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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2004; 14(2): 82-91
DOI: 10.1055/s-2003-814833
Wissenschaft und Forschung
© Georg Thieme Verlag KG Stuttgart · New York

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
Further Information

Publication History

Eingegangen: 22. September 2003

Angenommen: 6. Februar 2004

Publication Date:
15 April 2004 (online)

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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

Literatur

  • 1 Kirk J H, Ansell B M, Bywaters E GL. The hypermobility syndrome.  Ann Rheum Dis. 1967;  26 419-425
    CrossrefPubMedSearch in Google Scholar
  • 2 Beighton P, Grahame R, Bird H. Hypermobility of Joints (3rd ed.). London; Springer 1999
    Search in Google Scholar
  • 3 Mishra M B, Ryan P, Atkinson P, Taylor H, Bell J, Calver D, Fogelman I, Child A, Jackson G, Chambers J B, Grahame R. Extra-articular features of benign joint hypermobility syndrome.  Brit J Rheumatol. 1996;  35 861-866
    PubMedSearch in Google Scholar
  • 4 Larsson L G, Baum J, Mudhokar G S. Hypermobility: features and differential incidence between the sexes.  Arthr Rheumat. 1987;  30 1426-1430
    PubMedSearch in Google Scholar
  • 5 Beighton P B, Solomon L, Soskolne C L. Articular mobility in an African population.  Ann Rheum Dis. 1973;  32 413-418
    CrossrefPubMedSearch in Google Scholar
  • 6 Duro J C, Vega E. Prevalence of articular hypermobility in schoolchildren: a one-district study in Barcelona.  Rheumatology. 2000;  39 1153
    CrossrefPubMedSearch in Google Scholar
  • 7 Giessen L J van der, Liekens D, Rutgers K J, Hartman A, Mulder P G, Oranje A P. Validation of Beighton score and prevalence of connective tissue signs in 773 Dutch children.  J Rheumatol. 2001;  28 2726-2730
    PubMedSearch in Google Scholar
  • 8 El Garf A K, Mahmoud G A, Mahgoub E H. Hypermobility among Egyptian children: prevalence and features.  J Rheumatol. 1998;  25 1003-1005
    PubMedSearch in Google Scholar
  • 9 Al-Rawi Z S, Al A szawi, Al C halabi. Joint mobility among university students in Iraq.  Brit J Rheumatol. 1985;  24 326-331
    PubMedSearch in Google Scholar
  • 10 Graham R. Hypermobility syndrome in the elderly. In: Rovensky J (ed) Proceedings of the 1st Central European Congress of Rheumtology. Piestany, Slovakia; Časlekčes 1996
    Search in Google Scholar
  • 11 Bridges A J, Smith E, Reid J. Joint hypermobility in adults referred to rheumatology clinics.  Ann Rheum Dis. 1992;  51 793-796
    PubMedSearch in Google Scholar
  • 12 Child A H. Joint hypermobility syndrome inherited disorder of collagen synthesis.  J Rheumatol. 1986;  13 239-243
    PubMedSearch in Google Scholar
  • 13 Grahame R. Joint hypermobility and genetic collagen disorders: are they related?.  Arch Dis Child. 1999;  80 188-191
    CrossrefPubMedSearch in Google Scholar
  • 14 Bird H A, Calguneri M, Wright V. Changes in joint laxity occurring during pregnancy.  Ann Rheum Dis. 1981;  40 209-214
    PubMedSearch in Google Scholar
  • 15 Bluestone R, Bywaters E G, Hartog M, Holt P JL, Hide S. Acromegalic arthropathy.  Ann Rheum Dis. 1971;  30 243-258
    PubMedSearch in Google Scholar
