Discover and read the best of Twitter Threads about #hsd

Most recents (20)

We should take some of the most replicated findings in #MECFS and study them in #longCOVID patients. Some of these findings, if also present in #longCOVID, *could* potentially imply avenues for symptom management or therapeutic treatment.
Here are a few that might be interesting:
1️⃣Low serum carnitine: me-pedia.org/wiki/Carnitine
2️⃣ Low natural killer cell function: me-pedia.org/wiki/Natural_k…
3️⃣ Elevated lactate (blood, brain): me-pedia.org/wiki/Lactic_ac…
4️⃣ Cerebral hypoperfusion: me-pedia.org/wiki/Brain#Blo…
Read 25 tweets
EXERCISE FOR #FIBROMYALGIA & HYPERMOBILITY SPECTRUM DISORDER (#HSD) 1/4/2020:
@EmLyWill: “Androgens seem to promote growth and maintenance of connective tissues like tendons and muscles. Estrogen promotes similar growth but also rapid turnover-- something not seen with androgens. So musculoskeletal connective tissue will simply be weaker in females”.
“Deconditioning also lowers testosterone further decreasing muscle mass creating a challenging viscous cycle! Regaining lean mass is crucial in #ehlersdanlossyndromes and any #pain condition!”
Read 101 tweets
#IBS & #TMJ: an interesting essay showing why these seeming separate disorders are related; with emphasis on TMJ etiology.
Relation of IBS & TMJ: The nexus is hyper-mobile joints. TMJ occurs in TM joint of face uppermost in people who chronically tilt head; oft associated w. scoliosis (common in #HSD) & d/t Masseter muscle spasm attempting to maintain normal dental occlusion.
#IBS is associated with ligament laxity of SIJ & autonomic nervous system impingement within contiguous presacral plexus, which tracts to intestine; #IBS is a #dysautonomia. These are my clinical observations and theories
Read 17 tweets
“Hip” is socket (acetabulum) where femur (upper leg bone) inserts into pelvis (ilium/ischium). If hip were to dislocate, person would have excruciating pain & be unable to stand/walk. Sacroiliac joint (SIJ) is 17 cm square in area; vs. ilium & sacrum/coccyx (tail bone)....
SIJ commonly subluxes in pwHSD, generating painful ligament stretch interpreted as low back/hip pain in 13-30% pwLow Back Pain. When SIJ subluxes, Ilium rotates CW or CCW around a virtual transverse axis from Right to Left & through both mid-SIJs ....
Rotation of Ilium relative to Sacrum creates an oblique relationship of contours of the two bones. In a lean person, & depending on whether there is a CW or CCW rotation, the tail bone can appear to become stationed closer to the hip region on that side....
Read 15 tweets
CARDIOLOGY & #HSD & #PANIC ATTACKS

