pediatric hypermobility syndrome
Introduction
Introduction to children's joint hyperactivity syndrome Joint hyperactivity syndrome (jointhypermobility syndrome), also known as arthrochalasis, is one of the causes of joint pain in the limbs, affecting the limbs' activities and functions. This disease is a hereditary disease. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: ankle sprain, shoulder dislocation, scoliosis, flat foot
Cause
Causes of joint hyperactivity syndrome in children
(1) Causes of the disease
May be the result of a genetic disorder in connective tissue.
(two) pathogenesis
At present, some scholars attribute this disease to Ehlers-Danlos syndrome type III, which has only joint relaxation, and no skin relaxation and other characteristics of Ehlers-Danlos syndrome. It has family tendency and dominant inheritance.
Prevention
Prevention of joint hyperactivity syndrome in children
Follow the prevention measures of hereditary diseases and do a good job in genetic counseling.
Complication
Complications of joint hyperactivity syndrome in children Complications sprained shoulder dislocation scoliosis flat foot
Some children may have other bone and joint muscle complications, such as frequent ankle sprains, repeated hips, shoulder dislocation, tibial displacement and scoliosis, flat feet, degenerative arthritis.
Symptom
Symptoms of joint hyperactivity syndrome in children Common symptoms Joint relaxation joint pain Habitual dislocation Childhood overgrowth
There is no obvious gender difference in children with this symptom. Most of them are 2 to 3 years old and even learn to walk. There is joint relaxation. The pain often occurs in the lower limb joints. The knee joint is especially common. The upper limb shoulder and elbow joints also occur. Symmetrical bilateral, no joint swelling and limited activity, more obvious after exercise, although the pain is not very serious, but it is enough to affect children's normal games and activities.
Joint activity range check method
(1) Range of joint activity: Under normal circumstances, the range of joint activity varies with age. The range of joint activity in infancy is the largest, and then gradually decreases. The method of measuring and recording the range of joint activity should be unified, and the joint is the center of the activity. The range of motion is uniformly defined as the "starting point" of the joint extension of zero, not 180°, such as the elbow extension is 0°, and the flexion to the right angle is 90° flexion.
Measuring the range of motion of the joint should include both active and passive activities. When checking the range of motion of the joint, the movement should be gentle. Otherwise, the child will be painful. The limbs of the sick child should be placed in a comfortable position. Generally, the protractor should be used for measurement. Sometimes it can be used for visual inspection. It is estimated that it is worth noting that the protractor measurement may also be inaccurate due to unclear bone markers or soft tissue hypertrophy, atrophy and partial pressure during measurement.
Flexion generally refers to the action of joint reentry, that is, the position away from the zero "starting point". The boundaries of the two nouns of stretching and overstretching should be clear. The movements opposite to the flexion are not necessarily within the normal range, such as the elbow and knee joint. Excessive extension, adduction movement refers to the movement toward the axis of the body, and abduction movement is the activity away from the body axis. This action is described as the ulnar deviation and the deviation in the wrist joint, and the rotation refers to the palm of the hand turning to the front of the body or The palm is up, the front of the hand is the palm of the hand behind the body or the palm of the hand. The word varus is the inner joint of the finger joint, such as the inversion of the subtalar joint of the foot, that is, the action of raising the medial edge of the foot, the eversion is the opposite The movements, internal rotation and external rotation are self-evident.
(2) Elbow joint and knee joint: The typical joint of the joint is that the joint can only move freely on one plane. For example, the elbow joint and the knee joint are the zero starting point of the elbow joint when the elbow joint is straight. Normal range of motion is flexion: 0° to 150°; extension: from 150° to 0°; overextension: measured from 0°, generally 5° to 15°, overextension is not per person, elbow activity Restriction can be expressed as follows: elbow flexion 30° to 90° or elbow 30° flexion deformity can be flexed to 90°.
(3) Hip joint: The hip joint belongs to the ankle joint and has three directions of movement:
1 Check the hip joint should pay attention to whether the pelvis rotates or tilts. When checking, put one hand on the anterior superior iliac spine to understand when the pelvis begins to rotate, so that the sick child lies flat on the hard board, and the contralateral hip joint is fully flexed first. Lumbar vertebrae straightening, and then check the flexion contracture of the hip joint. Under normal circumstances, the hip joint can flex from 0° to 150°. The flexion limitation can be expressed by the method of describing the elbow joint: hip flexion 30°90°, or hip joint The buckling 30° deformity can be further flexed to 90°.
2 The sick child is still lying flat, and the hip joint is rotated under the flexion state. The hip and knee joints are each flexed by 90°. The front of the thigh is facing the front anterior palate, which is perpendicular to the examination table. When measuring the internal rotation, the thigh is measured. For the shaft, keep the calf away from the midline of the body, that is, the hip, and the external rotation is to rotate the calf to the center line with the thigh as the axis.
3 Check the adduction and abduction activities of the hip joint. When measuring hip abduction, be sure to pay attention to the position of the anterior superior iliac spine. Hold the pelvis in one hand and gradually abduct the hip to understand the activity of the pelvis, starting from 0°. Record the degree of abduction. When measuring the adduction, the contralateral lower limb should be lifted first so that the affected lower limb can pass under it. In addition, the hip joint rotation can be measured in the lower extremity position. In the prone position examination, the knee flexion is 90°, and the calf is perpendicular to the anterior superior iliac spine. At this time, the lower leg falls outward, the hip joint is rotated internally, the hip joint is externally rotated, and the hip joint is stretched. Take a prone position examination, or place a thin pillow under the abdomen of the sick child, or bend the contralateral lower limb to the end of the examination table, check the extension angle of the hip joint when straightening the lower limb or flexing the knee, and check the spine when the hip joint is extended. There will also be several degrees of activity in the next paragraph.
(4) scapular joint: check the scapular joint should first fix the scapula, scapular joint and shoulder and chest joint joint action can be abducted 90 °, and lift the upper limb to 180 °, when the shoulder blade rotates upward and outward.
Examine
Examination of pediatric joint hyperactivity syndrome
There are no special findings in general laboratory tests.
X-ray examination showed joint relaxation, hip, shoulder dislocation, patella displacement and bone deformity changes.
Diagnosis
Diagnosis and diagnosis of joint hyperactivity syndrome in children
diagnosis
Because joint pain is a common cause of diagnosis, in addition to detailed medical history, necessary laboratory tests, X-ray and comprehensive physical examination, sometimes it takes a period of clinical observation, which is very important for diagnosis, accompanied by joint muscle pain. While other tests have no evidence of any connective tissue abnormalities.
Diagnostic criteria for joint overactivity:
3 items on one side can be diagnosed according to the following criteria. Two sides can diagnose excessive joint activity.
(1) Excessive extension of the elbow joint >10°.
(2) Knee joint overstretch > 10 °.
(3) The fingers are placed side by side with passive dorsiflexion parallel to the forearm extension side.
(4) The passive movement of the thumb can touch the flexion of the forearm.
(5) Keep the knee joint straight, bend forward and touch the ground.
Differential diagnosis
In the differential diagnosis, the characteristics of several hereditary connective tissue diseases and Marfan syndrome, Ehlers-Danlos syndrome, rheumatic fever and some rare metabolic disorders such as homocystinuria may also have joint relaxation. However, this syndrome refers to the presence of systemic joint relaxation alone.
