of articular joints. Such preparations contain glucosamine and collagen, because it is these substances that restore the elasticity of the cartilage structure and form the basis of connective tissue.

Chondroprotectors (Chondroitin, Glucosamine). Glucosamine and chondroitin:

preserve and restore the elasticity and flexibility of cartilage;
have an anti-inflammatory effect;
improve the moisture saturation of cartilage tissue;
contribute to the proper construction of new cartilage tissue;
restore joint mobility;
reduce pain.

Calcium active, dietary supplement.

Take a course of mumiyo.

Collagen ultra.

Geladrink Forte - collagen, chondroitin, glucosamine, three in one, Czech drug.

If there is an excessive intake of hyaluronic acid in the form of medical drugs or during cosmetic procedures, the skin after a certain period of time ceases to produce it on its own. Medicinal substances that contain hyaluronic acid are divided into two types:

Hyaluronic acid preparations of animal origin are produced by distillation of animal tissue.
Medical products in which hyaluronic acid is produced by special microorganisms.

Hypermobility syndrome (HS) is a systemic connective tissue disease, which is characterized by joint hypermobility (HMS), combined with complaints from the musculoskeletal system and/or internal and external phenotypic signs of connective tissue dysplasia, in the absence of any other rheumatic disease.

The symptoms of joint hypermobility syndrome are varied and can mimic other, more common joint diseases. Due to insufficient familiarity with this pathology among general practitioners, and in some cases even rheumatologists and orthopedists, the correct diagnosis is often not established. Traditionally, the doctor's attention is drawn to identifying limited range of motion in the affected joint, rather than determining excess range of motion. Moreover, the patient himself will never report excessive flexibility, since he has coexisted with it since childhood and, moreover, is often convinced that this is more a plus than a minus. Two diagnostic extremes are typical: in one case, due to the absence of objective signs of pathology in the joints (except for visible hypermobility) and normal laboratory parameters in a young patient, “psychogenic rheumatism” is determined; in the other, the patient is diagnosed with rheumatoid arthritis or a disease from the group of seronegative spondyloarthritis and prescribe appropriate, by no means harmless, treatment.

Constitutional joint hypermobility is detected in 7-20% of the adult population. Although most patients first complain during adolescence, symptoms can appear at any age. Therefore, the definitions of “symptomatic” or “asymptomatic” HMS are quite arbitrary and reflect only the state of an individual with hypermobility syndrome at a certain period of life.

Causes of joint hypermobility

Acquired excessive joint mobility is observed in ballet dancers, athletes and musicians. Long-term repeated exercises lead to stretching of the ligaments and capsules of individual joints. In this case, local hypermobility of the joints occurs. Although it is obvious that in the process of professional selection (dancing, sports) persons who are initially distinguished by constitutional flexibility have a clear advantage, the fitness factor undoubtedly takes place. Changes in joint flexibility are also observed in a number of pathological and physiological conditions: acromegaly, hyperparathyroidism, pregnancy.

Generalized joint hypermobility is a characteristic feature of a number of hereditary connective tissue diseases, including Marfan syndrome, osteogenesis imperfecta, and Ehlers-Danlos syndrome. These are rare diseases. In practice, a doctor much more often has to deal with patients with isolated joint hypermobility, not associated with training and in some cases combined with other signs of weakness of connective tissue structures.

It is almost always possible to establish the familial nature of the observed syndrome and concomitant pathology, which indicates the genetic nature of this phenomenon. It has been noted that hypermobility syndrome is inherited through the female line.

Diagnosis of joint hypermobility syndrome

Among the many proposed methods for measuring range of motion in joints, Beighton's method, which is a nine-point scale assessing the subject's ability to perform five movements (four paired for the limbs and one for the trunk and hip joints), has received general recognition. Beighton proposed a simplified modification of the previously known method of Carter and Wilkinson.

Change in range of motion

Beighton criteria

1. Passive extension of the little finger of the hand more than 90°.
2. Passive pressing of the thumb to the inside of the forearm.
3. Hyperextension of the elbow joint more than 10°.
4. Hyperextension in the knee joint more than 10°.
5. Forward tilt of the body with palms touching the floor with straight legs.

