Hypermobility Types of HMS Hypermobility Spectrum Disorder HSD: Diagnostic Criteria Diagnosis Criteria Diagnosis Abbreviation Criteria Hypermobility Spectrum Disorder gHSD Generalised hypermobility assessed using the beighton score*, along with secondary musculo-skeletal manifestations (listed below) Peripheral hypermobility spectrum disorder pHSD Joint hypermobility of the hands and feet, and 1 or more musculoskeletal manifestation (listed below) Localised hypermobility spectrum disorder lHSD A single joint or group of joints is hypermobile, with one or more secondary musculoskeletal manifestations (listed below) Historical hypermobility spectrum disorder hHSD Symptoms of gHSD are reported, but the individual is no longer as hypermobile as joints have stiffened with age, injury, or surgery etc. Asymptomatic hypermobility Generalised hypermobility is present, but without symptoms. Although not part of the ‘diagnostic criteria’, patients may also have a variety of associated conditions such as Fibromyalgia, IBS, PoTs and irritable bladder. The relationship between HSD and these is not yet fully understood. *You can read more on the beighton score here, but it should always be borne in mind that the beighton score only covers a small number of joints, and only considers one plane of movement for each of those joints. If an individual scores low but has widespread hypermobility outside of the beighton scale, then a generalised HSD diagnosis may still be appropriate. Secondary musculoskeletal manifestations: 1. Pain 2. Musculoskeletal /soft tissue trauma, including dislocations, subluxations and soft tissue damage, and microtraumas. Microtraumas are injuries which result from frequent, repeated use of muscles, tendons, ligaments, joints, and bones. This includes small tears in fibres and connective tissue of the muscles as well as sprained ligaments, strained muscles, and overstretched tendons. 3. Disturbed proprioception – the body’s sense of where it is in space, and the effort needed to move to the desired place doesn’t work too well, often mistaken for being ‘just clumsy’. 4. Other musculoskeletal/Orthopaedic traits that may be related to interactions between softer tissues and mechanical forces during growth – like flexible flat feet, misaligned bones in elbows or toes, and curvature of the spine. Why a diagnosis of aysmptomatic hypermobility can be important. A diagnosis of asymptomatic hypermobility encourages recognition that hypermobility does not automatically mean pain, disability, and health problems. Many patients who are given appropriate advice and support when symptoms start may find that symptoms improve significantly, and their diagnosis can change from generalised HSD to asymptomatic hypermobility. It is helpful for an individual to know that they have asymptomatic hypermobility so that they can proactively manage their condition and respond appropriately to other symptoms should they develop. There is the added benefit that should symptoms occur, unnecessary medical investigation can be prevented and time can be saved by starting from the knowledge that hypermobility could be the underlying issue.