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Home/Large Joints and Extremities/Double-Jointed Adolescents: More Musculoskeletal Pain
Large Joints and Extremities

Double-Jointed Adolescents: More Musculoskeletal Pain

March 8, 2013 1 min read Premium comments

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Double-Jointed Adolescents: More Musculoskeletal Pain
Double jointed shoulder blades. Source: Wikimedia Commons and Freefaller25
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About two times as likely to develop joint pain…that is what a UK study has discovered about adolescents who are double-jointed (have “hypermobility”). As they age, these individuals are especially likely to develop musculoskeletal pain in the shoulders, knees, ankles and feet. This prospective study was published in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR).

Several studies have shown that joint pain is common in children with hypermobility, with some reports as high as 74% of children with joint hypermobility experiencing pain. Yet, other research suggests that while musculoskeletal pain is a frequent complaint in adolescents, it is no more common in those with joint hypermobility.

“With such conflicting evidence we set out to determine whether adolescents with joint hypermobility are at risk of developing musculoskeletal pain, ” explains lead author Professor Jon Tobias from the University of Bristol, UK, in the February 28, 2013 news release. In a study funded by Arthritis Research UK, the team recruited participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), also known as Children of the 90s.

Analysis of participants with complete data was conducted, with 1267 boys and 1634 girls evaluated. Approximately 5% of participants were hypermobile at age 14, and at age 18 close to 45% of participants reported any pain lasting one or more days. Joint hypermobility was associated with approximately a two-fold increased risk of moderately severe pain at the shoulder, knee, ankle and foot. Interestingly, this increased risk was particularly marked in obese participants, with over a ten-fold increased risk of knee pain observed in obese participants with hypermobility, possibly reflecting the role of mechanical factors.

Professor Tobias concludes, “Our study provides the first prospective evidence that adolescents who display joint hypermobility are at increased risk of developing musculoskeletal pain as they get older, particularly in the shoulder, knee, ankle or feet. Further investigation of increased joint pain in teens is warranted to determine if the long-term effects of joint hypermobility puts them at risk for developing osteoarthritis later in life.”

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Discussion

14
DS
Dr. Sarah MitchellOrthopedic Surgeon · Mayo Clinic

This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?

8
JT
James Thornton, MDSpine Fellow · HSS

Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.

5
RP
R. PatelSports Medicine · Stanford

We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.

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