Objective: Although diagnostic criteria for generalized ligamentous laxity (hypermobility) in children are widely used, their validity may be limited, due to the lack of robust descriptive epidemiologic data on this condition. The present study was undertaken to describe the point prevalence and pattern of hypermobility in 14‐year‐old children from a population‐based cohort.Methods: We performed a cross‐sectional analysis using the Avon Longitudinal Study of Parents and Children, a large population‐based birth cohort. Hypermobility among children in the cohort (mean age 13.8 years) was measured using the Beighton scoring system. Objective measures of physical activity were ascertained by accelerometry. Data on other variables, including puberty and socioeconomic status, were collected. Simple prevalence rates were calculated. Chi‐square tests and logistic regression analyses were used to assess associations of specific variables with hypermobility.Results: Among the 6,022 children evaluated, the prevalence of hypermobility (defined as a Beighton score of ≥4 [i.e., ≥4 joints affected]) in girls and boys age 13.8 years was 27.5% and 10.6%, respectively. Forty‐five percent of girls and 29% of boys had hypermobile fingers. There was a suggestion of a positive association between hypermobility in girls and variables including physical activity, body mass index, and maternal education. No associations were seen in boys.Conclusion: We have shown that the prevalence of hypermobility in UK children is high, possibly suggesting that the Beighton score cutoff of ≥4 is too low or that this scoring is not appropriate for use in subjects whose musculoskeletal system is still developing. These results provide a platform to evaluate the relationships between the Beighton criteria and key clinical features (including pain), thereby testing the clinical validity of this scoring system in the pediatric population.

Objective: To determine whether joint hypermobility (JH) in childhood is a risk factor for the subsequent development of musculoskeletal pain.Methods: JH was determined according to the Beighton score at age 13.8 years in children from the Avon Longitudinal Study of Parents and Children (ALSPAC), using a cutoff of ≥6 for the presence of hypermobility. Musculoskeletal pain was evaluated by questionnaire at age 17.8 years. Logistic regression analysis was performed in 2,901 participants (1,267 boys and 1,634 girls) who had complete data.Results: A total of 4.6% of participants had JH at age 13.8 years. Moderately troublesome musculoskeletal pain at age 17.8 years was reported most commonly in the lower back (16.1%), shoulder (9.5%), upper back (8.9%), knee (8.8%), neck (8.6%), and ankle/foot (6.8%). JH was associated with an increased risk of at least moderately troublesome musculoskeletal pain at the shoulder (odds ratio [OR] 1.68 [95% confidence interval (95% CI) 1.04, 2.72]), knee (OR 1.83 [95% CI 1.10, 3.02]), and ankle/foot (OR 1.82 [95% CI 1.05, 3.16]) (adjusted for sex, maternal education, and body mass index). An equivalent relationship was not observed at other sites, including the spine, elbows, hands, and hips. In analyses examining interactions with obesity, associations between JH and knee pain showed higher ORs in obese participants (OR 11.01) as compared with nonobese participants (OR 1.57) (P = 0.037 for the interaction of hypermobility and obesity).Conclusion: JH represents a risk factor for musculoskeletal pain during adolescence, comprising a specific distribution, namely, the shoulder, knee, and ankle/foot. These relationships were strongest in the presence of obesity, which is consistent with a causal pathway whereby JH leads to pain at sites exposed to the greatest mechanical forces.

Obesity is a risk factor for fibromyalgia in adults, but whether a similar relationship exists in children is uncertain. This study examined whether obesity is associated with reporting of musculoskeletal pain, including chronic regional pain (CRP) and chronic widespread pain (CWP), in adolescents, in a population-based setting. A pain questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children at age 17, asking about site, duration, and pain intensity, from which participants with different types of musculoskeletal pain were identified. Relationships between obesity and pain were examined by calculating odds ratios stratified by gender and adjusted for socioeconomic status as reflected by level of maternal education. A total of 3376 participants (1424 boys) with complete data were identified, mean age 17.8; 44.7% of participants reported any pain within the last month lasting 1day or longer; 16.3% reported lower back pain, 9.6% shoulder pain, 9.4% upper back pain, 8.9% neck pain, 8.7% knee pain, 6.8% ankle/foot pain, 4.7% CRP, and 4.3% CWP; 7.0% of participants were obese. Obesity was associated with increased odds of any pain (odds ratio [OR] 1.33, P=.04), CRP (OR 2.04, P=.005), and knee pain (OR 1.87, P=.001), but not CWP (OR 1.10, P=.5). Compared with non obese participants, those with any pain, knee pain, and CRP reported more severe average pain (P<.01). Obese adolescents were more likely to report musculoskeletal pain, including knee pain and CRP. Moreover, obese adolescents with knee pain and CRP had relatively high pain scores, suggesting a more severe phenotype with worse prognosis.

Objective. The aim of this study was to use quantitative sensory testing (QST) to explore the range and prevalence of somatosensory abnormalities demonstrated by patients with advanced knee OA. Methods. One hundred and seven knee OA patients and 50 age- and sex-matched healthy participants attended a 1-h QST session. Testing was performed on the medial side of the knee and the pain-free forearm. Light-touch thresholds were assessed using von Frey filaments, pressure pain thresholds using a digital pressure algometer, and thermal sensation and pain thresholds using a Thermotest MSA. Significant differences in median threshold values from knee OA patients and healthy participants were identified using Mann–Whitney U-tests. The z-score transformations were used to determine the prevalence of the different somatosensory abnormalities in knee OA patients. Results. Testing identified 70% of knee OA patients as having at least one somatosensory abnormality. Comparison of median threshold values between knee OA patients and healthy participants revealed that patients had localized thermal and tactile hypoaesthesia and pressure hyperalgesia at the osteoarthritic knee. Tactile hypoaesthesia and pressure hyperalgesia were also present at the pain-free forearm. The most prevalent somatosensory abnormalities were tactile hypoaesthesia and pressure hyperalgesia, evident in between 20 and 34% of patients. Conclusion. This study found that OA patients demonstrate an array of somatosensory abnormalities, of which the most prevalent were tactile hypoaesthesia and pressure hyperalgesia. Further research is now needed to establish the clinical implications of these somatosensory abnormalities.

Objectives. Sensorimotor deficits such as impaired joint proprioception and muscle weakness have been found in association with hypermobility syndrome (HMS) in adults. HMS is more common in children than adults, yet such deficits have not been adequately investigated in paediatric populations. It is therefore uncertain as to what sensorimotor deficits are present in children with HMS. This study investigated knee joint proprioception and muscle torque in healthy children and those with HMS. Methods. Thirty-seven healthy children (mean age ± s.d. = 11.5 ± 2.6 yrs) and 29 children with HMS (mean age ± s.d. = 11.9 ± 1.8 yrs) participated in this study. Knee joint kinaesthesia (JK) and joint position sense (JPS) were measured, with the absolute angular error (AAE) calculated as the absolute difference between the target and perceived angles. Knee extensor and flexor muscle torque was assessed and normalized to body mass. Mann–Whitney U-tests were performed to compare JK, JPS and muscle torque between the two groups. Results. Children with HMS had significantly poorer JK and JPS compared with the controls (both P < 0.001). Knee extensor and flexor muscle torque was also significantly reduced (both P < 0.001) in children with HMS compared with their healthy counterparts. Conclusions. The findings of this study demonstrated that knee joint proprioception was impaired in children with HMS. They also had weaker knee extensor and flexor muscles than healthy controls. Clinicians should be aware of these identified deficits in children with HMS, and a programme of proprioceptive training and muscle strengthening may be indicated.