Benignes Gelenkhypermobilitätssyndrom: Klinik, Diagnostik, physikalische Therapiemöglichkeiten

H. Mayr; M. Skoumal; G. Haberhauer

doi:10.1055/s-2003-814833

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, Table of Contents

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2004; 14(2): 82-91
DOI: 10.1055/s-2003-814833

Wissenschaft und Forschung

Benignes Gelenkhypermobilitätssyndrom: Klinik, Diagnostik, physikalische Therapiemöglichkeiten

Benign Joint Hypermobility Syndrome: Clinical Features, Diagnosing, Physical Therapy OptionsH. Mayr¹ , M. Skoumal² , G. Haberhauer³

¹Institut für Physikalische Medizin, Rehabilitation und Rheumatologie (Ärztlicher Leiter: Prim. Dr. Mayr) in der Krankenanstalt „Sanatorium Hera”, Wien, Österreich
²Institut für Rheumatologie der Kurstadt Baden in Kooperation mit der Donauuniversität Krems (Präsident: Univ.-Prof. Dr. N. Thumb) und Rheumasonderkrankenanstalt der SVA der gewerblichen Wirtschaft, Baden (Ärztlicher Leiter: OA Dr. Ch. Schödl), Österreich
³Institut für Rheumatologie der Kurstadt Baden in Kooperation mit der Donauuniversität Krems (Präsident: Univ.-Prof. Dr. N. Thumb), Österreich

Abstract

Zusammenfassung

Das benigne Gelenkhypermobilitätssyndrom (BGHS) repräsentiert ein gutartiges Overlap-Syndrom von nicht lebensbedrohlichen Komponenten der seltenen und besser definierten kongenitalen mesodermalen Dysplasien: Marfan-Syndrom, Ehlers-Danlos-Syndromen und Osteogenesis imperfecta. BGHS-Patienten leiden vorwiegend an Arthralgien, Kreuzschmerzen, weichteilrheumatischen Symptomen, rezidivierenden Gelenkluxationen und extraartikulären Manifestationen wie Angst, Stress, kutanen Striae, erhöhter Blutungsneigung, Mitralklappenprolaps, Spontanpneumothorax, Harninkontinenz, Beckenbodeninsuffizienz etc. Die BGHS simuliert oftmals chronisch entzündlich-rheumatische Erkrankungen. Am Beginn der Therapie steht die richtige Diagnosestellung. Die Patienten müssen wissen, dass der Arzt ihr Leiden erkannt hat und versteht. Lebensumstände, welche die Symptome verschlechtern, sollten nach Möglichkeit ausgeschaltet werden, da dies die Patienten vor unnötigen, potenziell schädlichen Therapien schützt. Jüngst wurden Arbeiten veröffentlicht, die Prolotherapie als wirksam in der Behandlung nachwiesen. Physikalische Therapie gilt als eine tragende Säule, evidenzbasierte Empfehlungen können derzeit infolge des Fehlens von Daten nur durch Anwendung von Analogieschlüssen gegeben werden. Die unterschiedlichen Ansatzpunkte der physikalischen Therapie werden umrissen.

Abstract

The benign joint hypermobility syndrome (BJHS) is a hereditary benign overlap disorder of connective tissue, which incorporates features seen in the Marfan syndrom, Ehlers-Danlos syndroms and osteogenesis imperfecta. Patients with BJHS usually present arthralgia, back pain, overuse soft tissue lesions, recurrent joint dislocation or subluxation and even extraarticular features, e. g. anxiety, stress, skin striae, easy bruising, mitral valve prolapse, pneumothorax, urinary incontinence and pelvic floor prolapse. The BJHS often simulates chronic inflammatory rheumatic diseases. There are many ways in which BJHS patients can be helped: Getting the diagnosis right is a start. Patients need to know that they have a condition that physicians recognize and understand. They should be encouraged to seek out factors in their daily activities that seem to provoke or aggravate their symptoms to prevent patients from treatment with unnecessary, potentially harmful treatment modalities. There are recent trials showing Prolotherapy to be an effective treatment. Physical therapy is said to be a mainstay of treatment, but currently evidence based recommendations can be given only based on conclusions by analogy. There are different levels of physical intervention, which are outlined in this paper.

Schlüsselwörter

Rheumatische Erkrankungen - Gelenkhypermobilität - Physikalische Therapie - Beratung

Key words

Rheumatic diseases - hypermobility - joint - physical therapy techniques - medical history taking - punctures

Full Text

References

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Dr. Hans Mayr

Institut für Physikalische Medizin, Rehabilitation und Rheumatologie in der Krankenanstalt „Sanatorium Hera”

Löblichgasse 16

1090 Wien · Österreich

Email: pmr-rheuma@hera.co.at