Applicability of cutoff scores of Chinese Cumberland Ankle Instability Tool and Foot and Ankle Ability Measure as inclusion criteria for study of chronic ankle instability in Chinese individuals.

OBJECTIVE: To examine the applicability of Chinese Cumberland Ankle Instability Tool (CAIT-C) and Foot and Ankle Ability Measure (FAAM-C) as inclusion criteria recommended by the International Ankle Consortium (IAC) for study of chronic ankle instability in the Chinese individuals. DESIGN: Cross-sectional comparative design with known groups. SETTING: Research laboratory. PARTICIPANTS: 145 participants with chronic ankle instability (CAI) and 66 participants without injury. MAIN OUTCOME MEASURES: CAIT-C and FAAM-C Activities of Daily Living (FAAM-C-ADL) and FAAM-C Sports (FAAM-C-Sports). RESULTS: The CAIT-C scores (18.2 ± 5.6), FAAM-C-ADL scores (97.0 ± 4.3) and FAAM-C-Sports scores (92.2 ± 10.3) of the CAI group were all lower than the CAIT-C scores (27.4 ± 3.1), FAAM-ADL scores (99.0 ± 2.1) and FAAM-Sports scores (98.4 ± 3.1) (P < 0.01) of the uninjured group. The recommended cutoff score of CAIT-C<24 by the IAC for identifying CAI had a sensitivity of 80.7% and a specificity of 84.9%. If the recommended cutoff scores of FAAM-ADL<90，FAAM-Sports<80 by the IAC as inclusion criteria for the study of CAI were applied, 97% of participants with CAI in this sample would be excluded. CONCLUSION: The results support the recommended cutoff score of CAIT-C<24 by the IAC to identify Chinese individuals with CAI for study. However, the recommended cutoff scores of FAAM-ADL<90 and FAAM-Sports<80 will exclude most Chinese individuals with CAI having only mild functional impairments.

Racial variations in knee joint laxity: A comparative study of the Jordanian Arab and Malay populations.

BACKGROUND: A high incidence of joint laxity has been reported among Asians compared with Western populations, but clear differences between more specific ethnic populations have not been established. This study aimed to determine the average knee laxity in the Malaysian and Jordanian populations. METHODS: Jordanian and Malaysian medical students from our institution were invited to participate in the study. General demographic data and factors affecting joint laxity were obtained from each participant using a printed questionnaire. Both knees were examined using the anterior drawer test while in 90° of flexion. Knee laxity was measured by three separate independent investigators through a knee laxity tester. RESULTS: One hundred and eighty-six participants (95 females) were enrolled in the study. Among them, 108 Malaysians participated. The Jordanians had significantly higher knee laxity in both knees compared with the Malaysians. The mean average right knee laxity for Jordanians was 2.98 mm vs. 2.72 mm for Malaysians (P = 0.005). Similarly, the mean average left knee laxity for Jordanians was 2.95 mm, while for Malaysians, it was 2.62 mm (P = 0.0001). Furthermore, smokers had significantly more laxity in both knees. After performing a multivariate linear regression analysis for all factors, race was the only independent factor that affected knee laxity in both knees. CONCLUSIONS: Race is directly associated with knee laxity. Jordanians tend to have more laxity in knee joints compared with Malaysians. Larger multi-center and genetic studies are recommended to establish the racial differences between different ethnic groups.

Detecting genetic modifiers of spondyloepimetaphyseal dysplasia with joint laxity in the Caucasian Afrikaner community.

Spondyloepimetaphyseal dysplasia with joint laxity (SEMDJL) is an autosomal-recessive skeletal dysplasia. A relatively large number of patients with SEMDJL have been identified in the Caucasian Afrikaans-speaking community in South Africa. We used a combination of Genome-Wide Human Single Nucleotide Polymorphism (SNP) Array 6.0 data and whole exomic data to potentially dissect genetic modifiers associated with SEMDJL in Caucasian Afrikaans-speaking patients. Leveraging the family-based association signal in prioritizing candidate mutations, we identified two potential modifier genes, COL1A2 and MATN1, and replicating previously identified mutation in KIF22. Importantly, our findings of genetic modifier genes and previously identified mutations are layered on the same sub-network implicated in syndromes characterized by skeletal abnormalities and intellectual disability, bone and connective tissue fragility. This study has potentially provided crucial insights in identifying the indirect modifying mutation(s) linked to the true causal mutation associated with SEMDJL. It is a critical lesson that one may use constructively especially when the pace of exomic sequencing of rare disorders continues apace.