This is a simple and time-consuming screening procedure and is used by doctors.

Based on a number of epidemiological studies, norms of joint mobility for healthy people were determined. The degree of joint mobility is distributed in the population in the form of a sinusoidal curve.

The usual Beighton score for Europeans is from 0 to 4. But the average, “normal” degree of joint mobility varies significantly across age, gender and ethnic groups. In particular, when examining healthy individuals in Moscow aged 16-20 years, more than half of women, and more than a quarter of men, demonstrated a degree of HMS exceeding 4 points according to Beighton. Thus, in the absence of complaints from the musculoskeletal system, excessive joint mobility in comparison with the average can be considered as a constitutional feature and even an age norm. In this regard, in pediatric practice there are no generally accepted standards for joint mobility - this indicator changes significantly during the period of child growth.

The so-called Brighton criteria for benign HMS syndrome (1998) are presented below. These criteria also attach importance to extra-articular manifestations of weakness of connective tissue structures, which makes it possible to speak of HMS syndrome in persons with a normal range of motion in the joints (as a rule, we mean older persons).

Criteria for joint hypermobility syndrome

To establish hypermobility, a generally accepted score is: 1 point means pathological hyperextension in one joint on one side. The maximum value of the indicator, taking into account two-way localization, is 9 points (8 for the first 4 points and 1 for the 5th point). An indicator from 4 to 9 points is regarded as a state of hypermobility.

Large criteria

Beighton score of 4 or more (at the time of examination or in the past)
Arthralgia for more than 3 months in four or more joints

Small criteria

Beighton score 1-3 (for people over 50 years old)
Arthralgia for less than 3 months in one to three joints or lumbodynia, spondylosis, spondylolysis, spondylolisthesis
Dislocation/subluxation in more than one joint or repeated in one joint
Periarticular lesions of more than two localizations (epicondylitis, tenosynovitis, bursitis)
Marfanoid (tall, thin, arm span/height ratio > 1.03, upper/lower body segment ratio< 0,83, арахнодактилия)
Abnormal skin: thinness, hyperextensibility, stretch marks, atrophic scars
Eye signs: drooping eyelids or myopia or antimongoloid fold
Varicose veins or hernias or uterine/rectal prolapse.

To diagnose FHMS, the presence of two major, one major and two minor or four minor criteria is required. Excluded: Marfan syndrome in the absence of damage to the lenses and ascending aorta; osteogenesis imperfecta in the absence of multiple bone fractures and “blue” sclera

Symptoms of joint hypermobility syndrome

The pathogenesis of HS is based on a hereditary collagen defect, accompanied by hyperextensibility and a decrease in the mechanical strength of connective tissue structures (including ligaments, entheses, tendons), leading to subluxations and microtraumatization of the articular apparatus (including the spine).

The symptoms of the syndrome are diverse and include both articular and extra-articular manifestations, which are generally reflected in the mentioned Brighton criteria for HMS syndrome.

A careful history taking is a significant aid in diagnosis. A characteristic fact in the patient’s life history is his special sensitivity to physical stress and a tendency to frequent injuries (sprains, subluxations of joints in the past), which suggests a failure of the connective tissue. The excess range of motion in the joints detected by the Beighton method complements the actual clinical forms of manifestation of joint hypermobility syndrome.

Joint symptoms and potential complications of joint hypermobility syndrome

Arthralgia and myalgia. The debut of arthralgia occurs at a young age, mainly in females. The sensations may be painful, but are not accompanied by visible or palpable changes in the joints or muscles. The most common localization is the knee, ankle, and small joints of the hands. In children, severe pain in the hip joint has been described, responding to massage. The severity of pain is often influenced by the emotional state, weather, and the phase of the menstrual cycle.

Acute post-traumatic articular or periarticular pathology accompanied by synovitis, tenosynovitis or bursitis.

Periarticular lesions(tendinitis, epicondylitis, other enthesopathies, bursitis, tunnel syndromes) occur more often in patients with VHMS than in the general population. Occur in response to unusual (unusual) load or minimal trauma.

