Double-Jointed Elbows in Hypermobility Syndromes

"Double-jointed" elbows may look like a fun trick, but they come with unique challenges, especially for those with connective tissue disorders like hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD). These conditions involve flexible, but often fragile, joints due to collagen irregularities, which can lead to a variety of musculoskeletal issues. Here, we'll explore why some people have double-jointed elbows, potential risks associated with them, and management strategies to support joint health.

What Makes an Elbow "Double-Jointed"?

When someone can hyperextend their elbows past the typical range, often more than 10 degrees, this is referred to as being "double-jointed" or hypermobile. In medical terms, hypermobility means a joint moves beyond the standard range due to loose ligaments and collagen structures, which support stability. For many, especially children and adolescents, double-jointedness is simply a quirky physical feature with minimal impact. However, in hEDS and HSD, hypermobile elbows can indicate a more systemic issue that affects the entire connective tissue network, leading to various symptoms and complications​​.

Anatomy of the Hypermobile Elbow

The elbow is a hinge joint formed by the humerus (upper arm bone) connecting to the ulna and radius (forearm bones), with surrounding ligaments, muscles, and nerves providing stability. In hypermobile individuals, the ligaments are more relaxed, allowing the joint to extend further than usual. This increased flexibility, especially without proper control, can strain muscles and put undue stress on surrounding tissues, making hypermobile joints prone to injury​.

Why Do Double-Jointed Elbows Occur?

1. Genetics and Connective Tissue Disorders: Conditions like hEDS are hereditary and involve genetic mutations affecting collagen. Collagen provides the strength and elasticity that stabilize joints. When collagen is compromised, as in hEDS, joints like the elbows are more prone to hypermobility, leading to joint instability​​.
2. Hormonal Factors: Some research suggests that hormonal changes, such as those during puberty, pregnancy, or menstruation, may contribute to increased joint laxity, especially in those predisposed to hypermobility​.
3. Age and Physical Activity: Hypermobility is often more pronounced in childhood when joints are naturally more flexible. Certain sports, like gymnastics or dance, can encourage joint flexibility, potentially enhancing hypermobility over time​.

Common Issues with Double-Jointed Elbows

While double-jointedness in the elbows can seem harmless, it can lead to various challenges over time, particularly if it is part of a broader connective tissue disorder:

• Joint Instability: Hypermobile elbows may feel “wobbly” or lack the stability to handle repetitive or forceful movements, increasing the risk of dislocations or subluxations (partial dislocations).
• Increased Risk of Injury: Ligaments around hypermobile joints can overstretch, leading to conditions like tennis elbow (lateral epicondylitis) or golfer’s elbow (medial epicondylitis), which involve painful inflammation around the elbow​​.
• Difficulty with Weight-Bearing Activities: In yoga poses or weight-lifting exercises, locking hypermobile elbows can cause strain, as the joint lacks muscle support, making it prone to discomfort or injury.
• Chronic Pain and Early Degeneration: Hypermobile elbows are at a higher risk of developing chronic pain and early joint degeneration as cartilage wears out from constant overextension​.

Practical Tips to Support Hypermobile Elbows

If you have hypermobile elbows, there are ways to protect them and enhance stability, especially if you experience pain or difficulty with movement. Here are some practical strategies:

1. Avoid Locking Out the Elbows: In activities like weight-bearing exercises, focus on keeping a slight bend in the elbows to engage the muscles around the joint, providing stability without overextending.
2. Strengthen Surrounding Muscles: Work with a physical therapist to develop exercises that build strength in the shoulders, upper back, and forearm. Strength in these areas helps reduce reliance on the elbow joint for stability.
3. Use Bracing or Support When Needed: In high-impact or repetitive activities, wearing an elbow brace can help limit excess movement and reduce strain on the ligaments​.
4. Work on Proprioception: Many people with hypermobility have decreased proprioception—the body’s ability to sense joint position. Exercises that improve body awareness can help reduce accidental overextension and promote safer movement.
5. Avoid Repetitive Stress: Repeatedly performing the same movement, especially with force, can exacerbate hypermobility issues. Limit repetitive motions, especially those that require full extension, to prevent strain​.

When to Seek Medical Support

If you’re experiencing persistent pain, frequent dislocations, or difficulty with everyday tasks, consider consulting a healthcare provider. They may recommend imaging tests to assess any structural damage or suggest therapies like occupational therapy or physical therapy to help manage symptoms. In some cases, surgical options may be considered to repair damaged ligaments or improve joint stability, though surgery is usually a last resort​.

Conclusion

Double-jointed elbows are a hallmark of hypermobility, but they can be both a blessing and a challenge. For those with connective tissue disorders like hEDS, proper management and strengthening are essential to protect the elbows from strain, injury, and degeneration. With a proactive approach to joint health, individuals with double-jointed elbows can maintain their flexibility while minimizing pain and improving joint stability.

FAQ:

Can you be double-jointed and not have EDS?

Yes, absolutely. Double-jointedness, or joint hypermobility, can occur without any underlying medical condition. Many people with joint hypermobility don’t experience any health issues, and it’s often just a benign trait. However, if double-jointedness is accompanied by pain, frequent dislocations, or other systemic symptoms, it may be related to a connective tissue disorder like Ehlers-Danlos Syndrome (EDS).

Why do I have double-jointed elbows?

Double-jointed elbows are usually caused by joint hypermobility, which may result from genetic differences in connective tissue. Loose ligaments and certain collagen variations allow joints to move beyond the typical range of motion. Sometimes, hypermobile elbows run in families and may not cause any problems; other times, they can be part of a connective tissue disorder like hEDS.

Can you be hypermobile but not double-jointed?

Yes. Hypermobile joints generally have an extended range of motion, but not all hypermobile individuals are considered “double-jointed.” “Double-jointed” is often used to describe joints that can bend in an exaggerated manner, such as elbows that hyperextend. Someone may be classified as hypermobile if they have flexibility in multiple joints that goes beyond the typical range, even if the flexibility is subtle and doesn’t appear extreme.

Can you have EDS but not be double-jointed?

Yes, it’s possible. Although joint hypermobility is a common feature of many types of EDS, some forms may not include obvious hypermobility. These types can affect other tissues, like skin, blood vessels, or bones, without visibly hypermobile joints. In hEDS, however, joint hypermobility is a primary diagnostic criterion.

Can you be hypermobile but not flexible?

Surprisingly, yes. Flexibility and hypermobility are related but different. Flexibility typically refers to muscle length and the ability to stretch, while hypermobility specifically refers to a joint’s range of motion due to ligament laxity. Some people may have hypermobile joints but tight muscles, resulting in joints that can move beyond the average range but lack overall flexibility due to restricted muscle length.

How do “double-jointed” people differ from others who are not?

People who are “double-jointed” have joints that can move beyond the normal range due to looser connective tissues. This trait is different from those with typical joint ranges, as double-jointed individuals often have more flexible ligaments and may be prone to joint instability. While this flexibility can sometimes be advantageous (as in gymnastics or dance), it also poses risks, such as joint pain, injury, and strain if not managed carefully.

‍