Hyperlaxity in Hand Surgery: A Cross-sectional Survey

Abstract

Background:

Joint hypermobility syndrome comprises a spectrum of disorders associated with increased rates of injury and degeneration in all joints. However, there is a paucity of literature on these patients’ features within the hand clinic. In this study, we characterize hyperlaxity patients in the hand clinic setting to help inform evaluation and management.

Methods:

All patients who presented to a single surgeon’s clinic over a 10-year period with a diagnosis of joint hypermobility were collected. Retrospective review of demographic data, orthopedic history, presenting symptoms, and diagnoses were collected. The Beighton score was recorded.

Results:

A total of 210 patients were included—6% of all new patients, or twice the expected rate. The hand clinic provided the first orthopedic evaluation for 46% of patients. Their average age was 37.1 years, with most lacking inciting trauma. The Beighton scores were above 6/9. Most patients had previous diagnoses of wrist pathology but not of hyperlaxity and had multiple, bilateral, and recurrent wrist disorders. Pain was present in 90% of patients. Conditions such as nerve compression and trigger fingers were uncommon.

Conclusion:

Joint hyperlaxity is prevalent in the hand clinic and is likely underdiagnosed. Hyperlaxity patients are, on average, younger than other hand surgery patients, with multiple complaints and a history of orthopedic injuries. These patients most commonly complain of wrist pathology. Of note, the hand clinic provided the first musculoskeletal specialist evaluation for half the hyperlaxity patients in our cohort, underscoring the importance of early screening, diagnosis, and multidisciplinary therapy in this setting.