Title: Ankle joint hypermobility in relation to the postural stability evaluated by the postural somatooscillography method Objectives: The aim of this dissertation is to assess the influence of the local joint hypermobility on the postural stabilization measured by postural somatooscilography. It also compares the postural stabilization ability in case of local ankle joint hypermobility to the constitutional hypermobility on the lower limb including acre. Methods: This thesis has been composed by means of descriptive-associative method using the quantitative research comparing two groups of twelve subjects. The research part was evaluated under standard conditions using the monopedal postural provocation test "3 steps - standing on one leg" which was measured on the instable platform "Posturomed". The test results were logged in application Microswing 6. The recorded data was exported and evaluated by "Posturomed Commander" software. Results: The research has not proved a significant statistical difference between the group with local ankle joint hypermobility and constitutional hypermobility. However, the group with local ankle joint hypermobility was found to have slightly worse results, primarily in the ability of long-term stabilization. Keywords: postural stability, Posturomed, ankle joint,...

Title: An effect of generalized joint hypermobility to the frequency of ankle joint injuries at girls basketball players of the age category U11-U17 Objective: The main objective of this thesis is to assess the frequency of generalized joint hypermobility and its relation to the frequency of injury of the ankle at girls' basketball players of the age from 7 to 16 years. The secondary goal of this work is to evaluate effectiveness of the balance exercises integrated into the experimental group of girls' basketball players. Methods: The theoretical part is elaborated as a recherche of foreign literature in particular. In the practical part, the injury frequency of the ankle is analyzed by the quantitative methods using a survey and the frequency of the generalized joint hypermobility assessed by clinical tests of motion by Carter and Wilkinson, Beighton and Bulbena. Furthermore, a controlled experiment is included in which practice balance exercises had been included to the training of the experimental group of girls' basketball players BK Brandys nad Labem and its effect to the dependent variable, the frequency of the ankle injury, was monitored and compared with the control groups BK Prosek and SK Aritma. Results: In this study the link between the frequency of the ankle injury and the presence of...

Thesis title: Prevalence of hypermobility and its potential impact on ice hockey players injuries. Objectives: The primary goal of this thesis is to outline joint hypermobility based on available literature sources. Focus is on ice hockey players due to reason ice hockey is muscle and contact based sport. Secondary goal is to chart hypermobility presence on ice hockey players and detect possible connection between hypermobility and their previous musculoskeletal system injuries. There will be training improvement suggestions set according to analytical study results. Methods: Theoretical part is based on foreign literature and researches. Practical part quantitative analysis monitors selected joints injury frequency and is focused on joint hypermobility presence in selected junior professional male hockey players, 16 to 19 years old. Information regarding injuries where gathered by questionnaire and joint hypermobility test was set by test battery created for this research using clinical physical tests by Janda, by Sachse, and by Hospital del Mar criteria. Results were analyzed in Microsoft Excel 2010. Hypermobility and injured segments matches were further analyzed. Results: Results of this thesis clearly stated the answers for research questions which were placed. Prevalence of hypermobility in...

A articulação temporomandibular (ATM) representa a ligação da mandíbula com o crânio, ela é uma das articulações mais complexas do corpo humano, devido aos complicados mecanismos envolvidos em seu funcionamento, podendo levar a alta incidência de disfunção temporomandibular (DTM). As DTMs envolvem o sistema mastigatório, afetando músculos, articulações e estruturas relacionadas. São classificadas em DTM muscular, DTM articular e DTM mista (muscular e articular). Subdividindo a DTM articular encontramos a hipermomibilidade condilar ou subluxação, caracterizada pelo deslocamento da cabeça da mandíbula além da eminência articular durante a abertura bucal, condição que predispõe a ATM à sobrecarga mecânica e instabilidade de suas estruturas. Portanto, o objetivo deste estudo foi analisar a relação entre hipermobilidade condilar e abertura bucal máxima, através de radiografias transcranianas. Foram traçadas 57 radiografias transcranianas da ATM, totalizando 114 traçados de articulações temporomandibulares. Sobre o traçado foram confeccionadas retas verticais e paralelas que passaram pelo ponto mais convexo da cabeça da mandíbula na posição de boca aberta e pelo ponto mais convexo da eminência articular. A distância entre as duas retas foi obtida através de paquímetro digital, assim como a medida da abertura bucal máxima durante a tomada radiográfica. Os dados foram analisados estatisticamente através de análise descritiva, teste de correlação e regressão. Foi encontrada uma moderada correlação entre abertura bucal máxima e deslocamento condilar, a média entre as medidas de máxima abertura bucal foi 42,5mm e de deslocamento condilar 5,3mm. Concluindo, o aumento na medida de abertura bucal promove o aumento no deslocamento da cabeça da mandíbula para além do ápice da eminência articular durante o movimento de máxima abertura bucal. / The temporomandibular joint (TMJ) is the link between the mandible and skull. The TMJ is considered one of the most complex joint in the human body due to the complex mechanisms involved in