What are the treatment options for a 6th grader with hypermobile (double-jointed) thumbs and fingers that can bend backwards?

Management of Hypermobile Joints in a 6th Grader

For a 6th grader with hypermobile thumbs and fingers that bend backwards, physical therapy focusing on joint stabilization exercises and proper body mechanics is the recommended first-line treatment to prevent long-term joint damage and pain. 1

Diagnostic Considerations

When evaluating a child with hypermobile joints, consider:

• Assessment using the Beighton scale (score of 5 or more indicates joint hypermobility)

  • Passive dorsiflexion of fifth fingers >90 degrees
  • Passive apposition of thumbs to forearm
  • Hyperextension of elbows >10 degrees
  • Hyperextension of knees >10 degrees
  • Ability to place palms flat on floor with knees extended 1

• Evaluate for associated features that may indicate Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos Syndrome (hEDS):

  • Soft or velvety skin
  • Recurrent joint subluxations
  • Chronic joint pain
  • Easy bruising 1, 2

Treatment Approach

Physical Therapy Interventions

• Joint Protection and Stabilization:

  • Teach proper joint alignment and body mechanics to prevent overextension
  • Focus on strengthening exercises for muscles surrounding hypermobile joints
  • Avoid postures that promote prolonged positioning of joints at end range 1, 3

• Exercise Program:

  • Emphasize low-impact weight-bearing exercises to build muscle strength
  • Include proprioceptive training to improve joint position awareness
  • Incorporate resistance training with proper form to stabilize joints 1, 3

• Avoid:

  • Aggressive upper extremity weight-bearing activities (cartwheels)
  • Activities involving joint distraction in suspension (monkey bars, tree climbing)
  • Contact sports if there are concerns about joint stability 1

Educational Interventions

• Educate the child and parents about:
  • The nature of joint hypermobility
  • Importance of avoiding showing off extreme joint positions
  • Proper ergonomics for school activities (writing, computer use)
  • Signs of joint strain or overuse to monitor 3

Orthotic Support

• Consider custom-molded foot orthoses if there are alignment issues affecting gait
• Wrist splints may be beneficial during certain activities or at night if there is wrist hypermobility 1

Monitoring and Follow-up

• Regular assessment of:

  • Pain levels
  • Joint stability
  • Muscle strength
  • Functional abilities 3

• Monitor for development of:

  • Chronic pain
  • Recurrent subluxations or dislocations
  • Functional limitations in daily activities 2, 4

Common Pitfalls to Avoid

1. Overlooking the condition as "just flexibility" - Hypermobility can lead to long-term joint problems if not properly managed 2

2. Encouraging extreme ranges of motion - "Party tricks" that demonstrate hypermobility should be discouraged as they can lead to joint instability 3

3. Inappropriate exercise prescription - Exercises that push joints to end ranges can worsen symptoms; focus should be on controlled movement within a safe range 1, 4

4. Ignoring pain complaints - Pain in hypermobile children should be taken seriously as it may indicate joint stress or injury 3

5. Delaying intervention - Early intervention with proper joint protection strategies and strengthening can prevent long-term complications 4

By implementing these recommendations, the goal is to help the child develop proper body mechanics, joint stability, and muscle strength to support their hypermobile joints, preventing pain and dysfunction as they grow.