Hypermobility in children

Hypermobility can be a normal variant in children but it is also found in a group of children presenting with musculoskeletal pain. A smaller group of children will have hypermobility associated with a more concerning syndrome. The clinical challenge is to differentiate those children who have isolated hypermobility with no other associations from those with syndromes that have potentially life limiting complications. In this review we will discuss the assessment of and provide a framework for classifying those children who are found to be hypermobile. We review the components of connective tissue and describe where known the genetic basis for particular phenotypes. In 2017 the international classification of Ehlers Danlos (EDS) was published which supersedes the Villefranche classification. This review describes the diagnostic criteria for the common subtypes of EDS, provides information on further differentials and discusses the management options.