Chronic mono- or polyarticular pain, in some cases accompanied by moderate synovitis provoked by physical activity. This manifestation of VHMS most often leads to diagnostic errors. The cause of the pain syndrome is a change in the sensitivity of proprioceptors to the load of supporting joints against the background of articular hypermobility.

Repeated dislocations and subluxations of joints. Typical localizations are the shoulder, patello-femolar, metacarpophalangeal joints. Sprained ligaments in the ankle joint.

Development of early (premature) osteoarthritis. This can be either true nodular polyosteoarthrosis or secondary damage to large joints (knees, hips) that occurs against the background of concomitant orthopedic anomalies (flat feet, unrecognized hip dysplasia).

Back pain . Thoracalgia and lumbodynia are common in the population, especially in women over 30 years of age, so it is difficult to make an unambiguous conclusion about the connection of these pains with joint hypermobility. However, spondylolisthesis is significantly associated with GMS.

Symptomatic longitudinal, transverse or combined flatfoot and its complications: medial tenosynovitis in the ankle joint, valgus deformity and secondary arthrosis of the ankle joint (longitudinal flatfoot), posterior talar bursitis, thalalgia, corns, hammertoe deformity, Hallux valgus (transverse flatfoot).

Insufficiency of the connective tissue fixing apparatus of the spine under the influence of unfavorable factors (prolonged non-physiological posture, difference in the length of the lower extremities, carrying a bag on one shoulder) entails compensatory development of spinal deformities(scoliosis) with subsequent overstrain of the muscular-ligamentous structures of the spine and the appearance of pain.

Extra-articular manifestations of the syndrome.

These signs are natural, since the main structural protein collagen, which is primarily involved in the described pathology, is also present in other supporting tissues (fascia, dermis, vascular wall).

Excessive extensibility of the skin, its fragility and vulnerability.
Striae not associated with pregnancy.
Varicose veins that begin in youth.
Mitral valve prolapse (before the introduction of echocardiography into widespread practice in the 70-80s, many patients with HMS syndrome were observed by a rheumatologist with a diagnosis of “rheumatism, minimal degree of activity” due to complaints of joint pain and heart murmurs associated with prolapse valves).
Hernias of various localizations (umbilical, inguinal, white line of the abdomen, postoperative).
Prolapse of internal organs - stomach, kidneys, uterus, rectum.

Thus, when examining a patient with suspected hypermobility syndrome, and this is every young and middle-aged patient with non-inflammatory joint syndrome, it is necessary to pay attention to possible additional signs of systemic connective tissue dysplasia. Knowledge of the phenotypic manifestations of Marfan syndrome and osteogenesis imperfecta allows us to exclude these hereditary diseases. If obvious skin and vascular signs are detected (skin hyperelasticity and spontaneous formation of bruises without signs of coagulopathy), it is legitimate to talk about Ehlers-Danlos syndrome. The question of differential diagnosis of benign joint hypermobility syndrome and the most “mild”, hypermobile type of Ehlers-Danlos syndrome remains open. This cannot be done using the Brighton criteria, which the authors specifically mention; in both cases there is moderate involvement of the skin and blood vessels. There is no known biochemical marker for either syndrome. The question remains open and will, apparently, be resolved only with the discovery of a specific biochemical or genetic marker for the described conditions.

Considering the widespread prevalence of constitutional hypermobility of joints in the population, especially among young people, it would be erroneous to explain all joint problems in this category of people only by hypermobility. The presence of hypermobility syndrome does not at all exclude the possibility of them developing any other rheumatic disease, to which they are susceptible with the same probability as persons with a normal range of motion in the joints.

Thus, the diagnosis of joint hypermobility syndrome becomes justified when other rheumatic diseases are excluded, and the existing symptoms correspond to the clinical signs of the syndrome, logically supplemented by the identification of excessive joint mobility and/or other markers of generalized connective tissue involvement.

Complications of hypermobility syndrome

Acute (traumatic)
1. Recurrent subluxations in the ankle joint.
2. Meniscus tear.
3. Frequent bone fractures.
4. Acute or recurrent subluxations of the shoulder, patella,
metacarpophalangeal, temporomandibular joints.
5. Traumatic arthritis.