  • 16 Rillo O L, Babini S M, Basnak A, Wainer E, Balbachan E, Cocco J AM. Tendinous and ligamentous hyperlaxity in patients receiving long-term hemodialysis.  J Rheumatol. 1991;  18 1227-1231
    PubMedSearch in Google Scholar
  • 17 Harpe A L De la, Brighton S W. The effect of long-term corticosteroid therapy on joint mobility.  Clin Exp Rheumatol. 1989;  7 79-80
    PubMedSearch in Google Scholar
  • 18 Carlsson C, Rundgren A. Hypermobility of joints in women alcoholics.  J Stud Alcohol. 1980;  41 78-82
    PubMedSearch in Google Scholar
  • 19 Klemp P, Stevens J E, Issacs S. A hypermobility study in ballet dancers.  J Rheumatol. 1984;  11 692-696
    PubMedSearch in Google Scholar
  • 20 Graham R. Joint hypermobility and the performing musicans.  NEJM. 1993;  329 1120-1121
    CrossrefPubMedSearch in Google Scholar
  • 21 Barton L M, Bird H A, Lindsay M, Newton J, Wright V. The quantification of joint hyperlaxity in athletes.  J Orthop Rheumatol. 1995;  8 79-86
    PubMedSearch in Google Scholar
  • 22 Hull R G. Articular hypermobility presenting after „aerobic” exercise.  Clin Exp Rheumatol. 1985;  3 359-364
    PubMedSearch in Google Scholar
  • 23 Hudson N, Fitzcharles M A, Cohen M, Starr M R, Esdaile J M. The association of soft-tissue rheumatism and hypermobility.  Brit J Rheumatol. 1998;  37 382-386
    PubMedSearch in Google Scholar
  • 24 Acasuso Diaz M, Collantes-Estevez E. Joint hypermobility in patients with fibromyalgia syndrome.  Arthr Care & Res. 1998;  11 39-42
    PubMedSearch in Google Scholar
  • 25 Adair S M, Hecht C. Association of generalized joint hypermobility with history, signs, and symptoms of temporomandibular joint dysfunction in children.  Paediatr Dent. 1993;  15 323-326
    PubMedSearch in Google Scholar
  • 26 Binns M. Joint laxity in idiopathic adolescent scoliosis.  J Bone Joint Surg. 1988;  70 420-422
    PubMedSearch in Google Scholar
  • 27 Larsson L G, Mudholkar G S, Baum J, Srivastava D K. Benefits and liabilities of hypermobility in the back pain disorders of industrial workers.  J Intern Med. 1995;  238 461-467
    CrossrefPubMedSearch in Google Scholar
  • 28 Kaalund S, Hogsaa B, Grevy C. Coxa saltans in patients with Ehlers-Danlos syndrome, type III.  Scand J Rheumatol. 1988;  17 229-230
    PubMedSearch in Google Scholar
  • 29 Al-Rawi Z, Nessan A H. Joint hypermobility in patients with chondromalacia patellae.  Brit J Rheumatol. 1997;  36 1324-1327
    PubMedSearch in Google Scholar
  • 30 Bird H A, Tribe C R, Bacon P A. Joint hypermobility leading to osteoarthrosis and chondrocalcinosis.  Ann Rheum Dis. 1978;  37 203-211
    CrossrefPubMedSearch in Google Scholar
  • 31 Jonsson H, Valtysdottir S T, Kjartansson O, Brekkan A. Hypermobility associated with osteoarthritis of the thumb base: a clinical and radiological subset of hand osteoarthritis.  Ann Rheum Dis. 1996;  55 540-543
    PubMedSearch in Google Scholar
  • 32 Woodward E G, Morris M T. Joint hypermobility in keratoconus.  Ophthal Physiol Opt. 1990;  10 360-362
    PubMedSearch in Google Scholar
  • 33 Haberhauer G, Feyertag J, Hanusch-Enserer U. Joint hypermobility syndrome and bilateral occlusion of the ulnar arteries presenting as Raynaud's phenomenon.  Clin Exp Rheum. 2000;  18 270-271
