Joint hypermobility: What causes 'loose joints'?

My doctor recently commented that I have "loose joints." What does this mean?

- Jean / Iowa

Answer

"Loose joints" is a lay term that may be used to describe hypermobile joints. Joint hypermobility — the ability of a joint to move beyond its normal range of motion — is common in children and decreases with age.

Having a few hypermobile joints isn't unusual. In most people, joint hypermobility causes no problems and requires no treatment.

But in some people, hypermobility causes joint pain and results in a higher incidence of dislocations, sprains and secondary osteoarthritis. Doctors refer to this as benign hypermobility syndrome.

Joint hypermobility is evaluated by the ability to successfully perform a series of joint maneuvers (Beighton criteria) that rate joint flexibility on a 9-point scale. These maneuvers include:

• Bending your little finger backward to a 90-degree angle
• Bending your thumb to your forearm
• Hyperextending your elbow 10 degrees beyond neutral
• Hyperextending your knee 10 degrees beyond vertical
• Bending forward with your knees straight and placing your hands flat on the floor

A diagnosis of benign hypermobility syndrome is made if you score at least 4 out of 9 points and have pain for more than three months in four or more joints.

In benign hypermobility syndrome, the ligaments that provide joint stability are loose and weak. This increases the risk of ligament injury or strain and can cause pain.

Treatment of benign hypermobility syndrome includes:

• Physical therapy to strengthen joints and to learn how to prevent hyperextension
• Activity modification to relieve pain
• Analgesics

Occasionally, joint hypermobility is a sign of a rare, serious disorder, such as Ehlers-Danlos syndrome, Marfan syndrome or rheumatoid arthritis. For this reason, joint hypermobility accompanied by joint pain should be evaluated by a doctor to determine the cause.

MORE ON THIS TOPIC

• Ehlers-Danlos syndrome
• Marfan syndrome
• Rheumatoid arthritis
• Secondary osteoarthritis: What are the causes?