Chronic (non-traumatic)
1. Epicondylitis.
2. Tendonitis.
3. Rotator cuff syndrome.
4. Bursitis.
5. Episodic juvenile arthritis (synovitis) of the knee joints (without signs of a systemic inflammatory reaction).
6. Nonspecific arthralgia.
7. Scoliosis.
8. Back pain.
9. Chondromalacia of the patella.
10. Osteoarthritis.
11. Fibromyalgia.
12. Dysfunction of the temporomandibular joint.
13. Carpal and tarsal tunnel syndromes.
14. Acroparesthesia.
15. Thoracic outlet syndrome.
16. Flat feet.
17. Raynaud's syndrome.
18. Delayed motor development (in children).
19. Congenital dislocation of the hip.

Treatment of joint hypermobility syndrome

Treatment for a patient with hypermobility syndrome depends on the specific situation. The variety of manifestations of the syndrome also requires a differentiated approach to each individual patient. It is important to understand the very cause of the problems - “weak ligaments”, this is not a serious disease and does not threaten any disability with an adequate lifestyle. For moderate arthralgia, it is enough to eliminate stress that causes pain and discomfort in the joints.

Decisive in the treatment of severe pain are non-drug methods, and first of all, optimizing lifestyle. This involves matching the loads and the threshold of their tolerance for a given patient. It is necessary to minimize the possibility of injury, which includes vocational guidance and the exclusion of team sports.

For persistent pain in one or more joints, elastic orthoses (knee pads, etc.) are used to artificially limit the range of motion. Timely correction of detected flat feet is very important. The shape and rigidity of the insoles is determined individually; the success of the treatment largely depends on this. It is often possible to cope with persistent arthralgia of the knee joints using this only method.

In ensuring the stability of the joint, not only the ligaments play a significant role, but also the muscles surrounding the joint. If it is impossible to influence the condition of the ligamentous apparatus through exercises, then strengthening and increasing muscle strength is a real task. Gymnastics for joint hypermobility syndrome has a peculiarity - it includes so-called “isometric” exercises, during which significant muscle tension occurs, but the range of motion in the joints is minimal. Depending on the location of the pain syndrome, it is recommended to strengthen the muscles of the hips (knee joints), shoulder girdle, back, etc. Swimming is useful.

Drug therapy is applicable as symptomatic treatment for arthralgia. Since pain in joint hypermobility syndrome is mainly non-inflammatory in nature, it is often possible to see a complete lack of effect from the use of non-steroidal anti-inflammatory drugs. In this case, greater results can be achieved by taking analgesics (paracetamol, tramadol).

Intra-articular administration of corticosteroids in the absence of signs of synovitis is absolutely ineffective.

Taking into account the pathogenetic basis of connective tissue failure and the systemic nature of manifestations of joint hypermobility syndrome, the main direction of treatment is the correction of impaired collagen metabolism. This helps prevent possible complications. Agents that stimulate collagen formation include ascorbic acid, mucopolysaccharide preparations (chondroitin sulfate, glucosamine sulfate), B vitamins (B1, B2, B3, B6) and trace elements (copper, zinc, magnesium). The latter are cofactors of intra- and extracellular maturation of collagen molecules and other structural elements of connective tissue.

Magnesium plays a special role in the regulation of connective tissue metabolism. Under conditions of its deficiency, there is an increase in the degradation of collagen and, possibly, elastin fibers, as well as polysaccharide strands of hyaluronan. This is due to the inactivation of hyaluronan synthetases and elastases, as well as an increase in the activity of hyaluronidases and matrix metalloproteinases. At the cellular level, magnesium deficiency also leads to an increase in the number of dysfunctional tRNA molecules, thereby slowing down the rate of protein synthesis. In addition, autoimmune reactions caused by the presence of the Bw35 allele of the HLA system play a certain role in the degradation of connective tissue. Activation of T-cell immunity to connective tissue components containing receptors corresponding to the Bw35 antigen leads to degradation of the connective tissue matrix, which is associated with uncontrolled loss of magnesium. Increased expression of this antigen was observed in patients with primary mitral valve prolapse, which is a phenotypic marker of hypermobility syndrome. A number of studies have shown the fundamental possibility of slowing down the processes of connective tissue degeneration when treated with magnesium preparations. This is achieved by enhancing the biosynthetic activity of fibroblasts, which are responsible for normalizing the fibrous structures of the connective tissue matrix.

