Orthopedics - Oleksa A.P. 2006

Neurogenic arthropathies
Hypermobility syndrome in children and adolescents

Hypermobility syndrome is quite common in children and adolescents, and may even persist in adult women.

Clinically, it manifests as an excessive range of joint movement that exceeds generally accepted norms. This syndrome is characterized by an increased amplitude of movement, particularly in the hand and elbow joints, and less frequently in the knees and feet. A very clear example of this is active hyperextension in the metacarpophalangeal and wrist joints, which increases sharply upon passive extension of the hand and fingers. Pronounced recurvation is observed in the knee joints, and excessive additional hyperextension in the hip joints. Furthermore, elbow hyperextension in women is often accompanied by some degree of forearm valgus deviation.

Hypermobility syndrome is accompanied by joint instability and decreased Muscle strength (Grebenev D.A., 1989; Artamonova V.A., Zakharova Yu.N., 1997).

Patients with hypermobility syndrome may complain of joint pain or arthralgia associated with weather changes. Some patients report arthralgia in the evening and at night following physical exertion, although most patients cannot pinpoint the cause of the pain. Occasionally, short-term Swelling of the small JOINTS OF THE hand, knees, and ankles may occur, resolving without Treatment. In some children, joint clicking can be heard, especially in the knees, or a dysplastic configuration of the joints may be detected, which is confirmed radiographically.

According to Yakovleva A.A. (1995) and Korshunov N.I. (1997), hypermobility syndrome can be a causative factor in many musculoskeletal pathological syndromes and diseases such as chronic Arthritis, osteoarthritis, Ankylosing spondylitis, etc.

Grahame R. (1990) and Martynov A.I. (1998) believe that hypermobility syndrome is caused by a genetically determined defect in the synthesis and METABOLISM of fibrillar structures, most commonly manifesting as Collagen and Elastin abnormalities.

Connective Tissue Dysplasia is studied across many medical disciplines. In particular, Korenev N.M. and Kosturina N.A. (2001) studied the Clinical and immunological features of hypermobility syndrome. In children with this syndrome, they found alterations in the T- and B-Cell immune systems: a decrease in total T-lymphocytes against the Background of an elevated (55%) T-active fraction. Shifts in T-lymphocyte subpopulations were characterized by hyposuppression (a decrease in T-helper Cells with a tendency toward a decrease in T-suppressor cells). These changes were accompanied by an abnormal immunoregulatory index, showing an increase in 41.8% of cases and a decrease in 17.9% of cases.

B-cell activation is accompanied by dysimmunoglobulinemia and elevated antibody levels, particularly against collagen Antigens, indicating the potential for damage to connective tissue structures in hypermobility syndrome.

Children with immune disorders associated with hypermobility syndrome should be under dispensary observation and do not require specialized treatment. They are prescribed Therapeutic Exercises, muscle massage, swimming, and general strengthening therapy.