Hypermobility

Introduction

Hypermobility describes a physiological phenomenon or normal variation in children and adults, whose range of joint motion generally lies at the upper limit or beyond what is considered common for average in the population. In most studies, this represents up to 10 % of children and thus is nearly as common as being left-handed (or having blue eyes for example) in Australia.

Children are also naturally more hypermobile than adults.

Being hypermobile is genetic (or familial) and is a strongly heritable gene variant that is commonly found in humans. Very few children would have a specific genetic disorder (such as Ehlers Danlos Syndrome or Marfan’s syndrome), nor would they need genetics assessment.

Most children with hypermobility do not need specialist input or tertiary allied health care.

The Perth Children’s Hospital (PCH) Rheumatology Department do not offer a comprehensive allied health service for uncomplicated or well children with joint hypermobility, or orthotics for children with flat feet. Community based resources are appropriate if needed.

Pre-referral investigations

• Clinical history including:
  • Episodes of sprains, strains or dislocations
  • Pains in joints
  • Functional limitations
• Physical examination including:
• Posture and balance.

Pre-referral management

• Recognise the typical patterns and findings and exclude more serious or chronic conditions
• Education and information about the benign nature and written/online information about sensible parental inputs (see useful resources below)
• Referrals to allied health specialists in the community:
  • Physiotherapy for muscle strengthening
  • Hand/Occupational Therapists for techniques for day-to-day activities
  • Podiatrist input for symptomatic feet or gross pes planus (flat feet)
    • See PCH pre referral guideline on flat feet
• Over-the-counter analgesia such as paracetamol and/or ibuprofen for occasional pain relief for severe growing pains.

When to refer

• Frequent joint dislocations or painful subluxations (with slow or poor recovery)
• Musculoskeletal pain interfering with normal activities for considerable time, or not responding to simple interventions
• Associated dysmorphic or syndromic features
• Parental anxiety and to help prevent over medicalisation.

How to refer

• Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
• Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
• For any advice, please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the on-call Rheumatologist.

Essential information to include in your referral

• Relevant history and finings
• Treatment regimens that have been tried.

This document can be made available in alternative formats on request for a person with a disability.