Assessment of joint laxity in children and adolescents: a review of methods.

Joint laxity is diagnosed when the mobility of small and large joints is increased in relation to standard mobility for any given age, gender and race, and after excluding systemic diseases. Many of authors noted the co-occurrence of joint laxity with the following symptoms: back and joints pain, as well as disturbance of body posture. Clinicians apply various methods to assess joint laxity. Beighton scale is the most frequent method used in clinical screening. It consists of assessing: extension of the fifth MPC joint to 90°, thumb abduction to front forearm, hyperextension of elbow and knee joint above 10°, as well as capability to stand bend and place one`s palms flat on the ground. Carter and Wilkinson method is similar to this scale. The difference concerns the assessment of passive hyperextension of all four II-V fingers, instead of the assessment of the fifth finger only. The second difference involves assessing the range of ankle dorsiflexion, instead of assessing the ability to touch the ground with one`s palms. Marshall test is another method for assessing joint laxity. This test is based on the thumb motion range measured in the forearm direction. Hakim and Grahame suggests that the diagnosis of joint laxity may be done with a 5-point questionnaire. It would allow a fast overview as its questions refer to symptoms observed both at present and in the past. Taken into account the common occurrence of joint laxity as well as common use the flexibility exercises in the physiotherapeutic process, the joint laxity should be systematically assessed by both physicians and physiotherapists.