Hypermobility Syndrome: Understanding, Diagnosis, and Multidisciplinary Treatment

Who Treats Hypermobility Syndrome?

Hypermobility syndrome (HMS) is typically managed by a multidisciplinary team of healthcare professionals, with various specialists addressing its diverse symptoms and complications to provide comprehensive, individualized care.

Understanding Hypermobility Syndrome (HMS)

Hypermobility syndrome, often referred to as Joint Hypermobility Syndrome (JHS) or, more recently, classified under Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos Syndrome (hEDS), is a connective tissue disorder characterized by joints that move beyond their normal range of motion. While benign joint hypermobility (BJHM) might not cause symptoms, HMS involves chronic pain, fatigue, dislocations, subluxations, and often systemic manifestations affecting various body systems beyond the musculoskeletal system, including the gastrointestinal, cardiovascular, and autonomic nervous systems. Due to its complex and systemic nature, effective management requires a coordinated approach from a range of medical and allied health professionals.

The Multidisciplinary Approach to Hypermobility Syndrome Treatment

Given the wide array of symptoms and potential complications associated with HMS, no single medical specialty can adequately address all aspects of the condition. Instead, a collaborative, multidisciplinary team approach is crucial for accurate diagnosis, comprehensive treatment, and ongoing management. This integrated care model ensures that all affected systems are monitored and treated, leading to better outcomes and improved quality of life for individuals with HMS.

Key Healthcare Professionals Involved in Diagnosis and Management

Identifying and managing hypermobility syndrome often involves a referral pathway through several specialists, each contributing their expertise:

• General Practitioner (GP) / Family Doctor: Often the first point of contact, the GP plays a vital role in recognizing initial symptoms, conducting preliminary assessments, and coordinating referrals to appropriate specialists. They also manage general health, routine screenings, and medication oversight.
• Rheumatologist: This specialist is typically central to the diagnostic process and ongoing management of HMS. Rheumatologists specialize in musculoskeletal conditions and autoimmune diseases, making them adept at diagnosing connective tissue disorders like HMS/hEDS. They manage joint pain, inflammation, and can differentiate HMS from other conditions causing similar symptoms.
• Physical Therapist (Physiotherapist): A cornerstone of HMS management. Physical therapists design individualized exercise programs focused on strengthening the muscles surrounding hypermobile joints to improve stability, proprioception (body awareness), and reduce pain. They teach safe movement patterns, energy conservation techniques, and help improve functional capacity.
• Occupational Therapist: These professionals help individuals adapt to daily activities that may be challenging due to joint instability or pain. They provide strategies for joint protection, recommend assistive devices, and teach adaptive techniques to perform tasks like dressing, cooking, and work-related activities more safely and efficiently.
• Pain Management Specialist: For individuals experiencing chronic and debilitating pain, a pain management specialist can offer advanced strategies beyond conventional pain relief, including nerve blocks, medication management, and interventional procedures, often working within a broader pain clinic setting.
• Geneticist: If hypermobile Ehlers-Danlos Syndrome (hEDS) or another specific type of EDS is suspected, a geneticist can provide a definitive diagnosis through clinical criteria and, in some cases, genetic testing (though specific genetic markers for hEDS are still being researched). They offer genetic counseling to patients and families.
• Orthopedic Surgeon: While surgery is generally avoided due to the challenges of healing in hypermobile tissue, an orthopedic surgeon may be consulted for specific severe joint instabilities, recurrent dislocations, or complications that require surgical intervention after conservative measures have failed.
• Cardiologist: Given that some forms of hypermobility (particularly certain EDS types) can affect the cardiovascular system (e.g., aortic dilation, dysautonomia), a cardiologist may be involved to monitor heart health and manage related symptoms.
• Gastroenterologist: Many individuals with HMS/hEDS experience gastrointestinal issues, including dysmotility, reflux, and irritable bowel syndrome-like symptoms. A gastroenterologist can diagnose and manage these digestive complaints.
• Neurologist: For neurological manifestations such as dysautonomia (POTS), headaches, or issues like Chiari malformation, a neurologist's expertise is essential for diagnosis and management.
• Psychologist/Psychiatrist: Living with chronic pain, fatigue, and unpredictable symptoms can significantly impact mental health. Psychologists or psychiatrists can provide support for anxiety, depression, fatigue management, and coping strategies.
• Podiatrist: Foot and ankle issues, including flat feet, bunions, and instability, are common in hypermobility. A podiatrist can provide orthotics, footwear advice, and specific treatments for lower limb problems.
• Dietitian/Nutritionist: Some individuals may benefit from nutritional guidance to manage gastrointestinal symptoms, address nutritional deficiencies, or support overall well-being.

The Diagnostic Process

Diagnosis of hypermobility syndrome typically involves a thorough clinical assessment by a rheumatologist or geneticist. This often includes:

• Medical History: Detailed review of symptoms, family history, and past medical conditions.
• Physical Examination: Assessing joint range of motion using standardized scales like the Beighton Score, and evaluating for other systemic signs of connective tissue fragility.
• Exclusion of Other Conditions: Ruling out other autoimmune, inflammatory, or neurological conditions that can mimic HMS symptoms.
• Application of Diagnostic Criteria: Using established criteria such as the Hypermobility Spectrum Disorder (HSD) criteria or the 2017 diagnostic criteria for hypermobile Ehlers-Danlos Syndrome (hEDS).

Long-Term Management and Self-Care

Effective long-term management of HMS goes beyond medical treatments and heavily relies on patient education and self-management strategies. This includes understanding one's body, pacing activities, practicing good joint hygiene, and adhering to prescribed exercise programs. Regular follow-ups with the multidisciplinary team are crucial to adjust treatment plans as symptoms evolve and to address new challenges.

Conclusion

Hypermobility syndrome is a complex, systemic condition requiring a holistic and coordinated approach to care. No single specialist holds all the answers; rather, the most effective treatment involves a collaborative effort from a diverse team of healthcare professionals. By working together, these experts can provide comprehensive diagnosis, symptom management, and long-term support, empowering individuals with hypermobility syndrome to manage their condition and improve their quality of life. If you suspect you have hypermobility syndrome, initiating a conversation with your General Practitioner is the first vital step towards assembling your personalized care team.