For periarticular lesions (tendonitis, enthesopathies, bursitis, tunnel syndromes), treatment tactics are practically no different from those in ordinary patients. In moderate cases, these are ointments with non-steroidal anti-inflammatory drugs in the form of applications or compresses; in more persistent cases, local administration of small doses of glucocorticosteroids that do not have a local degenerative effect (suspension of methylprednisolone crystals, betamethasone). It should be noted that the effectiveness of local corticosteroid therapy largely depends on the correctness of the topical diagnosis and the technique of performing the procedure itself.

Timely metabolic therapy plays an important role in the treatment and prevention of potential complications of hypermobility syndrome.

General practitioner Loginov E.V.

Hypermobility syndrome is a condition of the joints in which the amplitude of their movements significantly exceeds normal, physiological indicators. Depending on the elasticity and stretchability of the capsule, tendon and ligament, the degree of mobility is determined. Doctors agree that hypermobility is transmitted along the hereditary line, due to the fact that the child receives collagen that differs from normal in structure, namely, it acts as the basis of connective tissue protein.

Given this feature, people have increased fiber stretchability. The syndrome provokes rapid wear and tear of the surface of the joint, as well as the surrounding tissues. Against this background, symptoms of hypermobility may occur, but these are only medical assumptions, and doctors still do not have an exact answer. Based on statistical data and research, scientists assure that if a person uses joint hypermobility too often, then the symptoms increase. It is also worth noting that the syndrome is classified as a benign condition, but it provokes the development of many dangerous pathologies. Let's take a closer look at what hypermobile joint syndrome is.

Studying the clinical picture of different patients with the presented syndrome, experts note that both children and adults have a pronounced feeling of discomfort in the joints, the symptoms manifest themselves especially strongly after physical activity, as well as during the period of growth of bone structures.

In most cases, discomfort is present in the legs, but can also be localized in the upper extremities. Joint pain most often affects the knee joint, but there have been cases where the patient complains of discomfort in the ankle. Those people who engage in professional sports activities also suffer from soft tissue swelling and joint effusion.

The results of histological studies confirm the absence of inflammatory processes, and the general clinical picture is very similar to the condition after injury. The composition of synovial fluid is characterized by a small amount of protein and other cells. The degree of damage, in most cases, remains within normal limits, which allows the patient to continue playing his favorite sport.

Kinds

As mentioned earlier, the majority of clinical cases of this pathology are classified as a congenital condition of the joints, but hypermobility syndrome is not an independent disease. Increased mobility of joint nodes occurs against the background of the pathological state of the surrounding connective tissue, which is the main component of ligaments and joints.

Another characteristic is the fact that in most cases, even when experienced specialists carefully carry out all the necessary studies, it is not possible to identify connective tissue pathologies. In this case, doctors diagnose a tissue development disorder. Symptoms regarding joints will be typical, but the prognosis is favorable, due to the low likelihood of complications.

Sometimes artificially created increased mobility of joints is diagnosed. A similar condition is diagnosed in professional athletes who engage in gymnastics or acrobatics. Ballerinas also try to develop a similar joint ability through increased training aimed at stretching the muscular-ligamentous apparatus. In this way, it is possible to increase the elasticity and improve the flexibility of the body.

But it is worth noting that even excessive and prolonged training of an ordinary, healthy person will not give the same results as with hypermobility. Therefore, an artificially created condition is considered by doctors as a pathology.

Criteria

There are certain parameters for assessing the degree of joint hypermobility:

Passive flexion of the joint of the fifth finger in the area of the metacarpophalangeal joint in both directions;
Passive flexion of the first finger towards the forearm when moving in the wrist joint;
Hyperextension of the elbow and/or knee joint by more than 10 degrees;
When leaning forward, resting your palms on the floor, but your knees are not bent.

For a doctor to diagnose hypermobility, the patient must have any three indicators. Speaking of assessment, they use a scale from 1 to 9, where the smallest number indicates a pathological ability to hyperextend. A reading of up to two is considered normal.

