What is Ligamentous Laxity?
Ligamentous Laxity or ligament laxity is nothing, but loose ligaments which lead to chronic body pains. If this condition affects all the joints of the body then this condition is known as generalized joint hypermobility. Individuals with Ligamentous Laxity are able to extend their joints easily and painlessly beyond the normal range of motion. Joint hypermobility occurs when the ligaments, which hold the joints together, are extremely loose. Weak muscles surrounding the joint also can contribute to joint hypermobility.
The common joints which are affected are shoulders, knees, wrists, elbows and fingers. Ligamentous Laxity is quite a common condition, particularly in children, as their connective tissues are not fully developed. As the child grows older, the laxity of the joints and the ability to hyperextend decreases. Ligamentous Laxity is also known as "loose joints," "double-jointedness," "hypermobility syndrome," and "joint laxity."
Causes of Ligamentous Laxity
Ligamentous Laxity often appears without any underlying medical conditions. Such ligamentous laxity is known as benign hypermobility syndrome. The only symptom of ligamentous laxity is hypermobile joints, the causes of which include:
- The structure and shape of the bone.
- The structure of the muscle, such as the strength or tone of the muscle.
- The depth of the joint sockets
- Poor sense of proprioception, which is the ability to perceive how far you are stretching.
- Having a family history of hypermobility, as it could be inherited.
- Some injuries can also cause Ligamentous Laxity by damaging the ligaments or by overstretching them.
Individuals with Ligamentous Laxity or hypermobile joints can also have pain and stiffness in their joints. This condition is known as joint hypermobility syndrome. Rarely, Ligamentous Laxity could occur as a result of underlying medical conditions which include:
- Cleidocranial Dysostosis: This is an inherited bone development disorder.
- Down Syndrome: This is a developmental disability.
- Marfan Syndrome: This is a connective tissue disorder.
- Ehlers-Danlos Syndrome: This is an inherited syndrome which affects the elasticity.
- Morquio Syndrome: This syndrome is an inherited disorder which affects the metabolism.
Signs & Symptoms of Ligamentous Laxity
- Lax or loose ligaments are not able to effectively support the joints as healthy ligaments do. This increases the risk of injury for individuals who have Ligamentous Laxity.
- In some cases Ligamentous Laxity improves as the person ages.
- Patients having Ligamentous Laxity in the spinal region can experience disc degeneration and osteoarthritis.
- Individuals who are aged above 40 commonly have recurrent joint problems and tend to suffer from constant chronic pain.
- If there is extreme Ligamentous Laxity then the patient will have a decreased ability to sense their joint position, which can lead to joint damage.
- The poor limb positions which result from Ligamentous Laxity can contribute to degenerative joint conditions.
- There are many hypermobility or Ligamentous Laxity patients who suffer from chondromalacia patellae, osteoarthritis, disorders from nerve compression, mitral valve prolapse, excessive anterior mandibular movement, varicose veins and uterine prolapse.
- Patient suffers from arthralgia, frequently sprained ankles, knee effusions, shoulder dislocations, and back problems.
- Individuals with a sedentary job will often have back pain.
- Young females usually experience pain even with minor strains.
- The risk for bone dislocation is more in Ligamentous Laxity.
- Individuals with Ligamentous Laxity are able to bend their elbows, hips or knees beyond the normal range of motion.
- Individuals can also experience referred pain, which is pain in distant regions of the body away from the affected or injured area.
- Due to the abnormal movement of the joint, the adjacent tissues will go into a "protective mode" causing spasm or contraction of the muscles in an effort to bring the joint back to its correct or normal position and to stabilize it so that its protected from further damage.
- Ligamentous Laxity in the back causes vertebral instability which is fixed by fusing the vertebrae with metal or bone.
- Individuals with Ligamentous Laxity in the legs and feet will appear to have flat feet. The arch in their feet will flatten upon standing up, as the loose ligaments are not able to support the arch properly, which in turn leads to difficulty and pain upon standing and walking.
Patient should seek medical consultation if:
- There are sudden changes in the appearance of the joint.
- There are changes in joint mobility.
- There is pain in the lax joints during or after any movement.
- There are any changes in the functioning of the upper and lower extremities.
Investigations to Diagnose Ligamentous Laxity
- The doctor measures the patient's range of motion to assess the joint/Ligamentous Laxity. There is a simple test to diagnose Ligamentous Laxity which is done by bending the index finger backwards. If the patient is able to bend their index finger backward by 90 degrees without any discomfort, then it means that the patient has Ligamentous Laxity or loose ligaments.
- Beighton score is a tool, which is used for measuring loose ligaments or Ligamentous Laxity. Getting a score of 5 or more is a positive test; however, the patient may still have Ligamentous Laxity even if the test result is negative.
- The patient is assessed for other signs of joint hypermobility and connective tissue disorders, such as individuals having Ehlers-Danlos syndrome will often have skin elasticity.
- Further evaluation for other underlying medical conditions include echocardiogram, ophthalmologic examination etc.
Treatment for Ligamentous Laxity
- If the Ligamentous Laxity or hypermobility is causing musculoskeletal problems in a patient, then conventional treatment, such as physiotherapy, pain medicines and strength training of muscles is recommended.
- The aim of the treatment is to relieve pain and strengthen the joint. Over-the-counter pain relievers, sprays, creams etc. can be prescribed for joint pain.
- Individuals who have hereditary joint laxity are told to avoid hyperextension of the joints, impact activities and resistance exercises to cut down on the risk of subluxation and dislocation.
- Myofascial release can be achieved with massage, heat etc. for alleviation of pain.
- An exercise program consisting of low-resistance muscle toning with gradual increase in the frequency and repetitions helps in stabilizing the lax joints and also help in minimizing pain. It also helps in delaying the onset of arthritis.
- Flexible flatfoot commonly causes long-term disability and osteoarthritis. If the flexible flatfoot causes pain, then surgery may be indicated; however, it is not recommended in individuals with joint hypermobility who have conditions such as Marfan syndrome, Down's syndrome or Ehlers-Danlos syndrome.
- Orthotic therapy can also be done. It helps in stabilizing the foot and ankle so that the risk of injuries is less and irreversible damage to the joints is avoided. Stretching the heel cord helps in reducing the tightness in the muscles of the calf and lower limb.
- Conservative treatment for ligament injury or an ankle sprain comprises of R.I.C.E. (Rest, Ice, Compression, Elevation), to prevent and relieve any swelling.
- After the pain and swelling has subsided, then further examination will show which ligaments are affected and the severity of the injury. Surgical measures are considered for repairing the lax ligaments; however, conservative treatment is tried first.
- Patient should use padding or braces during any physical activity to protect his/her joints.
- Surgical procedures for improving joint stability usually do not succeed and only provide temporary relief.