Ann Rehabil Med.  2013 Dec;37(6):832-838. 10.5535/arm.2013.37.6.832.

Generalized Joint Hypermobility in Healthy Female Koreans: Prevalence and Age-Related Differences

• Kwon JW
• Lee WJ
• Park SB
• Kim MJ
• Jang SH
• Choi CK

• KMID: 2266562
• DOI: http://doi.org/10.5535/arm.2013.37.6.832

Abstract

OBJECTIVE
Objective To evaluate the prevalence of generalized joint hypermobility (GJH) in healthy female Koreans and to determine whether the degree of GJH differs between children and adults.
METHODS
Two groups of females were enrolled, a group of girls from an elementary school (n=404) and women from a call center (n=266). GJH was diagnosed using the Beighton score, which is composed of an evaluation of bilateral knees, elbows, thumbs, and fifth fingers as well as thoracolumbar joint. The GJH and localized hypermobility of each joint was compared between the two groups, and the pattern of hypermobility according to age and dominant hand was investigated.
RESULTS
Total prevalence of GJH was 50.0% (335/750), and it was more frequently observed in the group of girls (58.9%, 238/404) than women (36.5%, 97/266). The degree of GJH expressed in terms of Beighton score was inversely correlated with age (p<0.05). Significant differences in localized hypermobility of the thumb and fifth finger were found between the two groups and were postulated as the cause for the decline in GJH with age. The pattern of decreased mobility proportional to aging differed between the two joints. Decreased mobility occurred equally on both sides of the thumb but was biased toward the fifth finger of the dominant side (mostly the right).
CONCLUSION
The female Koreans appeared to have a high prevalence of GJH. The incidence of GJH decreased as age increased as a result of decreased mobility of the fifth finger on the dominant side.

Keyword

Joint hypermobility; Beighton score; Dominant hand; Stiff joint

MeSH Terms

Adult
Aging
Bias (Epidemiology)
Child
Elbow
Female*
Fingers
Hand
Humans
Incidence
Joint Instability*
Joints*
Knee
Prevalence*
Thumb

Figure

• 

  Fig. 1 Assessment using the Beighton hypermobility scoring system: (A) forward flexion of the trunk with the knees straight so that the palms of the hands rest easily on the floor, (B) hyperextension of the knee beyond 10°, (C) hyperextension of the elbow beyond 10°, (D) passive apposition of the thumb to the flexor aspects of the forearm, and (E) passive dorsiflexion of the fifth fingers beyond 90°. (A) was scored 1 point, and (B), (C), (D), and (E) were scored 2 points on both sides.

• 

  Fig. 2 Comparisons of the localized joint scores and total Beighton scores between the groups of girls and women. Bilateral scores were added for each joint except for the back. The scores of the thumbs and fifth fingers as well as the total score were significantly higher in the group of girls than those in the group of women. *p<0.05 using the t-test.

• 

  Fig. 3 Comparison of the bilaterality of hypermobility of the thumbs and fifth fingers between the groups of girls and women. The four patterns of bilaterality are as follows in counterclockwise order: pattern A, bilateral nonhypermobility; pattern B, left-sided hypermobility; pattern C, right-sided hypermobility; and pattern D, bilateral hypermobility. The percentage of pattern A was greatly increased in the thumbs of the women, whereas that of pattern D was correspondingly decreased compared with that in the thumbs of the girls. However, the percentage of pattern B was greatly increased and that of pattern D correspondingly decreased in the fifth fingers of the women, compared with that in the fifth fingers of the girls. *p<0.05 by chi-square test.

Reference

1. Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr. 2011; 158:119–123. PMID: 20850761.

2. Wolf JM, Cameron KL, Owens BD. Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg. 2011; 19:463–471. PMID: 21807914.

3. Guma M, Olive A, Roca J, Forcada J, Duro JC, Holgado S, et al. Association of systemic lupus erythematosus and hypermobility. Ann Rheum Dis. 2002; 61:1024–1026. PMID: 12379529.

4. Rikken-Bultman DG, Wellink L, van Dongen PW. Hypermobility in two Dutch school populations. Eur J Obstet Gynecol Reprod Biol. 1997; 73:189–192. PMID: 9228503.

5. Leone V, Tornese G, Zerial M, Locatelli C, Ciambra R, Bensa M, et al. Joint hypermobility and its relationship to musculoskeletal pain in schoolchildren: a cross-sectional study. Arch Dis Child. 2009; 94:627–632. PMID: 19465584.