Also, for a more accurate assessment, they use a graduated scale, which evaluates movements in each joint from 2 to 7, but this technique is rarely practiced.

In children

Each child who has a feature in the form of joint hypermobility can express various complaints regarding the discomfort that arises in the musculoskeletal system. Most often they talk about pain in the area of pathological joints, which manifests itself after physical activity in which hypermobile joints are involved. Pain appears in one or more joints, and can be symmetrical or generalized.

In most cases, symptoms occur in the knee joint, but any joints can be affected, including the spinal column. The pain most often goes away on its own, but after overexertion it reappears. In rare cases, patients in the younger age group complain of muscle pain, spasms and other discomfort not related to the joints.

Speaking about the connection of pathology with diseases of the cardiac or vascular system, it is worth noting that hypermobility syndrome is detected in children who suffer from mitral heart valve disease. After all, it is in this case that the pathology affects the connective tissue. Gradually, while the child grows, the connective tissue matures and strengthens, and accordingly, the symptoms of the syndrome decrease.

Causes

In medicine, many theories are considered regarding the likelihood of the syndrome occurring. Most scientists agree that the most likely cause of increased joint mobility is collagen extensibility. But the whole point is that it is an integral part of muscles, ligaments, cartilage and other structural tissues. When collagen fibers are stretched beyond normal, the joints can perform a greater range of motion, which causes ligament weakness.

It is worth noting that hypermobility syndrome is a fairly common phenomenon, and in medical practice a similar condition is diagnosed in 15% of the population. However, doctors do not detect it every time, because the symptoms are not expressed enough, and patients tend to think that they have weak ligaments.

Speaking about childhood pathology, most cases have a direct connection with metabolic disorders, low intake of vitamins in food, and rapid growth. Doctors also note that the majority of patients are representatives of the fairer sex. People in the older age group practically do not suffer from hypermobility.

Also, the presented syndrome often develops in conjunction with certain pathologies. Let's take a closer look at what diseases can cause hypermobility.

This pathology is the most common provocateur of the development of hypermobility of articular joints. It was with him that almost all cases of weak ligaments that could be diagnosed were associated. A characteristic feature for patients is excessive thinness, they are tall, their upper limbs are elongated and quite mobile, their joints are excessively flexible. In some cases, it may seem that their limbs are like rubber, and especially their fingers.

Physiotherapy can play a special role in treatment. The use of healthy mud, laser therapy, paraffin treatment, etc. is very effective.

It is also worth saying that an excessive level of joint mobility can be stopped with special medical physical therapy or exercise therapy. In combination, the doctor will suggest performing the correct gymnastic exercises that will help make the joint stable and strong by developing muscle elasticity.

Thus, exercises will be selected not only to force the joints to bend or straighten, but also to tense the muscles. Actions that involve static and strength are best suited, while the rhythm of execution should be slow, but weights should not be used.

About the syndrome

Due to the significant extensibility of the ligaments, patients can excessively bend their arms and legs in the joints, which a healthy person cannot do. Weakness of the ligamentous apparatus leads to loose joints, frequent dislocations, and premature development of osteoarthritis.

Blue eyed blondes

and hypermobility syndrome

Hypermobility syndrome occurs among both boys and girls. But most often it is combined with blue eyes (a bluish tint to the sclera), blond hair, thin and long limbs.

Many modern beauty queens suffer from hypermobility syndrome. The most flexible girls are selected for rhythmic gymnastics, many of whom have hereditary abnormalities in the structure of connective tissue.

People with excessively mobile joints usually have delicate, elastic skin. All this is due to changes in the structure of collagen, which forms the basis of all connective tissue structures (skin, ligaments, sclera, blood vessels).

Due to the increased elasticity of the ligaments that hold the internal organs, in patients with hypermobility, ultrasound often reveals prolapse of the kidneys or uterus. After childbirth, these women suffer more from stretch marks on the abdomen and varicose veins.

The main risk factor for hypermobility is heredity.

Testing ourselves for flexibility

The diagnosis of hypermobility is the simplest and most difficult at the same time. Simple because it can be diagnosed by a doctor based on examination, and complex because there are no standard methods for treating this hereditary disease.

