[Generalized laxity of the ligaments in children]

Joint hypermobility

Patients with joint hypermobility, perhaps the mildest of the various inherited abnormalities of connective tissue, may present to a rheumatologist or general practitioner although a large proportion are recognized by health professionals, particularly physiotherapists. Hypermobility may be generalized or extreme at a small number of joints. Sometimes it is associated with involvement of other organs because of abnormal inherited collagen structure elsewhere. A small proportion of patients will have one of the more serious conditions such as Ehlers-Danlos syndrome, Marfan's syndrome or osteogenesis imperfecta. Management is multidisciplinary requiring a team including physicians, physiotherapists, occupational therapists and podiatrists, among others. Patients often wait a long time before receiving their definitive diagnosis and are sometimes dismissed as malingerers. Patients often have a lot of queries about their condition unrelated to their joints. Among these are whether there will be problems in pregnancy, whether the condition will be passed on to their children, whether symptoms arising from organs other than the joints are related and whether they might have been incorrectly accused of battering their children.

Joint mobility measurements: reliability of a standardized method

Assessment of hypermobility and hypomobility is frequently performed visually with all its limitations. In this study, a standardized joint mobility measurement method is suggested, and its reliability is tested. The maximal range of motion of passive digit five hyperextension, passive thumb apposition to the wrist, active elbow and knee hyperextension, active ankle dorsal flexion and trunk flexion was measured in 30 healthy subjects. All measurements were performed bilaterally, except for trunk flexion. Three experienced observers performed the measurements according to a rigidly standardized protocol, using appropriate goniometers and rules. During one measurement session each observer measured each subject. Two consecutive measurement sessions were organized. Analysis of variance, with subject and time as explaining variables, was performed on the data obtained. The inter-observer variability ranged from 1.42 degrees (left knee hyperextension) to 4.05 mm (right thumb apposition) in the first measurement session and from 1.35 degrees (left knee hyperextension) to 4.58 degrees (right digit five hyperextension) in the second measurement session. The intra-observer variability ranged for observer A from 0.75 degree (left knee hyperextension) to 3.67 mm (left thumb apposition), and from 0.93 degree (left knee hyperextension) to 3.88 degrees (left digit five hyperextension) for observer B. Observer C ranged from 0.71 degree (left knee hyperextension) to 4.01 mm (right thumb apposition). Based on the results of this study, the authors conclude that joint mobility can be measured reliably and accurately with the presented simple tools.(ABSTRACT TRUNCATED AT 250 WORDS)

Musculoskeletal changes in children prenatally exposed to polychlorinated biphenyls and related compounds (Yu-Cheng children)

Fifty-five Yu-Cheng (oil-disease) children born between 1978 and 1985 to mothers who ate PCB-contaminated rice oil in 1978-1979 were studied and compared to age- and sex-matched control subjects in 1991. The children's growth profiles, bone mineral density and soft tissue composition, joint laxity, and serum parathyroid hormone, vitamin D, calcium, alkaline phosphatase, and phosphate were compared. The Yu-Cheng children were 3.1 cm (p < .05) smaller and had less total lean mass and soft tissue mass as compared to the matched control subjects. All other parameters studied were similar in both groups. The shorter height and decreased total lean mass and soft tissue content were only seen in the Yu-Cheng children who were the first born after the ingestion, but not in subsequent children. This was most likely due to decreased body burdens of the PCBs and related contaminants over time in the mothers.