its joint function, which may cause the high incidence of temporomandibular disorder (TMD). The TMDs involves the masticatory system, affecting muscles, joints and related structures. The TMDs are classified in muscular TMD, joint TMD and mixed TMD (muscle and joint). In the subdivision of the joint TMD, we can find the condylar hypermobility or subluxation, which is characterized by head of the mandible displacement jointly with the articular eminence during mouth opening, predisposing the TMJ to mechanical overload and structural instability. Furthermore, the aim of this study was to analyze the relation between condylar hypermobility and maximum mouth opening, using transcranial radiographs. Fifty-seven transcranial radiographs of TMJ and one hundred and fourteen temporomandibular joint were traced. Vertical and parallel straight were made through the most convex point of head of the mandible with maximum mouth opening and the most convex point of articular eminence. The distance between straights and the maximum mouth opening during radiographic were measured by digital caliper. The data were analyzed through descriptive analysis, correlation test and regression test. The results indicated a moderate correlation between maximum mouth opening and condylar displacement. The mean value of maximum mouth opening was 42,5mm, and the mean value of condylar displacement was 5,3mm. In conclusion, the increase in the measurement of mouth opening caused increase in displacement of the head of mandible, which is beyond of the articular eminence apex during maximum movement of mouth opening.

In this thesis I have studied how hypermobile joints affect my violin playing and tried to to find solutions how to cope with hypermobility.  The purpose is to find tools how to change my left-hand technique so that I can play Bach´s Fugue from Solo sonata in g minor in my master concert without pain in my 4th finger and without tension in my left-hand. The goal is to find a way to play with hypermobile joints so that my technique will serve the music in the best possible way.  The biggest questions are: what hypermobility is, how can I cope with it, how to play more relaxed and how to develop a better support for my left-hand little finger, 4th finger.  The thesis will first focus more on the theoretical side of hypermobility in order to get better understanding of what hypermobilty is and how it might affect a violinist. Then I will get more into the aspects of violin playing and my process. After this process I noticed that working with hypermobile joints is a lifelong process. In order to have a good left-hand technique while having hypermobile joints it is crucial to have good muscle control and awareness. The most important thing is to find the right tools that work for yourself while trying to cope with hypermobility.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A articulação temporomandibular (ATM) é uma articulação complexa com características e funções únicas. Certamente é uma das articulações mais utilizadas e seu uso inadequado e excessivo consequentemente promove inúmeros transtornos. Dentre as alterações de hipermobilidade articular, o deslocamento mandibular refere-se ao posicionamento, geralmente anterior, do côndilo mandibular sobre a eminência articular, com completa separação das superfícies articulares e consequente travamento. Quando os episódios se tornam frequentes, algum método de tratamento, seja conservador ou cirúrgico, deve ser utilizado, devido ao grande transtorno funcional e social gerados. A injeção de sangue autógeno na articulação temporomandibular é uma técnica minimamente invasiva, com escassos relatos na literatura e que foi recentemente reintroduzida. Onze pacientes diagnosticados com luxação recidivante da articulação da cabeça mandibular receberam injeções bilaterais de sangue autógeno no compartimento articular superior e região pericapsular. Em acompanhamento, que variou de 24 a 35 meses (média de 29,6 meses), 3 (27,3%) pacientes apresentaram recidivas. O mesmo protocolo de tratamento foi repetido para estes três casos, porém sem sucesso, sendo então encaminhados para procedimento cirúrgico de eminectomia. Dessa forma, dos 11 pacientes inicialmente tratados, 8 (72,7%) não apresentaram episódios de deslocamento mandibular recorrente após o procedimento proposto. Trata-se de um procedimento simples, rápido, pouco invasivo, de baixo custo e com mínima possibilidade de complicações, sendo uma alternativa de tratamento viável, antes de se indicar procedimentos cirúrgicos. / The temporomandibular joint (TMJ) is a complex joint with unique features and functions. It is certainly one of the most used joints and its improper and excessive use consequently promotes numerous breakdowns. Among the changes of joint hypermobility, the mandibular displacement refers usually as an anterior displacement of the condyle on the articular eminence with complete separation of the articular surfaces and consequent locking. When episodes become frequent, some method of treatment, either conservative or surgical, should be used, because of the functional and social disturbances. The injection of autologous blood in the temporomandibular joint is a minimally invasive technique, recently reintroduced. Eleven patients diagnosed with recurrent mandibular dislocation received bilateral injections of autologous blood in the upper joint compartment and pericapsular region. In follow-up ranging from 24 to 35 months (mean 29.6 months), 3 (27.3%) patients had recurrences. The same treatment protocol was repeated for these cases without success and were taken to surgical eminectomy. Thus, of the 11 patients initially treated, 8 (72.7%) didnt show any episode of recurrent mandibular dislocation after the proposed procedure. It is a simple, quick, minimally invasive procedure, with low cost and with minimal possibility of complications making a viable alternative treatment before recommending surgical procedures.

