Case of the Month #30: Pain and Hypermobility

Miss L was assessed by the patient’s local pain service’s multidisciplinary team. This was a joint initial assessment with a doctor in pain medicine and a specialist physiotherapist. She told them her story of pain, explaining that she had suffered with aching joint pain and widespread tenderness for many years. 

She recalled it began soon after she started secondary school, when she would get aching joints the following day after PE. She loved dancing and gymnastics and worked hard to join the school’s gymnastic squad, training hard in her teenage years. She was known for being flexible and was able to compete at a regional level with her team. Over the years, her pain gradually increased and started to impact on her ability to train. By the time she left school for university, her pain was present on most days. She found the move away from home quite stressful and struggled to finish her first year, after taking lots of time off because of her pain. She eventually completed her degree and got a job in hospitality, which required lots of standing and long hours. She met her partner in her new role, and they had two children. She had recently returned to work in the hospitality sector and was now struggling to juggle her demanding role as well as look after her children. 

She disliked painkillers because of the thought of being dependant on them, but she did have co-codamol 30/500, which she used most mornings to get going and took extra in the afternoon to allow her to get tasks done. She also had occasional ibuprofen, although it was of minimal benefit. She was on no other medication and she had no other significant past medical history.  

• What other conditions are characterised by joint hypermobility?
• Are there any other clinical features you would look for on assessment?
• What would you consider when formulating a management plan with Miss L?