6. van der Giessen LJ, Liekens D, Rutgers KJ, Hartman A, Mulder PG, Oranje AP. Validation of Beighton score and prevalence of connective tissue signs in 773 Dutch children. J Rheumatol. 2001; 28:2726–2730. PMID: 11764224.

7. Birrell FN, Adebajo AO, Hazleman BL, Silman AJ. High prevalence of joint laxity in West Africans. Br J Rheumatol. 1994; 33:56–59. PMID: 8162460.

8. Jansson A, Saartok T, Werner S, Renstrom P. General joint laxity in 1845 Swedish school children of different ages: age- and gender-specific distributions. Acta Paediatr. 2004; 93:1202–1206. PMID: 15384884.

9. Al-Rawi ZS, Al-Aszawi AJ, Al-Chalabi T. Joint mobility among university students in Iraq. Br J Rheumatol. 1985; 24:326–331. PMID: 4063624.

10. Hudson N, Fitzcharles MA, Cohen M, Starr MR, Esdaile JM. The association of soft-tissue rheumatism and hypermobility. Br J Rheumatol. 1998; 37:382–386. PMID: 9619887.

11. Czaprowski D, Kotwicki T, Pawlowska P, Stolinski L. Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner. Scoliosis. 2011; 6:22. PMID: 21981906.

12. Konopinski MD, Jones GJ, Johnson MI. The effect of hypermobility on the incidence of injuries in elite-level professional soccer players: a cohort study. Am J Sports Med. 2012; 40:763–769. PMID: 22178581.

13. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973; 32:413–418. PMID: 4751776.

14. Grahame R, Bird HA, Child A. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000; 27:1777–1779. PMID: 10914867.

15. Adib N, Davies K, Grahame R, Woo P, Murray KJ. Joint hypermobility syndrome in childhood: a not so benign multisystem disorder? Rheumatology (Oxford). 2005; 44:744–750. PMID: 15728418.

16. Gunal I, Kose N, Erdogan O, Gokturk E, Seber S. Normal range of motion of the joints of the upper extremity in male subjects, with special reference to side. J Bone Joint Surg Am. 1996; 78:1401–1404. PMID: 8816658.

17. Kim HJ, Yeom JS, Lee DB, Kang KT, Chang BS, Lee CK. The association of benign joint hypermobility with spinal segmental motion and its clinical implication in active young man. Spine (Phila Pa 1976). 2013; 3. 7. [Epub]. http://dx.doi.org/10.1097/BRS.0b013e31828ffa15.

18. Pacey V, Nicholson LL, Adams RD, Munn J, Munns CF. Generalized joint hypermobility and risk of lower limb joint injury during sport: a systematic review with meta-analysis. Am J Sports Med. 2010; 38:1487–1497. PMID: 20601606.

19. Ridge MD, Wright V. The ageing of skin: a bio-engineering approach. Gerontologia. 1966; 12:174–192. PMID: 5924845.

20. Verzijl N, DeGroot J, Oldehinkel E, Bank RA, Thorpe SR, Baynes JW, et al. Age-related accumulation of Maillard reaction products in human articular cartilage collagen. Biochem J. 2000; 350 Pt 2:381–387. PMID: 10947951.

21. Schweitzer G. Laxity of metacarpophalangeal joints of fingers and interphalangeal joint of the thumb: a comparative inter-racial study. S Afr Med J. 1970; 44:246–249. PMID: 5438949.

22. Kim SI, Kim WS, Cho KJ. The type of handedness and correlation analysis of handedness assessment items on university students in Korea. Korean J Phys Anthropol. 2008; 21:245–253.

23. Greenstein S, McDevitt R. Measuring the broadband bonus in thirty OECD countries. Paris: OECD Publishing;2012.

24. McManus IC, Kemp RI, Grant J. Differences between fingers and hands in tapping ability: dissociation between speed and regularity. Cortex. 1986; 22:461–473. PMID: 3769497.

25. Radwin RG, Oh S, Jensen TR, Webster JG. External finger forces in submaximal five-finger static pinch prehension. Ergonomics. 1992; 35:275–288. PMID: 1572337.

26. Molenaar HM, Selles RW, Willemsen SP, Hovius SE, Stam HJ. Growth diagrams for individual finger strength in children measured with the RIHM. Clin Orthop Relat Res. 2011; 469:868–876. PMID: 20963526.