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Review ArticleClinical Review

Diagnosis and Management of Hypermobility Spectrum Disorders in Primary Care

Karina Atwell, William Michael, Jared Dubey, Sarah James, Andrea Martonffy, Scott Anderson, Nathan Rudin and Sarina Schrager
The Journal of the American Board of Family Medicine July 2021, 34 (4) 838-848; DOI: https://doi.org/10.3122/jabfm.2021.04.200374
Karina Atwell
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
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William Michael
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
MD
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Jared Dubey
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
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Sarah James
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
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Andrea Martonffy
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
MD
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Scott Anderson
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
MS
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Nathan Rudin
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
MD
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Sarina Schrager
From Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison (KA, WM, JD, SJ, AM, SS); University of Wisconsin Department of Kinesiology, Madison (SA); Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison (NR).
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Abstract

Hypermobility spectrum disorders (HSDs) encompass an array of connective tissue disorders characterized by joint instability and chronic pain. Fatigue and other systemic symptoms that affect daily functioning may occur, as well. Accurate data on incidence and prevalence of HSDs is hampered by lack of awareness of these conditions and the wide heterogeneity of their clinical presentation. Identifying which type of HSD is present is important in guiding appropriate care. In particular, making the diagnosis of hypermobile Ehlers-Danlos syndrome (hEDS) is important, as individuals with hEDS may be at risk for more significant multisystem involvement. Diagnostic criteria for hEDS include measures of joint hypermobility, skin and other connective tissue findings, and lack of evidence of a different type of Ehlers-Danlos syndrome. Beyond accurate diagnosis, HSDs pose many challenges for primary care providers, as ongoing patient education, patient empowerment, and coordination of a multidisciplinary treatment team are integral to proper care. This article describes the incidence and prevalence, pathophysiology, diagnosis, and management of HSDs, including clinical cases exemplifying how joint hypermobility might present within a primary care setting.

  • Chronic Pain
  • Joint Hypermobility
  • Musculoskeletal System
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The Journal of the American Board of Family     Medicine: 34 (4)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 4
July/August 2021
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Diagnosis and Management of Hypermobility Spectrum Disorders in Primary Care
Karina Atwell, William Michael, Jared Dubey, Sarah James, Andrea Martonffy, Scott Anderson, Nathan Rudin, Sarina Schrager
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 838-848; DOI: 10.3122/jabfm.2021.04.200374

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Diagnosis and Management of Hypermobility Spectrum Disorders in Primary Care
Karina Atwell, William Michael, Jared Dubey, Sarah James, Andrea Martonffy, Scott Anderson, Nathan Rudin, Sarina Schrager
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 838-848; DOI: 10.3122/jabfm.2021.04.200374
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  • Article
    • Abstract
    • Case 1
    • Case 2
    • Joint Hypermobility and Hypermobility Spectrum Disorders—Definitions
    • Hypermobility Spectrum Disorder—Diagnostic Criteria
    • Skin Manifestations
    • Joint Findings in Patients with HSDs
    • Challenges in Primary Care
    • Differential Diagnosis
    • Treatment Options
    • Conclusion
    • Notes
    • References
  • Figures & Data
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Keywords

  • Chronic Pain
  • Joint Hypermobility
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