What specialist should I consult for joint hypermobility?

Specialist Referral for Joint Hypermobility

For joint hypermobility, you should consult with a rheumatologist who can properly diagnose and coordinate care, especially if you have symptoms beyond just flexible joints. 1

Diagnostic Approach for Joint Hypermobility

Initial Assessment

• The Beighton scoring system is used to assess joint hypermobility:

  • Score ≥6/9 in children before puberty
  • Score ≥5/9 from puberty to age 50
  • Score ≥4/9 for those over 50 years 1

• Beighton assessment includes:

  • Passive dorsiflexion of fifth fingers >90°
  • Passive apposition of thumbs to forearm
  • Hyperextension of elbows >10°
  • Hyperextension of knees >10°
  • Ability to place palms flat on floor with knees extended 2

When to Suspect Hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorders (HSDs)

• Joint hypermobility plus:
  • Soft or velvety skin
  • Recurrent joint subluxations
  • Chronic joint pain
  • Easy bruising 2
  • GI symptoms (nausea, abdominal pain, bloating, constipation) 1
  • Autonomic symptoms (POTS) 1

Specialist Referral Pathway

Primary Specialist: Rheumatologist

• Rheumatologists are the primary specialists for diagnosing and managing joint hypermobility conditions 1
• They can provide:
  • Expert assessment and diagnosis of musculoskeletal problems
  • Access to necessary diagnostic facilities
  • Monitoring of conditions to ensure optimal management
  • Education and counseling 1

Additional Specialists Based on Symptoms

1. If you have autonomic symptoms (lightheadedness when standing, palpitations, fatigue):

   • Consider referral to cardiology or neurology for POTS evaluation 1

2. If you have allergic-type symptoms (flushing, hives, GI symptoms affecting multiple systems):

   • Consider referral to allergy specialist or mast cell disease center for MCAS evaluation 1

3. If you have significant pain and functional limitations:

   • Physical therapy for joint stabilization exercises 2
   • Occupational therapy for joint protection strategies 3

4. If you have psychological symptoms (anxiety, depression):

   • Mental health professional referral may be beneficial 3

What to Expect from Specialist Care

A rheumatology service should provide:

• Timely access to expert assessment and diagnosis
• Access to a multidisciplinary team including physiotherapists and occupational therapists
• Education and support to help you manage your condition
• Protocols for ongoing management
• Effective communication with your primary care physician 1

Treatment Approaches

Physical Therapy (First-Line Treatment)

• Joint stabilization exercises
• Proper body mechanics training
• Low-impact weight-bearing exercises
• Proprioceptive training
• Resistance training with proper form 2

Activities to Avoid

• Aggressive upper extremity weight-bearing
• Activities involving joint distraction
• Contact sports if joint stability is a concern 2

Supportive Devices

• Custom-molded foot orthoses for alignment issues
• Wrist splints for certain activities if needed 2

Important Considerations

• Joint hypermobility may be asymptomatic or symptomatic, non-syndromic or syndromic 4
• Even "asymptomatic" joint hypermobility may result in repetitive use injury or alter biomechanics 4
• Treatment should focus on preventing joint injury and managing symptoms 3
• Avoid exercises that push joints to end ranges as these can worsen symptoms 2

Remember that proper diagnosis is essential, as joint hypermobility can be part of a broader connective tissue disorder requiring comprehensive management by a coordinated team of specialists.