A articulação temporomandibular (ATM) representa a ligação da mandíbula com o crânio, ela é uma das articulações mais complexas do corpo humano, devido aos complicados mecanismos envolvidos em seu funcionamento, podendo levar a alta incidência de disfunção temporomandibular (DTM). As DTMs envolvem o sistema mastigatório, afetando músculos, articulações e estruturas relacionadas. São classificadas em DTM muscular, DTM articular e DTM mista (muscular e articular). Subdividindo a DTM articular encontramos a hipermomibilidade condilar ou subluxação, caracterizada pelo deslocamento da cabeça da mandíbula além da eminência articular durante a abertura bucal, condição que predispõe a ATM à sobrecarga mecânica e instabilidade de suas estruturas. Portanto, o objetivo deste estudo foi analisar a relação entre hipermobilidade condilar e abertura bucal máxima, através de radiografias transcranianas. Foram traçadas 57 radiografias transcranianas da ATM, totalizando 114 traçados de articulações temporomandibulares. Sobre o traçado foram confeccionadas retas verticais e paralelas que passaram pelo ponto mais convexo da cabeça da mandíbula na posição de boca aberta e pelo ponto mais convexo da eminência articular. A distância entre as duas retas foi obtida através de paquímetro digital, assim como a medida da abertura bucal máxima durante a tomada radiográfica. Os dados foram analisados estatisticamente através de análise descritiva, teste de correlação e regressão. Foi encontrada uma moderada correlação entre abertura bucal máxima e deslocamento condilar, a média entre as medidas de máxima abertura bucal foi 42,5mm e de deslocamento condilar 5,3mm. Concluindo, o aumento na medida de abertura bucal promove o aumento no deslocamento da cabeça da mandíbula para além do ápice da eminência articular durante o movimento de máxima abertura bucal. / The temporomandibular joint (TMJ) is the link between the mandible and skull. The TMJ is considered one of the most complex joint in the human body due to the complex mechanisms involved in its joint function, which may cause the high incidence of temporomandibular disorder (TMD). The TMDs involves the masticatory system, affecting muscles, joints and related structures. The TMDs are classified in muscular TMD, joint TMD and mixed TMD (muscle and joint). In the subdivision of the joint TMD, we can find the condylar hypermobility or subluxation, which is characterized by head of the mandible displacement jointly with the articular eminence during mouth opening, predisposing the TMJ to mechanical overload and structural instability. Furthermore, the aim of this study was to analyze the relation between condylar hypermobility and maximum mouth opening, using transcranial radiographs. Fifty-seven transcranial radiographs of TMJ and one hundred and fourteen temporomandibular joint were traced. Vertical and parallel straight were made through the most convex point of head of the mandible with maximum mouth opening and the most convex point of articular eminence. The distance between straights and the maximum mouth opening during radiographic were measured by digital caliper. The data were analyzed through descriptive analysis, correlation test and regression test. The results indicated a moderate correlation between maximum mouth opening and condylar displacement. The mean value of maximum mouth opening was 42,5mm, and the mean value of condylar displacement was 5,3mm. In conclusion, the increase in the measurement of mouth opening caused increase in displacement of the head of mandible, which is beyond of the articular eminence apex during maximum movement of mouth opening.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A articulação temporomandibular (ATM) é uma articulação complexa com características e funções únicas. Certamente é uma das articulações mais utilizadas e seu uso inadequado e excessivo consequentemente promove inúmeros transtornos. Dentre as alterações de hipermobilidade articular, o deslocamento mandibular refere-se ao posicionamento, geralmente anterior, do côndilo mandibular sobre a eminência articular, com completa separação das superfícies articulares e consequente travamento. Quando os episódios se tornam frequentes, algum método de tratamento, seja conservador ou cirúrgico, deve ser utilizado, devido ao grande transtorno funcional e social gerados. A injeção de sangue autógeno na articulação temporomandibular é uma técnica minimamente invasiva, com escassos relatos na literatura e que foi recentemente reintroduzida. Onze pacientes diagnosticados com luxação recidivante da articulação da cabeça mandibular receberam injeções bilaterais de sangue autógeno no compartimento articular superior e região