Association between general joint hypermobility and knee, hip, and lumbar spine osteoarthritis by race: a cross-sectional study.

BACKGROUND: Osteoarthritis (OA) prevalence differs by race. General joint hypermobility (GJH) may be associated with OA, but differences by race are not known. This community-based study examined the frequency of GJH and its relationship with knee, hip, and lumbar spine OA by race (African American vs. Caucasian). METHODS: Data were from the Johnston County OA project, collected 2003-2010. GJH was defined as Beighton score ≥4. OA symptoms were defined as the presence of pain, aching, or stiffness on most days separately at the knee, hip, and lower back. Radiographic OA (rOA) of the knee or hip was defined as Kellgren-Lawrence grade 2-4. Lumbar spine rOA was disc space narrowing grade ≥1 and osteophyte grade ≥2 in ≥ 1 at the same lumbar level. Lumbar spine facet rOA was present in ≥ 1 lumbar levels. Separate logistic regression models stratified by race were used to examine the association between hypermobility and rOA or OA symptoms at each joint site, adjusting for age, sex, previous joint injury, and body mass index (BMI). RESULTS: Of 1987 participants, 1/3 were African-American and 2/3 were women (mean age 65 years, mean BMI 31 kg/m2). Nearly 8% of Caucasians were hypermobile vs. 5% of African-Americans (p = 0.03). Hypermobility was associated with lower back symptoms in Caucasians (adjusted odds ratio (aOR) 1.54, 95% confidence interval (CI) 1.00, 2.39), but not in African-Americans (aOR 0.77, 95% CI 0.34, 1.72). Associations between hypermobility and other knee, hip, or lumbar spine/facet OA variables were not statistically significant. CONCLUSIONS: General joint hypermobility was more common in Caucasians than African-Americans. Although there were no associations between hypermobility and rOA, the association between hypermobility and lower back symptoms may differ by race.

Measurement Properties of the Brazilian-Portuguese Version of the Lumbar Spine Instability Questionnaire.

STUDY DESIGN: Cross-cultural adaptation and analysis of measurement properties. OBJECTIVE: To translate and cross-culturally adapt the Lumbar Spine Instability Questionnaire (LSIQ) into Brazilian-Portuguese and to test its measurement properties in Brazilian patients with low back pain. SUMMARY OF BACKGROUND DATA: The selection of subgroup of patients that respond better to specific interventions is the top research priority in the field of back pain. The LSIQ is a tool able to stratify patients with low back pain who responds better to motor control exercises. There is no Brazilian-Portuguese version of the LSIQ available. METHODS: The original version of the LSIQ was translated and cross-culturally adapted. We collected data from 100 patients with low back pain. In addition to LSIQ, we also collected information about physical activity levels (measured by the International Physical Activity Questionnaire short version), disability (measured by the Roland Morris Disability Questionnaire), pain intensity (measured by the Pain numerical Rating Scale), kinesiophobia (measured by the Tampa Scale of Kinesiophobia), and depression (measured by the Beck Depression Inventory). The measurement properties tested were internal consistency, reproducibility (reliability and agreement), construct validity, and ceiling and floor effects. RESULTS: The Brazilian-Portuguese version of the LSIQ showed good measurement properties with a Cronbach alpha of 0.79, an intraclass correlation coefficient of 0.75, a standard error of measurement of 1.65 points, and a minimal detectable change of 3.54 points. We did not detect ceiling and floor effects. The construct validity analysis was observed a moderate correlation between the LSIQ and Pain Numerical Rating Scale r = 0.46, Roland Morris Disability Questionnaire r = 0.66, Tampa Scale of Kinesiophobia r = 0.49, and Beck Depression Inventory r = 0.44. CONCLUSION: The Brazilian-Portuguese version of LIQ has adequate measurement properties and can be used in clinical practice and research. LEVEL OF EVIDENCE: NA.

The 2014 ABJS Nicolas Andry Award: The puzzle of the thumb: mobility, stability, and demands in opposition.

BACKGROUND: The paradoxical demands of stability and mobility reflect the purpose and function of the human thumb. Its functional importance is underscored when a thumb is congenitally absent, injured, or afflicted with degenerative arthritis. Prevailing literature and teaching implicate the unique shape of the thumb carpometacarpal (CMC) joint, as well as its ligament support, applied forces, and repetitive motion, as culprits causing osteoarthritis (OA). Sex, ethnicity, and occupation may predispose individuals to OA. QUESTIONS/PURPOSES: What evidence links ligament structure, forces, and motion to progressive CMC disease? Specifically: (1) Do unique attributes of the bony and ligamentous anatomy contribute to OA? (2) Can discrete joint load patterns be established that contribute to OA? And (3) can thumb motion that characterizes OA be measured at the fine and gross level? METHODS: We addressed the morphology, load, and movement of the human thumb, emphasizing the CMC joint in normal and arthritic states. We present comparative anatomy, gross dissections, microscopic analysis, multimodal imaging, and live-subject kinematic studies to support or challenge the current understanding of the thumb CMC joint and its predisposition to disease. RESULTS: The current evidence suggests structural differences and loading characteristics predispose the thumb CMC to joint degeneration, especially related to volar or central wear. The patterns of degeneration, however, are not consistently identified, suggesting influences beyond inherent anatomy, repetitive load, and abnormal motion. CONCLUSIONS: Additional studies to define patterns of normal use and wear will provide data to better characterize CMC OA and opportunities for tailored treatment, including prevention, delay of progression, and joint arthroplasty.

Paleopathological interpretations of hypermobility syndrome in the art from ancient America.

Paleopathological representations of hypermobility syndrome were assumed in pre-Columbian artifacts from different ancient civilizations from America. Anthropomorphic sculptures from several museums and galleries visited on site or thru Internet show the human figure in contorted positions. These positions are only possible within well-trained individuals or persons with hyperextensibility of the joints.

Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature.

OBJECTIVE: This literature review of generalized joint hypermobility (GJH) syndromes discusses information regarding sex-, age-, and race-related factors from publications that specifically document validated GJH criteria. METHODS: We present an analysis of criterion-referenced connections that identify similarities among major and minor clinical criteria that identify both GJH and benign joint hypermobility syndrome (BJHS). In our search, we found considerable empirical evidence that supports an increased prevalence of hypermobility among children, women, and certain racial groups. Two commonly used clinical assessment tools, the Carter and Wilkinson criteria (>or= 3 positive tests out of 5) and the Beighton method (>or= 4 positive tests out of 9), are the sources of these data. BJHS is diagnosed through a set of major and minor criteria - a combination of symptoms and objective findings -- that include arthralgia, back pain, spondylosis, spondylolysis/spondylolisthesis, joint dislocation/subluxation, soft tissue rheumatism, marfanoid habitus, abnormal skin, eye signs, varicose veins or hernia or uterine/rectal prolapse. RESULTS: Clinically, there is some evidence that arthralgia, the proposed BJHS major criterion, is a major component of alleged hypermobility-related problems. In contrasting, there is no clear evidence that proposed BJHS minor diagnostic criteria are associated with hypermobility-related problems. An empirical correlation between hypermobility and osteoarthritis is possible, but so far unproven. There are no randomized controlled studies regarding effects of existing treatments. CONCLUSION: Generalized hypermobility is both sex- and age-related. Racial differences are also identifiable. The existence of BJHS can be accepted using present criteria.

[Generalised joint hypermobility and benign joint hypermobility syndrome. II: epidemiology and clinical criteria]. / Hypermobilitas articulorum og hypermobilitetssyndrom. II: epidemiologi og klinik.