The Brayton method for determining hypermobility will help you examine yourself for the presence of hypermobility:

you can reach your thumb to the inside of your forearm (helping yourself with your other hand);
you extend your little finger more than 90 degrees;
when extending the elbow joint, your arm continues to move even after it has reached a straight line with the shoulder (hyperextension at the elbow joint is more than 10 degrees);
By bending forward, you can touch the floor with your palms.

How do gutta-percha people live?

Patients may experience discomfort with excessive physical activity. Quite often pain appears in the knee, shoulder or wrist joints. Rest, local ointments and gels with analgesics and non-steroidal anti-inflammatory components, and physiotherapy help reduce pain.

To prevent subluxations in the joints, it is advisable to engage in physical therapy daily. There is no need to come up with overly complicated exercises. The main thing is to form a muscular corset around the joints, then a fall or awkward movement will not be accompanied by a dislocation.

When actively playing sports, it is necessary to wear orthoses on the joints that bear the maximum load (knee pad, elastic bandage on the lumbar region, ankle or wrist joints).

If the connective tissue has increased elasticity, you should not play with weight. Gaining body weight followed by sudden weight loss will cause the skin to sag, become flabby, and internal organs to drop below physiological values.

In case of significant pathology of the internal organs, special surgical operations are performed to lift the prolapsed organ and restore its function.

Since there is a high risk of developing flat feet, it won’t hurt to learn in advance exercises aimed at strengthening the arch of the foot (picking up a napkin from the floor with your toes, lifting a pencil with your toes, walking on the inner or outer surface of the foot, on tiptoes, on your heels). If flat feet cannot be avoided, you need to get arch supports.

To prevent early osteoarthritis of the joints, even young patients are prescribed chondroprotective therapy (Dona, Artra, Teraflex, Piascledine, etc.). Subsequently, when osteoarthritis develops, hyaluronic acid preparations are injected into the joint cavity, which has a noticeable therapeutic effect.

If a child has weak joints, then possible reasons are the toxic effect of environmental factors on the developing child’s body (lack of calcium in water and soil, imbalance of microelements in food).

For childhood arthritis, it is recommended to reduce the load on the joints and use drugs that eliminate pain, reduce muscle contraction, and improve the nutrition of cartilage. Plus physiotherapy (ultrasound, Bernard currents), spa treatment (mud, hydrogen sulfide and radon sources), exercise therapy, massage.

Fish and foods with calcium are very useful. Fish oil is very good for joints. Take a teaspoon 3 times a day.

If a small child's joints are cracking

Children's joints are very fragile. Even a slight crunch or clicking noise made by a child's joints can greatly frighten parents.

Some children actually hear cracking sounds in their joints during certain movements. The reason is the immaturity of the ligamentous-muscular system. The connective tissue of a child’s joints is not as dense as in adults and is more elastic. The muscular system is much less developed, which is why the joints crack. As the joints grow (when the child gets older), the crunching goes away, so there’s nothing wrong with that.

But if only one joint cracks, and the crunch does not go away with age, this may be a harbinger of joint pathology or the beginning of any diseases of the musculoskeletal system. Sometimes cracking joints is an anatomical feature; it can be corrected with proper nutrition.

Nutrition for joints

Calcium, phosphorus, vitamin D and manganese are very necessary. You need to drink enough fluids throughout the day, because... water stimulates the production of intra-articular fluid.

Ears and tails are a natural source of collagen. And collagen is a constituent protein of connective tissue. Connective tissue - muscles, ligaments, bones, cartilage, joints, blood vessels, parenchyma of internal organs, skin, nails, hair, dentin of teeth and joints.

Collagen hydrolyzate can be obtained by cooking - this is what we call jellied meat.

Products that are good for joints

Magnesium is found in dates, prunes, raisins, dried apricots, beans, soybeans, buckwheat honey, oatmeal and buckwheat, nuts, bran, whole grain bread, dark chocolate, cocoa.

Selenium is interconnected with vitamin E - consumption of one requires proportional consumption of the other.

Vitamin D prevents the leaching of calcium from bones: it is found in fish liver, butter, cottage cheese, cheese, dairy products and egg yolk.