pericapsular. Em acompanhamento, que variou de 24 a 35 meses (média de 29,6 meses), 3 (27,3%) pacientes apresentaram recidivas. O mesmo protocolo de tratamento foi repetido para estes três casos, porém sem sucesso, sendo então encaminhados para procedimento cirúrgico de eminectomia. Dessa forma, dos 11 pacientes inicialmente tratados, 8 (72,7%) não apresentaram episódios de deslocamento mandibular recorrente após o procedimento proposto. Trata-se de um procedimento simples, rápido, pouco invasivo, de baixo custo e com mínima possibilidade de complicações, sendo uma alternativa de tratamento viável, antes de se indicar procedimentos cirúrgicos. / The temporomandibular joint (TMJ) is a complex joint with unique features and functions. It is certainly one of the most used joints and its improper and excessive use consequently promotes numerous breakdowns. Among the changes of joint hypermobility, the mandibular displacement refers usually as an anterior displacement of the condyle on the articular eminence with complete separation of the articular surfaces and consequent locking. When episodes become frequent, some method of treatment, either conservative or surgical, should be used, because of the functional and social disturbances. The injection of autologous blood in the temporomandibular joint is a minimally invasive technique, recently reintroduced. Eleven patients diagnosed with recurrent mandibular dislocation received bilateral injections of autologous blood in the upper joint compartment and pericapsular region. In follow-up ranging from 24 to 35 months (mean 29.6 months), 3 (27.3%) patients had recurrences. The same treatment protocol was repeated for these cases without success and were taken to surgical eminectomy. Thus, of the 11 patients initially treated, 8 (72.7%) didnt show any episode of recurrent mandibular dislocation after the proposed procedure. It is a simple, quick, minimally invasive procedure, with low cost and with minimal possibility of complications making a viable alternative treatment before recommending surgical procedures.

Temporomandibular dysfunction (TMD) include a variety of clinical problems that reach the temporomandibular joint, masticatory muscles and associated structures. Generalized joint hypermobility (GJH) has been reported as a predisposing factor for the occurrence of TMD. However, no consensus has been reached concerning this relation. This study aims to verify the incidence of GJH in individuals with TMD and asymptomatic individuals and their relation with clinical aspects and electrical activity of the masticatory muscles. 61 female volunteers were evaluated (34 individuals with TMD and 27 asymptomatic), with ages from 18 to 35 years, diagnosed with and without TMD by the Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD). The participants were evaluated according to the presence of GJH through the Beighton Score. Electromyographic exams of the masseter and anterior temporal muscles were carried out, bilaterally, in mandibular rest, maximum intercuspal and mastication. A presence of 64.71% of GJH in individuals with TMD and 40.74% in the asymptomatic group was verified. A moderate positive correlation was observed between the GJH scores and the amplitude of passive mouth opening (p=0.0034), with pain (p=0.0029) and without pain (p=0.0081) in the TMD group. In this group, the individuals with GJH presented higher values of range of mandibular movement, except for protrusion. There was an opening mandibular range of movement with pain (p=0.0279) significantly higher in the group with TMD and GJH. Multiple diagnoses, according to RDC/TMD were present in most of the individuals with TMD. All subjects presented myofascial pain and 91.12% presented some joint impairment, especially arthralgia (79.41%). Disc disorders were present in 41% of the subjects. In the electromyographic evaluation, larger levels of resting electrical activity of temporal muscles were noted in relation to the masseters in individuals with TMD, with statistical significance for the left temporal muscle (p=0.0352). The volunteers with TMD and GJH presented larger values of RMS of the masticatory muscles in relation to individuals without hypermobility, with values in hyperactivity level for temporal muscles and statistical significance for the right masseter (p=0.0232) and left masseter (p=0.0129) muscles. In mastication, higher EMG activity was recorded in the control group, with significant difference for the right temporal muscle (p=0.0286). However, no significant difference was found regarding the presence of GJH. From these results, it can be concluded that individuals with TMD associated or not to GJH do not differ regarding the clinical aspects evaluated, except in relation to the mandibular opening range of movement. Electrical activity seems to have been influenced by GJH. The highest level of electrical activity observed in the subjects with GJH suggests that articular instability may lead to difficulties in the modulation of muscular contraction for the maintenance of the mandibular resting position. / A disfunção temporomandibular (DTM) abrange uma variedade de problemas clínicos que atingem a articulação temporomandibular, músculos mastigatórios e estruturas associadas. A hipermobilidade articular generalizada (HAG) é uma condição sistêmica que tem sido considerada como fator contribuinte para o desenvolvimento de sinais e sintomas da DTM, porém, não existe um consenso sobre essa relação. Este estudo teve como objetivo verificar a prevalência de HAG em indivíduos com DTM e assintomáticos e sua relação com aspectos clínicos/psicossociais e a atividade elétrica dos músculos mastigatórios. Foram avaliados 61 voluntários do gênero feminino (34 indivíduos com DTM e 27 assintomáticos), com idades entre 18 e 35 anos, diagnosticados com e sem DTM pelo Inventário Critérios de Diagnóstico para Pesquisa de Desordens Temporomandibulares (RDC/TMD). Os participantes foram avaliados quanto à presença HAG pelo Escore de Beighton. O exame eletromiográfico dos músculos masseter e temporal anterior foi realizado, bilateralmente, em situação de repouso mandibular, máxima intercuspidação e mastigação. Verificou-se presença de HAG em 64,71% indivíduos com DTM e 40,74% no grupo de assintomáticos. Foi observada correlação positiva moderada entre os escores de HAG e a amplitude de abertura bucal passiva (p=0,0034), com dor (p= 0,0029) e sem dor (p=0,0081) no grupo com DTM. Neste grupo, os indivíduos com HAG apresentaram maiores valores de amplitude de movimento mandibular, exceto para a protrusão. Houve amplitude de abertura com dor (p=0,0279) significativamente maior no grupo com DTM e HAG. Múltiplos diagnósticos estiveram presentes na maioria dos indivíduos com DTM, sendo que todos apresentaram dor miofascial e 91,12% algum comprometimento articular, especialmente artralgia (79.41%). Desordens discais estiveram presentes em 41% dos sujeitos. Elevados percentuais de depressão e sintomas físicos não específicos foram observados em indivíduos com DTM, independente da presença de HAG. Na avaliação eletromiográfica, observaram-se maiores níveis de atividade elétrica de repouso dos músculos temporais em relação aos masseteres nos indivíduos com DTM, com significância estatística para o músculo temporal esquerdo (p=0,0352). Os voluntários com DTM e HAG apresentaram maiores valores de RMS dos músculos mastigatórios em relação aos indivíduos sem hipermobilidade, com valores em níveis de hiperatividade para os músculos temporais e significância estatística para os músculos masseter direito (p=0,0232) e esquerdo (p=0,0129). Na mastigação, maior atividade EMG foi registrada no grupo controle, com diferença significativa para o músculo temporal direito (p=0,0286), porém não houve diferença significativa quanto à presença de HAG. A partir destes resultados, conclui-se que indivíduos com DTM associada ou não à HAG não diferem quanto aos aspectos clínicos e psicossociais avaliados, exceto quanto à amplitude de movimento de abertura mandibular. A atividade elétrica parece ter sido influenciada pela HAG. O nível mais elevado de atividade elétrica de observada nos sujeitos com HAG sugere que a instabilidade articular possa levar à dificuldade na modulação da contração muscular para manutenção da posição de repouso mandibular.

ABSTRACT Purpose:  This study aims to describe how major symptoms of pain and fatigue affect occupational performance and adaptation of individuals with Ehlers-Danlos Hypermobility Type (hEDS). Method: Eleven individuals with hEDS (2017 diagnostic criteria) were interviewed using a semi-structured questionnaire. The data was analysed following Giorgi’s modified five steps descriptive phenomenological method.  Results:  The following six occupational adaptations emerged during data analysis: Experiences of body unconsciousness, conserving energy in activities, goal setting, restricted physical and social environment, new family role, and healthcare system interventions. Conclusions:  Experiences of severe fatigue and episodes of severe pain affected the occupational adaptation of daily performance, routines, occupational choices and social and physical environment. IMPLICATIONS FOR REHABILITATION Occupational therapists working with individuals with hEDS need to take into consideration the impacts of chronic pain and fatigue on occupational performance and identity.