Hypermobility Testing PDF

Petra Gaul Aláčová, MPT, Ph.D. Faculty of Health Sciences Palacký University in Olomouc JANDA'S HYPERMOBILITY TESTING Petra Gaul Aláčová, MPT, Ph.D. Faculty of Health Sciences Palacký University in Olomouc Hypermobility according to Sachs − Constitutional – whole body, but not necessarily equal...

Petra Gaul Aláčová, MPT, Ph.D. Faculty of Health Sciences Palacký University in Olomouc JANDA'S HYPERMOBILITY TESTING Petra Gaul Aláčová, MPT, Ph.D. Faculty of Health Sciences Palacký University in Olomouc Hypermobility according to Sachs − Constitutional – whole body, but not necessarily equal deficit on upper and lower half of the body, often asymetrical − crucial to determine the extent and choose the right approach − General pathological – neurological disorders (tabes dorsales, Down syndrome, central disorders ….) − Posttrauma (pathological/local) and compensational – as a result of mechanical decrease in ROM in one segment, the segment above and bellow have to compensate Hypermobility - ROM of a joint beyond the typical - around 1 in 10 people is hypermobile - more common in women and children, and people of Afro-Caribbean and Asian descent - common in gymnasts, athletes, dancers and musicians - many hypermobile people have no significant symptoms (‘asymptomatic hypermobility’) Symptomatic hypermobility a. Specific heritable disorders of connective tissue, like Ehlers-Danlos syndromes, Marfan syndrome, Stickler syndrome, osteogenesis imperfecta and others. b. Joint shape, looser ligaments, or poor muscle tone (without a connective tissue disorder) c. Other conditions (like Down’s syndrome, Cerebral Palsy etc) d. Injury or repeated stretching/training (yogies, gymnasts, dancers)  Hypermobility 1. It may explain musculoskeletal symptoms and Myopia, astigmatism loss of physical function: Poor response to local anaesthetic Isolated or widespread, and recurrent injury to joints, ligaments, tendons and other soft tissues Pelvic floor weakness, rectal and/or uterine around joints may occur prolapse, chronic bladder inflammation (including mast cell activation) Acute and chronic joint pain, and neuropathic symptoms can arise Influence of progesterone – worsening musculoskeletal symptoms; also heavy and There may be associated instability leading to joint painful menstrual cycle subluxation or dislocation, or vertebral listhesis; and /or poor proprioception increasing the risk of Musculoskeletal and pelvic complications of injury pregnancy, The ability to undertake daily activities of living, or Anxiety disorders, such as panic disorder and exercise, schooling, or work may be significantly agoraphobia. compromised. 4. There may be an underlying heritable disorder 2. It may be associated with a chronic pain of connective tissue that explains concerns such syndrome and chronic fatigue, requiring as: adaptation to treatments to account for Multiple fractures hypermobility / joint instability. Poor wound healing, bruising, thin or atrophic 3. There is a growing recognition of an association scarring, excess stretch marks with other concerns such as: Eye problems – cataracts, retinal detachment Cardiovascular symptoms and dysautonomia Heart valve disease and arterial vascular (tachycardia, hypotension, syncope) pathologies such as dissection / aneurysm Mechanical and neuropathic bowel dysfunction Spontaneous rupture of viscera (hernia, reflux, sluggish bowel and constipation, and chronic inflammation (including mast cell activation))  Beighton scale score of 5/9, of 6/9 or modified score of 3/9 Total of 9 points from 5 maneuvers: Beighton Score 1. Passive dorsiflexion of the little fingers beyond 90° - 1 point for each hand 2. Passive apposition of the thumbs to the flexor aspects of the forearm - 1 point for each thumb 3. Hyperextension of the elbows beyond 10° - 1 point for each elbow 4. Hyperextension of the knee beyond 10° - 1 point for each knee 5. Forward flexion of the trunk with knees fully extended so that the palms of the hands rest flat on the floor – 1 point It is important to note that the Beighton score is not definitive. It only looks at a limited number of joints, and only takes one direction of movement into account. Individuals can have significant, widespread hypermobility but still have a low Beighton score. https://www.hypermobility.org/professionals https://www.ehlers-danlos.com/assessing-joint-hypermobility/#1651847838931-ebcfecfd-3df3 Janda's hypermobility tests − Neck rotation − “Scarf“ test − Internal-external rotation test (Apley’s Scratch Test) − Palm-to-scapula test − Extended elbows test − Facing hands test − Facing fingers test − Flexion test (Thomayer test) − Lateroflexion test − Heel sitting test Neck rotation test − Physiological ROM 80° − HM > 90° and possibility for passive increase in ROM − Increase in ROM in AO? or entire cervical spine − No flexion or extension Scarf test − Elbow in the vertical axis − Tips of fingers on spinal processi − Elevation of scapula Internal-External rotation test Apley’s Scratch Test / Rotator cuff test / Multi-directional shoulder flexibility test − Physiology: tips of fingers touching − HM: even palms across each other − Hyperlordosis in L spine − Test both sides!!! Palm-to-scapula test − Tips of fingers reach contralateral acromion − HM – hands cover scapula − Test both hands! Extended elbows test − From fully flexed elbows into the extension − Physiology = 110°FL − HM > 110° − Gap between elbows − Obesity limits Facing Hands test − 90° DFL in wrist − HM > 90° − Palms fully touching even in the last phase of the test Facing fingers test − MCP joint 80° − HM > 80° − Forearms and hands in one axis − Fingers touching even in the final phase of the test Thomayer test − Necessary to focus on ALL segments allowing the flexion − Bent knees − Not in all the segments Lateroflexion test − Axilla and intergluteal gap in one line − Do not only watch how far the fingers reach − Lateral pelvic shift − Rotation or flexion Heel sitting test − HM pelvis significantly lower than the ankle line − Trunk flexion https://www.google.com/search?q=janda+hypermobility&oq=janda+hypermobility&aqs=chrome..69i57j33i160.8833j0j4&sourceid=chrome&ie =UTF-8#fpstate=ive&vld=cid:6ea42a08,vid:uSXawOz1tzM