    PubMedSearch in Google Scholar
  • 34 Handler C E, Child A, Light N D, Dorrance D E. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome.  Brit Heart J. 1985;  54 501-508
    PubMedSearch in Google Scholar
  • 35 Morgan A W, Pearson S B, Bird H A. Respiratory symptoms in Ehlers-Danlos syndrome and the benign joint hypermobility syndrome.  Arthr Rheum. 1996;  39 136
    PubMedSearch in Google Scholar
  • 36 Marshman D, Percy J, Fielding I, Delbridge L. Rectal prolaps: relationship with joint mobility.  Aust NZ J Surg. 1987;  57 827-829
    PubMedSearch in Google Scholar
  • 37 Al-Rawi Z S, Al-Rawi Z T. Joint hypermobility in women with genital prolapse.  Lancet. 1982;  24 1439-1441
    PubMedSearch in Google Scholar
  • 38 Martin-Santos R, Bulbena A, Porta M, Gago J, Molina L, Duro J C. Association between joint hypermobility syndrome and panic disorder.  Am J Psychiatry. 1998;  155 1578-1583
    PubMedSearch in Google Scholar
  • 39 Beighton P H, Solomon L, Soskolne C L. Articular mobility in an African population.  Ann Rheum Dis. 1973;  32 413-418
    CrossrefPubMedSearch in Google Scholar
  • 40 Graham R, Bird H A, Child A, Dolan L, Edwards-Fowler A, Ferrell W, Gurley-Green S, Keer R, Mansi E, Murray K J, Smith E. The revised (Beighton 1998) criteria for the diagnosis of benign joint hypermobility syndrom (BJHS).  J Rheumatol. 2000;  27 1777-1779
    PubMedSearch in Google Scholar
  • 41 Karaaslan Y, Haznedaroglu S, Öztürk M. Joint hypermobility and primary fibromyalgia. A clinical enigma.  J Rheumatol. 2000;  27 1774-1776
    PubMedSearch in Google Scholar
  • 42 Bird H A, Wright V. Joint hypermobility mimicking pauci-articular juvenile polyarthitis.  Brit Med J. 1978;  2 402-403
    PubMedSearch in Google Scholar
  • 43 Scharty Y, Nahir A M. Hypermobility syndrome mimicking juvenile chronic arthritis.  Rheumatol Rehab. 1982;  21 78-80
    PubMedSearch in Google Scholar
  • 44 Lewkonia R M, Ansell B M. Articular hypermobility simulating chronic rheumatic disease.  Arch Dis Child. 1983;  58 988-992
    PubMedSearch in Google Scholar
  • 45 Gedalia A, Person D A, Giannini E H, Brewer E J. Joint hypermobility in juvenile episodic arthritis/arthralgia.  J Rheumatol. 1984;  11 716
    PubMedSearch in Google Scholar
  • 46 Bridges A J, Smith E, Reid J. Joint hypermobility in adults referred to rheumatology clinics.  Ann Rheum Dis. 1992;  51 793-796
    PubMedSearch in Google Scholar
  • 47 Guma M, Olive A, Roca J, Forcada J, Duro J C, Holgado S, Casado E, Mezquiriz X, Tena X. Association of systemic lupus erythematosus and hypermobility.  Ann Rheum Dis. 2002;  61 1024-1026
    CrossrefPubMedSearch in Google Scholar
  • 48 Garnero P, Piperno M, Gineyts E, Chrisgau S, Delmas P D, Vignon E. Cross sectional evaluation of biochemical markers of bone, cartilage, and synovial tissue metabolism in patients with knee osteoarthritis: relations with disease activity and joint damage.  Ann Rheum Dis. 2001;  60 619-626
    CrossrefPubMedSearch in Google Scholar
  • 49 Murphy E, FitzGerald O, Saxne T, Bresnihan B. Increased serum cartilage oligomeric matrix protein levels and decreased patellar bone mineral density in patients with chondromalacia patellae.  Ann Rheum Dis. 2002;  61 981-985
