Doctors Lounge - Orthopedics Answers
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Forum Name: Joint surgery
|lizzard - Mon Nov 10, 2008 9:05 pm||
I am having trouble with the medical establishment in dealing with my lax joints. I currently have a wrist, ankle, hip and two shoulders that are loose enough to cause dysfunction, specific symptoms vary. The problem is that I can never get a doctor to look at the whole problem. I am seeing a PT for the hip and ankle, but she only will look at one at a time, and a different pt for the wrist because it put me out of work (massage therapist). They keep telling me that there is nothing i can do about it, that its normal, that strengthening the muscles is all I can do. However, I had knee surgery, orthoscopic and it helped that knee. Also, in every range of motion I am stronger than 90% of women in any age group, and my range of motion draws surprised gasps from every doctor I see. Since I have been getting PT, the problems are getting worse because there is no way to strenthen muscles perfectly evenly, and muscles do, after all, move.
I am an athlete and I cannot perform when I cant even walk! Is there anything at all I can do? I have talked to other people with BHJS who have had success with ankle and shoulder surgery, and near-miraculous recovery with prolotherapy, but my doctors (Ive seen over 20 about this in the last several years) all say it doesnt really exist unless a patient has morfans syndrom or Ehlers.
What can I do? What are my options? Im very frustrated and in a lot of pain, and want to fix the cause of it rather than kill my brain with drugs.
|Tom Plamondon PA-C - Wed Dec 03, 2008 3:31 pm||
With hypermobility of peripheral joints, I think the issue of strength is interesting. Excellent strength through the entire range of motion is one thing while stabilizing strength of the joint is another. What I mean by this is that when a limb moves in a single plane (eg extending the knee), one set of muscles (the knee extensors) work. Fine. However, there are more than one set of muscles which act upon the knee. We have adductors, abductors, flexors and extensors. These muscles certainly move the limb but are also important in stabilizing the joint. This dual muscle function of mobility and stability is important throughout the body - in the knee, shoulder, fingers, spine, etc. Stability is important when a load is applied to a joint. eg. in the ankle, knee, and hip during standing, walking, and running. It provides leverage for the body to move; in other words without stability movement is difficult. When a joint is unstable (in this case hypermobility), the joint is susceptible to abnormal wear; this is caused by shearing forces on the joint - leading to arthritis, cartiledge damage, or ligament damage. Also the synovium is at risk of inflamation.
These conditions in turn cause problems with mobility and strength.
So I think it is important to understand the principles of joint mobility and stability in order to find a solution for joint hypermobility. The risk of injury (and pain) is not during the mobility phases of function but during the stability phases of function. This is the main point and rehab must focus on the stabilizing phases of the joint or body part.
It's also important that muscles and joints are innervated with nerves and have intricate associations with the central nervous system. So joints and muscles need training - neuromuscular training. This is one main principle behind plyometric training for athletes.
Certainly, prolotherapy looks promising for a few ligaments or tendons that are overstretched e.g. chronic ankle sprains but for general hypermobility I would think that there are too many and too much non contractile tissues (ligament and joint capsule) to treat.
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