Definition

• Children with this syndrome have loose joints
• Movement at their joints are excessive
• Joints can be stretched beyond the normal range
• Affects over 10% of children

Health Information

Symptoms

• Usually, there is no pain or other symptoms.
• Joint pains may follow hard sports or play. The pain is from over-stretching of the ligaments around the joints. It is usually mild and doesn’t last long.
• Some of these children are "double-jointed" (usually refers to fingers). Many can easily do the "splits" or other extreme postures.
• Slight increased risk for dislocated shoulder or kneecap with injuries.

Diagnosis

The diagnosis is made by the findings below on physical exam:

• Thumb can touch the wrist
• Little finger can be bent backward more than 90 degrees
• Elbow can be bent backward more than 10 degrees
• Knee can also be bent backward more than 10 degrees
• Palms of the hand can rest flat on the floor while bending from the waist. The knees must remain straight.
• Feet are flat with no arch
• A few children with this are double-jointed. This means they can dislocate some of their joints at will.
• Lab tests or X-rays are of no value in making this diagnosis.

Cause

• The ligaments that hold the joints together are loose or lax.
• The elastic (collagen) tissue found in ligaments stretches more than normal. This difference is genetic.
• Loose-jointed findings are often present in other family members.

Care Advice

1. Overview:
   • Loose joints are a normal variation, not a disease.
   • Pain is not common.
   • Here is some care advice that should help.
2. Pain Medicine:
   • Pain medicines (Tylenol or ibuprofen) can be taken if the joint hurts.
   • The pain is from a stretched ligament.
   • Pains should not occur often.
3. Strength Training:
   • Teenagers who take part in sports can stabilize their joints by strength training.
   • Reason: Increases the muscle mass that goes around the joints.
   • During weight training, avoid doing full range of motion. Reason: Can overstretch ligaments even more.
   • A physical therapist can help design a training program.
4. Avoid Surgery:
   • There is no medical or surgical treatment that will tighten up the joints.
5. Stay Active:
   • You do not need to limit your child’s sports or play. Your child can participate in all activities.
6. What to Expect:
   • Overall, the extra looseness of joints is lifelong.
   • During the teenage years, it may improve in some children.
   • Injuries during sports are slightly increased. They usually involve stretching the loose ligaments around a joint. A common example is a sprained ankle.

Call Your Doctor If

• Joint swelling occurs
• Joint pains become frequent
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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