    CrossrefPubMedSearch in Google Scholar
  • 50 Shashikirian U, Rastogi A, Gupta R P, Sabir M. Ehlers-Danlos syndrome type VI variant presenting with recurrent respiratory infections and responding to high dose vitamin C.  J Assoc Physicians India. 1999;  47 554-555
    PubMedSearch in Google Scholar
  • 51 Sastry P S. Matrixmetalloproteinase inhibitor therapy to prevent complications as well as therapy for Ehlers-Danlos syndrome.  Med Hypotheses. 2002;  59 314-315
    PubMedSearch in Google Scholar
  • 52 Russek L N. Examination and treatment of a patient with hypermobility syndrome.  Phys Ther. 2000;  80/4 386-389
    PubMedSearch in Google Scholar
  • 53 Russek L N. Hypermobility Syndrome.  Phys Ther. 1999;  79 591-599
    PubMedSearch in Google Scholar
  • 54 Graham R. Hypermobility Syndrome in Rheumatology (eds: Klippel JH, Dieppe PA). London; Mosby 1994: 181-186
    Search in Google Scholar
  • 55 Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard C H. Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow.  J Bone Joint Surg (B). 1992;  74 646-651
    PubMedSearch in Google Scholar
  • 56 Balint M. Der Arzt, sein Patient und die Krankheit. Stuttgart; Klett 1965
    Search in Google Scholar
  • 57 Sachse J, Hinzmann J L, Janda V, Ruhm B. Normuntersuchung der Beweglichkeit junger Erwachsener.  Phys Rehab Kur Med. 2002;  12 325-329
    Thieme ConnectPubMedSearch in Google Scholar
  • 58 Pountain G. Musculoskeletal pain in Omanis, and the relationship to joint mobility and body mass index.  Br J Rheumatol. 1992;  31 81-85
    PubMedSearch in Google Scholar
  • 59 Konrad K. Joint hypermobility: frequent cause of low back pain. (Hungarian).  Orvosi Hetilap. 1996;  137/30 1643-1646
    PubMedSearch in Google Scholar
  • 60 Müller K, Kreutzfeldt A, Schwesig R, Müller-Pfeil J, Bandemer-Geulich U, Schreiber B, Bahrke U, Fikentscher E. Hypermobilität und chronischer Rückenschmerz.  Orthop Praxis. 2002;  38 716-721
    PubMedSearch in Google Scholar
  • 61 Baquie P. An investigation into the potential relationship between intervertebral joint hypermobility and pain response in ballet dancers suffering lower back pain (abstract).  Aust J Physiother. 1986;  32/3 204-205
    PubMedSearch in Google Scholar
  • 62 Grob K R, Kuster M S, Higgins S A, Lloyd D G, Yata H. Lack of correlation between different measurements of proprioception in the knee.  J Bone Joint Surg Br. 2002;  84 614-618
    CrossrefPubMedSearch in Google Scholar
  • 63 Mallik A K, Ferrell W R, McDonald A G, Sturrock R D. Impaired proprioceptive acuity at the proximal interphalangeal joint in patients with the hypermobility syndrome.  Br J Rheumatol. 1994;  33 631-637
    CrossrefPubMedSearch in Google Scholar
  • 64 Hall M G, Ferrell W R, Sturrock R D, Hamblen D L, Baxendale R H. The effect of the hypermobility syndrome on knee joint proprioception.  Br J Rheumatol. 1995;  34 121-125
    PubMedSearch in Google Scholar
  • 65 Barrett D S, Cobb A G, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees.  J Bone Joint Surg Br. 1991;  73 53-56
    PubMedSearch in Google Scholar
  • 66 Marks R, Quinney H A, Wessel J. Proprioceptive sensibility in women with normal and osteoarthritic knee joints.  Clin Rheumatol. 1993;  12 170-175
