Programme excentrique dans le traitement de l’hyperlaxité du coude

Introduction: Joint hypermobility involves an increased range of motion compared to normal amplitudes for the same age, sex and ethnic group. Benign Joint Hypermobility Syndrome (BJHS) affects between 5 and 10% of the Caucasian population but it also concern rare hereditary dystrophies with abnormal collagen structure or metabolism (i.e.: Ehlers-Danlos Syndrome (EDS)). Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom.
Case Report: An EDS patient presented pain in the right elbow and the right wrist after a season of tennis. Her physiotherapy consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken on an isokinetic device after an evaluation. She was also given an orthosis restricting the joint range of motion of the wrist. The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified symmetric values and an improvement in maximal torque of 20 to 25% in all trained muscles of the right elbow. She was also given individualized home exercises.
Conclusion: The goal of rehabilitation is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Thus, muscles were reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises could be carried out safely on an isokinetic device. Indeed eccentric exercises at slow speed and limited range of joint motion avoided risk of luxation. Patients must be informed that it’s a long-term treatment and that in addition to exercises with the physiotherapist personal home exercises are essential.