Hypermobility: The Brighton Criteria Copy

Following on from our Hypermobility: Beighton Score post is the next part of the clinical diagnosis essential from Hypermobility Syndrome identification, let us introduce the Brighton Criteria.

Benign hypermobility syndrome is a relatively prevalent condition of the spectrum of heritable connective tissue disorders, with musculoskeletal, visceral and psychological manifestations.

The diagnostic Brighton criteria characterises hypermobility findings into ‘major’ and minor’ categories (table 1). Benign joint hypermobility syndrome is diagnosed in a few ways. Firstly, the presence of 2 major criteria's, or secondly 1 major and 2 minor criteria's, or finally 4 minor criteria's. Within some of these criteria is the Beighton score which we discussed in the previous hypermobility post, mentioned earlier.

Although there has been a lot of research into joint hypermobility syndrome it still remains insufficiently identified, inadequately understood and very commonly, poorly managed by practitioners. As we discussed in the first hypermobility post, patients often get pin-balled around from doctor to physiotherapist to chiropractor etc without an appropriate diagnosis or management plan. This is something I feel strongly about, and this needs to improve, for the long term health of performers.

Did you know Joint hypermobility syndrome is relatively common – it affects more females than males to a ratio of 2:1 and is more common in non-Caucasian populations.

Table 1 Shows the Brighton Criteria scoring system

With these assessments and graphs, if Hypermobility syndrome is considered then alternative causes of generalised joint laxity needs to be ruled out, these include heritable connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, Larsen syndrome and osteogenesis imperfecta. With patients with one of these conditions, yes generalised joint laxity is a prominent finding, and often one that is identified firstly. However, these patients can also present with significant cardiovascular, skin, bone and eye abnormalities. If this is expected then onward referral is required, and working with the wider multidisciplinary team (MDT) essential, such as a doctor, geneticist, nutritionist etc. This allows appropriate management for all areas of concern. The common features with these syndromes can be seen in the chart below:

Table 2 Adapted from: Malfait F, Francomano C, Byers P, Belmont J, et al. The 2017 International classification of the Ehlers-Danlos syndromes. Amer J Med Genetics 2017; 175c (1): 8–26.

The lack of awareness of joint hypermobility syndrome may delay the diagnosis and effective care of the condition, in turn exacerbating symptoms. There is no treatment, so management is the route of care and this can be successfully achieved when the condition is identified.

The management plan should include:

  • Exercise is essential, including appropriate strength training
  • Proprioception training
  • Rehab and training plans need to be closely managed as progressed/regressed as able to avoid tissue/joint overload, which in turn leads to pain and/or injury.
  • Pacing and managing symptoms
  • Manual therapy must be used cautiously
  • It’s important to note that recovery and healing is often slower in this population.
  • Knowing when referral is needed (cardiologist, orthopod etc) and then working closely with them is essential.

Does any of these tables of symptoms seem familiar, if you’re a clinician have you worked with any patients with hypermobility syndrome? How have you managed it? And if any of the above sounds like you, as a performer, rest assured there are strategies available to maximise your performance and controlling any pains you may suffer.

Like always we would love to hear your thoughts.

Thanks for reading.


Sophie

@sophielanephysio