    PubMedSearch in Google Scholar
  • 67 Pai Y C, Rymer W Z, Chang R W, Sharma L. Effect of age and osteoarthritis on knee proprioception.  Arthritis Rheum. 1997;  40 2260-2265
    CrossrefPubMedSearch in Google Scholar
  • 68 Koralewicz L M, Engh G A. Comparison of proprioception in arthritic and age-matched normal knees.  J Bone Joint Surg Am. 2000;  82 1582-1588
    PubMedSearch in Google Scholar
  • 69 Sharma L, Pai Y C, Holtkamp K, Rymer W Z. Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis?.  Arthritis Rheum. 1997;  40 1518-1525
    CrossrefPubMedSearch in Google Scholar
  • 70 Hewitt B A, Refshauge K M, Kilbreath S L. Kinesthesia at the knee: the effect of osteoarthritis and bandage application.  Arthritis Rheum. 2002;  47 479-483
    CrossrefPubMedSearch in Google Scholar
  • 71 Sharma L, Pai Y C. Impaired proprioception and osteoarthritis.  Curr Opin Rheumatol. 1997;  9 253-258
    PubMedSearch in Google Scholar
  • 72 Richie D H. Functional instability of the ankle and the role of neuromuscular control: a comprehensive review.  J Foot Ankle Surg. 2001;  40 240-251
    CrossrefPubMedSearch in Google Scholar
  • 73 Lofvenberg R, Karrholm J, Sundelin G. Proprioceptive reaction in the healthy and chronically unstable ankle joint.  Sportverletz Sportschaden. 1996;  10 (4) 79-83
    PubMedSearch in Google Scholar
  • 74 Jerosch J, Prymka M. Knee joint proprioception in patients with posttraumatic recurrent patella dislocation.  Knee Surg Sports Traumatol Arthrosc. 1996;  4 (1) 14-18
    CrossrefPubMedSearch in Google Scholar
  • 75 Parkhurst T M, Burnett C N. Injury and proprioception in the lower back.  J Orthop Sports Phys Ther. 1994;  19 282-295
    PubMedSearch in Google Scholar
  • 76 Ramsay J R, Riddoch M J. Position-matching in the upper limb: professional ballet dancers perform with outstanding accuracy.  Clin Rehabil. 2001;  15 324-330
    CrossrefPubMedSearch in Google Scholar
  • 77 Hurley M V, Scott D L. Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime.  Br J Rheumatol. 1998;  37 1181-1187
    CrossrefPubMedSearch in Google Scholar
  • 78 Jerosch J, Pfaff G, Thorwesten L, Schoppe R. Effects of a proprioceptive training program on sensorimotor capacities of the lower extremity in patients with anterior cruciate ligament instability.  Sportverletz Sportschaden. 1998;  12 (4) 121-130
    PubMedSearch in Google Scholar
  • 79 Beard D J, Dodd C A, Trundle H R, Simpson A H. Proprioception enhancement for anterior cruciate ligament deficiency. A prospective randomised trial of two physiotherapy regimes.  J Bone Joint Surg Br. 1994;  76 654-659
    PubMedSearch in Google Scholar
  • 80 Bartlett M J, Warren P J. Effect of warming up on knee proprioception before sporting activity.  Br J Sports Med. 2002;  36 132-134
    CrossrefPubMedSearch in Google Scholar
  • 81 Perlau R, Frank C, Fick G. The effect of elastic bandages on human knee proprioception in the uninjured population.  Am J Sports Med. 1995;  23 251-255
    CrossrefPubMedSearch in Google Scholar
  • 82 Walker H L, Schreck R C. Relationship of hyperextended gait pattern to chondromalacia patellae.  Physiotherapy. 1978;  1 1-9
    PubMedSearch in Google Scholar
