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Hyperligamentous Laxity

Test, Exam and Sign Description

Exaggerated flexibility of joints beyond the normal range occurs in certain individuals and had been recognized from ancient times. While joint hypermobility is a feature of several inherited diseases of connective tissue such as osteogenesis imperfecta, Marfan syndrome and Ehlers-Danlos syndrome, it is also present in a subset of otherwise normal individuals. Prevalence of joint hypermobility varies based on age, sex and necessity. It is common in children and decreases with age. Men have less hypermobility in women.

DESCRIPTION

While there are several ways to test and determine if someone has hyperligamentous laxity, there are a few key motions that are performed to determine as such. The Beighton Method measures joint laxity by means of five simple tests. Specifically for the upper extremity, there are three basic tests derived from the Beighton Method to determine laxity:

  1. Hyperextend elbow
  2. Bend thumb back on the front of the forearm
  3. Hyperextend little finger
Presentation Photos and Related Diagrams
  • Hyperligamentous laxity of thumb - relatively uncommon but normal variant
    Hyperligamentous laxity of thumb - relatively uncommon but normal variant
Definition of Positive Result
  1. Ability to hyperextend elbow ≥10°
  2. Ability to bend thumb back on the front of the forearm
  3. Ability to hyperextend little finger to 90°
Definition of Negative Result
  1. Extension of elbow to ≤0°
  2. Inability to bend thumb back on the front of the forearm
  3. Extension of little finger to <90°
Comments and Pearls
  • When assessing joint stability always consider the degree of normal joint laxity before concluding a joint is unstable.
  • Always compare right and left upper extremities.
Diagnoses Associated with Tests, Exams and Signs
References
  1. Andel, C., Roescher, W., Tromp, M., Ritt, M., Strackee, S., & Veeger, D. (2008). Quantification of Wrist Joint Laxity. The Journal of Hand Surgery, 33(A), 667-674.
  2. Lawrence, A. (2014). Benign joint hypermobility syndrome. Indian Journal of Rheumatology, 9, S33-S36. http://dx.doi.org/10.1016/j.injr.2014.09.009