Gender-, age- and race-related generalised joint hypermobility (GJH) is elucidated, based on publications that have used validated criteria for GJH. Furthermore, we analysed the connection between GJH and the clinical criteria for benign joint hypermobility syndrome (BJHS), and we looked for literature on the treatment of BJHS. There seems to be evidence in support of an increased prevalence of hypermobility among children, females and certain races when the diagnosis of hypermobility is based on the Carter and Wilkinson criteria (> or =3 positive tests out of 5) and/or Beighton's tests (> or =4 positive tests out of 9). However, there are no unequivocal statements that hypermobility predisposes to the various clinical situations used as major or minor criteria for BJHS, e.g., arthralgia, low back and pelvic pain, joint luxation, soft tissue rheumatism, abnormal cutis or genitourinary prolapse, varicose veins and hernia. There have been no randomised controlled studies of the effect of treatment.

Knee joint laxity in a native Canadian Indian population.

BACKGROUND: Clinical observation of increased laxity has been noted in native Canadians. Comparative studies support the possible relationship between joint hypermobility and the development of osteoarthritis or other joint ailments. If joint laxity predisposes to osteoarthritis, there may be far-reaching consequences to the general Native population. METHODS: A cohort of 52 Native Canadians (NC) and 52 non-Native Canadians (NNC) were evaluated for knee laxity. All patients had no prior history of knee injury or complaints of symptoms related to knee pathology at the time of the examination. Bilateral knee examination was performed. Objective laxity was measured using the KT-1000 tensiometer. Subjective findings were also recorded. RESULTS: Comparison for instability between the groups (NC and NNC) revealed that the NC group had significantly greater laxity on both right and left sides for all knee ligament grading (p < or = 0.0001). The values for displacement during KT-1000 measurements were significantly greater in the NC group for all forces (p < or = 0.0001). Presence of all the following were also significantly greater in the NC group: pivot shift (p < or = 0.001); medial and lateral collateral ligament opening (p < or = 0.001); posterior cruciate drawer test (p < or = 0.001). INTERPRETATION: This prospective matched cohort reveals that there is a significant joint hypermobility in this Native Canadian population.

Lumbar spine listhesis in older African American women.

BACKGROUND CONTEXT: Degenerative changes in the lumbar spine may result in a loss of spinal stability and subluxation of one vertebra relative to another. Cadaveric studies and clinical case series have suggested that listhesis may be much more common in African Americans than in whites. PURPOSE: To determine the prevalence of lumbar spine listhesis (anterolisthesis and retrolisthesis) among African American women aged 65 years and older and the relationship of listhesis to low back pain, physical function and quality of life. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: A total of 481 African American women aged 65 years and older who were enrolled in the Study of Osteoporotic Fractures. These women were recruited from population-based listings in Baltimore, MD, Minneapolis, MN, Pittsburgh, PA, and Portland, OR. OUTCOME MEASURES: Not applicable. METHODS: Lateral radiographs of the lumbar spine were digitized, and listhesis (anterolisthesis and retrolisthesis) was assessed at spinal levels L3-L4, L4-L5 and L5-S1. Usable data were obtained for 470 women. Listhesis was defined as present when the subluxation (antero or retro) was 3 mm or more. RESULTS: The overall prevalence of anterolisthesis was 58.3% and varied by spinal level (13.2% at L3-L4, 36.5% at L4-L5 and 29.6% at L5-S1). The prevalence increased with age but was lower among oophorectomized women and those currently on estrogen replacement therapy. Anterolisthesis was not associated (p>.05) with disc height nor was it related to back function. Retrolisthesis occurred in 4% of women and was associated with decreased disc height and an increased prevalence of spinal problems and walking problems. CONCLUSIONS: The prevalence of anterolisthesis among older African American women living in the community was two to three times greater than that found in white women of a similar age. This condition was not related to an increased frequency of back problems nor did it adversely affect general physical function. Retrolisthesis was relatively rare but was associated with decreased back function.

Articular mobility in Maori and European New Zealanders.