  • 83 Young A. Current issues in arthrogenous inhibition.  Ann Rheum Dis. 1993;  52 829-834
    PubMedSearch in Google Scholar
  • 84 Gedney H Earl. Hypermobile Joint (a preliminary report).  Osteopathic Profession. 1937;  4 9
    PubMedSearch in Google Scholar
  • 85 Dechow E, Davies R K, Carr A J, Thomson P W. A randomized controlled trial of sclerosing injections in patients with chronic low back pain.  Rheumatology. 1999;  38 1255-1259
    CrossrefPubMedSearch in Google Scholar
  • 86 Klein R G, Eek B C, DeLong W B, Mooney V. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain.  J Spinal Disord. 1993;  6 23-33
    PubMedSearch in Google Scholar
  • 87 Reeves K D, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy.  J Altern Complement Med. 2000;  6 311-320
    CrossrefPubMedSearch in Google Scholar
  • 88 Reeves K D, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity.  Altern Ther Health Med. 2000;  6 68-74
    PubMedSearch in Google Scholar
  • 89 Klemp B. Hypermobility: (Editorial).  Annals of the Rheumatic Diseases. 1997;  56 573-575
    PubMedSearch in Google Scholar
  • 90 Diaz M A, Estevez E C, Guyjo Sanchez P. Jolint hyperlaxity and musculoligamentous lesions: study of a population of homogeneous age, sex, and physical exertion.  Br J Rheumatol. 1993;  32 120-122
    PubMedSearch in Google Scholar
  • 91 March L, Silman A. Joint hyperlaxity: is there a case for screening?.  Br J Rheumatol. 1993;  32 91-92
    PubMedSearch in Google Scholar
  • 92 MacIntyre D L, Reid W D, Lyster D M, Szasz I J, McKenzie D C. Presence of WBC, decreased strength, and delayed soreness in muscle after eccentric exercise.  J Appl Physiol. 1996;  80 1006-1013
    PubMedSearch in Google Scholar
  • 93 Tokmakidis S P, Kokkinidis E A, Smilios I, Douda H. The effects of Ibuprofen on delayed muscle soreness and muscular performance after eccentric exercise.  J Strength Cond Res. 2003;  17 53-59
    CrossrefPubMedSearch in Google Scholar
  • 94 Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors.  Sports Med. 2003;  33 145-164
    CrossrefPubMedSearch in Google Scholar
  • 95 Eston R G, Finney S, Baker S, Baltzopoulos V. Muscle tenderness and peak torque changes after downhill running following a prior bout of isokinetic eccentric exercise.  J Sports Sci. 1996;  14 291-299
    CrossrefPubMedSearch in Google Scholar
  • 96 Prou E, Guevel A, Benezet P, Marini J F. Exercise-induced muscle damage: absence of adaptive effect after a single session of eccentric isokinetic heavy resistance exercise.  J Sports Med Phys Fitness. 1999;  39 226-232
    PubMedSearch in Google Scholar
  • 97 Brockett C L, Morgan D L, Proske U. Human hamstring muscles adapt to eccentric exercise by changing optimum length.  Med Sci Sports Exerc. 2001;  33 (5) 783-790
    PubMedSearch in Google Scholar
  • 98 Dannecker E A, Koltyn K F, Riley J L, Robinson M E. The influence of endurance exercise on delayed onset muscle soreness.  J Sports Med Phys Fitness. 2002;  42 458-465
    PubMedSearch in Google Scholar
  • 99 Graham R, Bird H. British consultant rheumatologists' perceptions about the hypermobility syndrome: a national survey.  Rheumatology (Oxford). 2001;  40 559-562
    CrossrefPubMedSearch in Google Scholar
  • 100 http://www3.who.int/icf/ . 