Collagen is a complex protein that forms the basis of all human connective tissue, which is approximately 25-35% of the total protein mass in the body.

Fruits and vegetables should be cooked as little as possible, and peeled and cut immediately before consumption to preserve vitamin C.

Hyaluronic acid and joints

Hyaluronic acid is one of the main components of the extracellular matrix and is found in many biological fluids (saliva, synovial fluid, etc.).

In the joint cavity there is a special synovial fluid that has a unique biological composition and properties. Its composition is similar to blood plasma, but it contains less proteins and contains hyaluronic acid, which is necessary to ensure that the fluid is viscous and the joints are constantly lubricated.

Hyaluronic acid is the main component of synovial fluid, responsible for its viscosity. Along with lubricin, hyaluronic acid is the main component of biological lubricant - an important component of articular cartilage.

These are seaweed, mussels, shrimp and other seafood, as well as ligaments, bones and cartilage of fish, birds and animals - it is from these products that jellies, jellied meats, and jellied meats are prepared. Often these useful parts are considered waste; chicken feet, fish heads, beef and pork bones are thrown away.

Wash the heads (1-2 pieces) thoroughly, remove the gills, cut into several parts, put in a pan with cold water, cook over low heat for about an hour. It is good to cook with black pepper (6-7 peas) and bay leaf; You can also add fins and a tail.

Next, add 2 chopped onions, carrots, bell pepper and tomato, dry seaweed (2 tsp), add sea salt to taste, cook for another 5-7 minutes. Place a slice of lemon on each plate of the finished fish soup and pour in a little lemon juice. Sprinkle with fresh herbs. Excellent fish soup for joints!

Running and joints

But walking is very beneficial for joints. Both sports and ordinary. So walk more.

Pharmacy products for joints

Pharmacies sell various products to strengthen joints. There are many medications whose purpose is to strengthen joints and maintain the elasticity of articular joints. Such preparations contain glucosamine and collagen, because it is these substances that restore the elasticity of the cartilage structure and form the basis of connective tissue.

Chondroprotectors (Chondroitin, Glucosamine). Preserve and restore the elasticity and flexibility of cartilage;

have an anti-inflammatory effect; improve the moisture saturation of cartilage tissue;

contribute to the proper construction of new cartilage tissue;

restore joint mobility; reduce pain.

Calcium active, dietary supplement.

Collagen ultra.

Geladrink Forte - collagen, chondroitin, glucosamine, three in one, Czech drug.

If there is an excessive intake of hyaluronic acid in the form of medical drugs or during cosmetic procedures, the skin after a certain period of time ceases to produce it on its own.

Medicinal substances that contain hyaluronic acid are divided into two types:

Hyaluronic acid preparations of animal origin are produced by distillation of animal tissue.

Medical products in which hyaluronic acid is produced by special microorganisms.

If the joints pop out

If the joints pop out, it is called a habitual dislocation. This phenomenon is also called chronic dislocation. It is expressed primarily in the weakness of the ligaments. May be as a result of a dislocation. To prevent this from happening, you need to train your muscles. Slowly, with moderate loads. Make sure that the joint does not pop out during training. But before you start training, go to the doctor. You may have torn ligaments as a result of a sprain.

How to treat this phenomenon?

First you need to reduce inflammation. Use anti-inflammatory drugs such as ketorol or voltaren. Well, limit the movement of the sore joint. And of course, massage, physiotherapy, and moderate physical activity are required.

If the pain is severe, you can apply ice to the joint.

Muscles need to be strengthened. Then there will be significantly fewer dislocations and the joints will be trained. Trained muscles are in themselves a protection against popping joints.

The total duration of treatment for such dislocations is about six weeks.

But you shouldn’t give up physical activity in the future. This will only be beneficial. Exercise is life and therefore you should not stop training, even if the course of treatment is already over. Think for yourself. After all, if you quit, sooner or later the pain will return. Such is the nature of man and his organs. Where there is no load, stagnation and degradation develop. It is for these reasons that we do not recommend that you quit gymnastics.

Exercises to strengthen ligaments and tendons

This video shows techniques for strengthening ligaments and tendons. Using the example of the shoulder and elbow joints. You can train the hip and knee joints in a similar way.