OBJECTIVES: To determine the prevalence of hypermobility and of the hypermobility syndrome (HMS) in Maori and European New Zealanders. METHODS: The prevalences of generalized hypermobility (Beighton's score > or = 4), of hypermobility at individual sites and of HMS were determined in 804 Maori and European subjects. Musculoskeletal system (MSS) manifestations were documented in all subjects by personal interview and an MSS examination. Radiographs were obtained where appropriate. RESULTS: The percentage of hypermobile subjects was 6.2 for Maori (9.0 for females and 2.2 for males) and 4.0 for Europeans (5.6 and 1.9). Hypermobility was more prevalent in females (P=0.0001). Hypermobility of the elbow was more prevalent in Maori (P=0.003) and hyperextension of the fifth finger and apposition of thumb to forearm were more prevalent in females (P<0.001). HMS was present in two of 41 (4.9%, 95% confidence interval 0.6-17.6%) hypermobile subjects. Both were Maori females and therefore 2/23 hypermobile Maori females (8.7%, 1.1-31.4%) had HMS. CONCLUSION: The prevalence of hypermobility in Maori is similar to that in European New Zealanders and Caucasians elsewhere. Larger studies are necessary to determine the prevalence of HMS in Maori, particularly Maori females.

Pelvic organ prolapse and connective tissue abnormalities in Korean women.

OBJECTIVE: To evaluate the relationship between pelvic organ prolapse in Korean women and joint hypermobility, which suggests a metabolic collagen fiber abnormality. STUDY DESIGN: Between March 1998 and March 2000, we investigated 55 patients with prolapse. The prevalence of joint hypermobility, by measuring finger extension angle, and the proportion of patients with joint hypermobility were measured in patients with pelvic organ prolapse and benign gynecologic patients (control group). RESULTS: In middle-aged women (40-59 years), the average finger extension angles were higher in the POP group than in the control group (50.04 +/- 9.70 degrees vs. 39.50 +/- 12.19 degrees, respectively; P < .05), but in older women there was no significant difference between the two groups (42.84 +/- 13.05 degrees vs. 43.00 +/- 13.34 degrees, respectively; P > .05). CONCLUSION: The prevalence of joint hypermobility was higher in the POP group and with advanced POP stage (III, IV) than in the control group and early POP stage (I, II). Our results suggest that intrinsic connective tissue abnormality is related to the development of pelvic organ prolapse. Further study involving more patients with pelvic organ prolapse is warranted, and molecular studies to determine the genetic basis of pelvic organ prolapse are also required to further elucidate this abnormality.

Instability of the hip in neonates. An ethnic and geographical study in 24,101 newborn infants in Malmö.

In a prospective study conducted between 1990 and 1997, 24 101 newborn infants were examined for neonatal instability of the hip and classified by the ethnic origin of their parents. In 63% their mother and father were of Swedish extraction and in 24% they were born in a foreign country. Those of foreign extraction were split into ethnic and geographical subgroups. Although the incidence of treated (dislocatable-unstable) hips was greater in Swedes (7.6/thousand), than in other geographical groups (5.8/thousand) it was not significantly different (p = 0.065). A total of 12.7/thousand were referred from the neonatal ward to the orthopaedic clinic with suspected dislocatable or unstable hips; 6.8/thousand were treated (5.4/thousand dislocatable, 1.4/thousand unstable), but 5.9/thousand were not treated since their ultrasound examination was normal. Two hips were diagnosed late and one case of mild avascular necrosis was found. Examination by dynamic ultrasound decreased the number of treated cases by 5.9/thousand but was not an absolute guarantee of diagnosis.

A study of joint mobility in a normal population.

Joint hypermobility is a clinical entity that has been little studied in Southeast Asia in contrast to the many studies that have been conducted in the West. A pioneer study was conducted in Singapore involving 306 subjects from the three major races i.e. Chinese, Malays and Indians. Their ages ranged from 15 to 39 years. The objective was to ascertain the joint mobility profile in a study sample representative of the Singapore population and the prevalence of joint hypermobility amongst normal individuals. Joint mobility was assessed using criteria according to Carter and Wilkinson modified by Beighton et al. The distribution of the three major races in the study sample was based on the 1990 census of the Singapore population. The prevalence of joint hypermobility was found to be 17%. The results showed that joint mobility decreases with age and that females had consistently higher degree of joint mobility compared to males throughout the age group. Among the racial groups, Malays had the highest degree of joint mobility followed by Indians and Chinese.