  • 101 Semark A, Noakes T D, St Clair Gibson A, Lambert M I. The effect of a prophylactic dose of flurbiprofen on muscle soreness and sprinting performance in trained subjects.  J Sports Sci. 1999;  17 197-203
    CrossrefPubMedSearch in Google Scholar
  • 102 Bourgeois J, MacDougall D, MacDonald J, Tarnopolsky M. Naproxen does not alter indices of muscle damage in resistance-exercise trained men.  Med Sci Sports Exerc. 1999;  31 4-9
    PubMedSearch in Google Scholar
  • 103 Craig J A, Cunningham M B, Walsh D M, Baxter G D, Allen J M. Lack of effect of transcutaneous electrical nerve stimulation upon experimentally induced delayed onset muscle soreness in humans.  Pain. 1996;  67 (2 - 3) 285-289
    CrossrefPubMedSearch in Google Scholar
  • 104 Smith L L, Keating M N, Holbert D, Spratt D J, McCammon M R, Smith S S, Israel R G. The effects of athletic massage on delayed onset muscle soreness, creatine kinase, and neutrophil count: a preliminary report.  J Orthop Sports Phys Ther. 1994;  19 93-99
    PubMedSearch in Google Scholar
  • 105 Hasson S M, Wible C L, Reich M, Barnes W S, Williams J H. Dexamethasone iontophoresis: effect on delayed muscle soreness and muscle function.  Can J Sport Sci. 1992;  17 8-13
    PubMedSearch in Google Scholar
  • 106 Ernst E. Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review.  Br J Sports Med. 1998;  32 212-214
    CrossrefPubMedSearch in Google Scholar
  • 107 Craig J A, Bradley J, Walsh D M, Baxter G D, Allen J M. Delayed onset muscle soreness: lack of effect of therapeutic ultrasound in humans.  Arch Phys Med Rehabil. 1999;  80 318-323
    CrossrefPubMedSearch in Google Scholar
  • 108 Minder P M, Noble J G, Alves-Guerreiro J, Hill I D, Lowe A S, Walsh D M, Baxter G D. Interferential therapy: lack of effect upon experimentally induced delayed onset muscle soreness.  Clin Physiol Funct Imaging. 2002;  22 339-347
    CrossrefPubMedSearch in Google Scholar
  • 109 Kraemer W J, Bush J A, Wickham R B, Denegar C R, Gomez A L, Gotshalk L A, Duncan N D, Volek J S, Putukian M, Sebastianelli W J. Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise.  J Orthop Sports Phys Ther. 2001;  31 282-290
    CrossrefPubMedSearch in Google Scholar
  • 110 Karjalainen K A, Malmivaara A O, Tulder M W van, Roine R P, Jauhiainen S, Hurri H O, Koes B W. Biopsychosocial rehabilitation for repetitive-strain injuries among working-age adults.  Scand J Work Environ Health. 2000;  26 373-381
    PubMedSearch in Google Scholar
  • 111 Moore L E, Wiesner S L. Hypnotically-induced vasodilation in the treatment of repetitive strain injuries.  Am J Clin Hypn. 1996;  39 97-104
    PubMedSearch in Google Scholar
  • 112 Torkki M, Malmivaara A, Reivonen N, Seitsalo S, Laippalo P, Hoikka V. Individually fitted sports shoes for overuse injuries among newspaper carriers.  Scand J Work Environ Health. 2002;  28 176-183
    PubMedSearch in Google Scholar
  • 113 Tittiranonda P, Rempel D, Armstrong T, Burastero S. Effect of four computer keyboards in computer users with upper extremity musculoskeletal disorders.  Am J Ind Med. 1999;  35 647-661
    CrossrefPubMedSearch in Google Scholar
  • 114 Rempel D, Tittiranonda P, Burastero S, Hudes M, So Y. Effect of keyboard keyswitch design on hand pain.  J Occup Environ Med. 1999;  41 111-119
    CrossrefPubMedSearch in Google Scholar
  • 115 Giombini A, Cesare A Di, Casciello G, Sorrenti D, Dragoni S, Gabriele P. Hyperthermia at 434 MHz in the treatment of overuse sporttendinopathies: a randomised controlled clinical trial.  Int J Sports Med. 2002;  23 207-211
    Thieme ConnectPubMedSearch in Google Scholar
  • 116 Melhorn J M. A prospective study for upper-extremity cumulative trauma disorders of workers in aircraft manufacturing.  J occup Environ Med. 1996;  38 1264-1271
    PubMedSearch in Google Scholar

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