Hypermobility and peripartum pelvic pain syndrome in pregnant South African women.

OBJECTIVE: To determine the incidence and correlation of joint hypermobility (HM) and peripartum pelvic pain (PPPP) in an homogeneous pregnant South African population. STUDY DESIGN: A cross-sectional study among Cape Coloured pregnant women. Joint mobility was measured by Beighton score; PPPP with a specially developed PPPP score. RESULTS: Using the Beighton scores with a cut-off point of HM > or = 5/9, only 4.9% of the 509 pregnant women were hypermobile. Hyperextension of the elbow was the largest contributor to HM (35.4%). No correlation of HM with the incidence of PPPP was established. Only 20 very mild cases of PPPP were recorded. Back pain increased significantly during pregnancy to a mean of 38%. Right handedness occurred in 95.9%. No significant relation was found between HM and the non-dominant side. CONCLUSION: Hypermobility in pregnant Cape Coloured women was surprisingly low (4.9%) with a decrease with age, but no increase during pregnancy. Peripartum pelvic pain is virtually absent and has no correlation with joint laxity. Back pain increased during pregnancy to a mean of 38%. Right handedness was high (96%) in comparison with the world-wide figure of 85%. No correlation was found between the dominant body side and hypermobility.

Localized glenoid hypoplasia. An anatomic variation of possible clinical significance.

Examinations were done on 1150 scapular bone specimens from museum collections. A localized hypoplasia of the posteroinferior glenoid was found in significant numbers (20%-35%) depending on the population group studied. Criteria were established for the identification of this variant in computed tomography and magnetic resonance studies. Localized hypoplasia of the posteroinferior glenoid was detected as an incidental finding in 54 (18%) of 300 such studies. Using these same imaging criteria in a prospective manner, 9 of 12 patients seen for voluntary multidirectional instability of the shoulder displayed a localized posteroinferior glenoid hypoplasia. This phenomenon also may add to the picture of extreme posterior glenoid wear that sometimes is seen in association with osteoarthritis of the shoulder.

Comparative pathoanatomy of the Asian and Caucasian trapeziometacarpal joint.

The frequency and distribution of idiopathic osteoarthritis (OA) in the upper extremity has been observed to vary considerably among different races. This study seeks to investigate the prevalence of trapeziometacarpal OA and differences in pathologic anatomy in comparable populations of Caucasian and Asian peoples. Sixty-one postmortem Japanese, Chinese and Indian specimens were examined for integrity of both the stabilising soft tissue structures and articular surfaces. Chondromalacia and eburnation were assessed by location in the joint relative to previously described patterns of disease in Caucasian specimens. Among 35 Japanese specimens, 23 (66%) were found to have completely normal joint surfaces, 5 (14%) had chondromalacia limited to the dorsal surfaces, 2 (6%) had chondromalacia on the volar surfaces, and 5 (14%) exhibited eburnation consistent with advanced degenerative disease. A similar distribution was noted for the 22 Chinese specimens. When present, the pattern of arthritic disease was identical to that seen in Caucasian joints; eburnation of surfaces was only seen in the volar compartment and dorsal joint cartilage was typically spared. Detachment of the volar beak ligament was evident in all joints with eburnation, and degeneration of the metacarpal insertion was present in specimens with volar chondromalacia. The concavoconvex configuration of the joint surfaces was more shallow in Japanese and Chinese specimens than comparable Caucasian joints. A similar study of Caucasian joints demonstrated only 25% with normal articular surfaces, 10% with dorsal chondromalacia as a lesion indicative of physiologic aging, 15% with volar chondromalacia as a prearthritic progressive lesion, and 50% with eburnation indicative of end-stage arthritic disease. Based upon the study of postmortem material, the anatomical prevalence of trapeziometacarpal joint osteoarthritis is considerably less in the Japanese and Chinese than in the Caucasian race.(ABSTRACT TRUNCATED AT 250 WORDS)