pwHSD=persons with HSD
HSD=Hypermobility Spectrum Disorder
MVP=Mitral Valve Prolapse
PA=Panic Attack
For decades, doctors have been aware of a relationship vs. Mitral Valve Prolapse & Anxiety Attacks. Lack of physiologic understanding caused many sufferers to be labeled “psychologic”.
In these patients who had frequent Panic Attacks, the primary etiologic factor was oft regarded to be an anxiety-infused mind driven by a“hysteria”.
Read 38 tweets
By my estimation about 15% of the population is beset with hypermobility tissue variations, and most are women. These tissue variations are genetic traits & seemingly conserved within the population.
It might be a consideration that occurrence of these tissue variations negatively impacts the incidence of population-wide fecundity and procreativity. I do not know if anyone has studied this hypothetical dynamic.
Read 40 tweets
Twitter thread about these relationships follows:
ANXIETY AND PANIC ATTACKS:
I have my own theories about these disorders in those with #HSD. Panic attacks are common in persons with #Fibromyalgia, the patient population I study.
Often people with #Fibromyalgia come to me by way of federally-funded clinic Psychologists, who are treating them for psychologic disorders. They want me to prescribe major psych meds.
Read 19 tweets
My regard: ligaments in those with #HSD are super flexible & hyper loose, but not stretchable. Normally, ligaments resist being stretched, & reason for confessions during Spanish inquisition (on the rack). Muscle spasms are unconscious attempts to compensate for joint laxity. t.co/M8rLtd52nG
I agree, “bendy” is not correctly illustrative & too carnivalesque. Better terms to describe anatomical characteristics of persons with #HSD are “tilt” & “twist”. A good portion of persons have a palpable scoliosis when upright; oft absent prone, thereby “functional” because ...
vertebral disks are specialized ligaments holding bones of vertebral spine together & being flexible they twist (a word better understood by laypeople than “scoliosis”) as spine-post bears weight of upper body; oft on platform of an unstable pelvic platform. Gravity impress ....
Read 25 tweets
DYSPAREUNIA:
Many years ago, I encountered a young woman who had pelvic pain and dyspareunia. “Jane” suffered from chronic low back pain & with pelvic pain during intercourse, “dyspareunia”.
Jane consulted a Gynecologist who told her that vaginal prolapse was cause of her dyspareunia. Many visits were taken in attempt to deal with her problem: pessaries, creams, etc. Nothing helped.
Finally, the Gynecologist wrote a consultative note that she now considered that Jane was experiencing pain originating from a “musculoskeletal” disorder. Jane came to my office.
Read 41 tweets
Unilateral dominance of chronic pain & disability is something I commonly see in the #fibromyalgia patients I study. My theory is that they injure one side of their low back. The explanation seems to be in the pelvis...
The pelvic girdle is a bony ring & is platform for the spine. When the pelvis is fractured it commonly breaks in two places on the ring. However, forces that are not strong enough to fracture bone can tear ligaments.
When pelvic joint ligaments are injured, it usually occurs to one of the sacroiliac joints (SIJ). My guess is that impact of injury springs one joint first; tearing ligaments here first & this defuses/decompresses force from injuring other SIJ; protecting it.
Read 9 tweets
I think you are expressing that baseline inherited ligament laxity potentiates additional ligament laxity. This seems correct. In medicine we call ligaments, “plastic tissues”. They can be lengthened if exposed to chronic repetitive stretch. Ligaments connect bones at joints.
Each joint has a normal range of motion. Ligaments hereditarily & excessively stretchable endow joints w. greater range of motion (ROM). Over time joints experience repeated mechanical stress of forced ROM & repetitive mechanical stress tends to stretch ligaments into new lengths
Over time, as ligament becomes longer, this endows joint w. even greater ROM. Greater ROM of joint imposes greater angular moment of force on ligament, with additional excessive stretching. The dynamic of stress-ROM-stretch magnifies over time; lengthening this plastic tissue.
Read 10 tweets
COSTOCHONDRITIS : is more common in women. Etiology can be related to trauma, but IMO most is related to repetitive stress. The loci of pain occur in regions where the rib (bone=costo) joins with chondro (cartilage) tissue of connection with the breast bone (sternum).
The reason for inflammation seems to be that the connections incur repetitive mechanical stress. The structure of the chest wall (all the ribs) is like a barrel. All the ribs connect to the spine in the back and breast plate (sternum) in the front.
Commonly there is a twist in the spine as either a kyphosis (curve forward) or scoliosis (curve sideways) or scoliosis with a rotation (clockwise or counter-clockwise as seen from above). These curvatures shift the ribs askew & the neat lineup of ribs & sternum is interrupted.
Read 15 tweets
Hydromorphone (dilaudid) not interact with CYP-450 enzyme system, but rather metabolized by another pathway. Many patients w. EDS have defective CYP-450 metabolism, a genetic trait, so the active metabolites of other opiates are underproduced, resulting in ineffective analgesia. t.co/Hr0vn5P7GT
Dr. Tenant demonstrated many of the more widely promoted (by doctors) analgesics like hydrocodone (Norco) are metabolized by CYP-450 enzymes & in many people there are genetic defects (CYP-2D6, CYP-2C9, CYP-2C19) that ineffectively generate the active metabolite, w. ill results.
Doctors are mostly ignorant of these enzyme dynamics. When patients complain of ineffective analgesia, doctors assume the patient is “drug seeking”. Once branded, the patient commonly finds resistance vs. opiates from other doctors who review the medical record.
Read 9 tweets
An interesting inquiry: what is primary and what is secondary? t.co/BJIYB1bWvT
The question is whether the primary etiology of hypermobility of soft tissues is ineffective nutrition having been used. Also, could improper nutrition be a co-factor in development of hypermobile tissues?
NUTRITIONAL DEFICIENCIES IN GI DYSFUNCTIONS ASSOCIATED WITH HYPERMOBILITY SPECTRUM DISORDER (#HSD): Issue has been raised about nutritional deficiencies associated with #HSD & whether deficiencies lead to connective tissue defects manifest as abnormal soft tissue hypermobility.
Read 38 tweets
CRPS is devastating and medical consensus is that cause is unknown. Based on my clinic experience, I will offer my opinion about the etiology of Chronic Regional Pain Syndrome (CRPS).
As stated in the video, CRPS usually afflicts one extremity & among signs and symptoms there are dysautonomias: paresthesias & vascular changes. Obviously, the autonomic nervous system is affected.
In those with CRPS of the upper extremity I have examined, a constant finding has been premonitory Thoracic Outlet (TO) Syndrome (TOS); whereat the brachial neurovascular bundle & contiguous autonomic nerves to arm are intermittently impinged within the TO.
Read 30 tweets
#FIBROMYALGIA CAUSATION A LINEAR EQUATION? Theory might regard “fibromyalgia” to be a label for a variety of disorders that have simply devolved from patterns of chronic widespread pain. A Twitter Thread....
Do neural pain fiber activities initiate mast cell degranulation that then cause other populations of nerves to activate? Does degranulation occur regionally to generate a specific pattern of tissue disfunction? Does ligament pain arouse mast cell degranulation?
IMO, #MCAS association w. #Fibromyalgia requires other insights. Body stress/assault, beset w. pain & marginal metabolic activity, arouses General Alarm Response (after Hans Selye & Walter Cannon) & hyper-dynamic hormonal/immunologic functions needed for organism survival.
Read 21 tweets
AN HOLISTIC THEORY OF FIBROMYALGIA - ESCALATING SYMPTOMS: Recent tweets re: #Fibromyalgia expressed ideas that each setback (symptom escalation, operation, injury etc) incited regression of baseline functioning & pain control.
Setbacks are directly related to etiology of #Fibromyalgia, & which I use as a model of chronic #HSD problems in this tweet thread. IMO, etiology is an unstable body tower, d/t loose joints, under repetitive assault by gravity; a soft tissue repetitive stress disorder.
In #Fibromyalgia sufferers, tissues supporting unstable upright body tower evolve chronic spasms experienced as chronic widespread pain (CWP). Loose joints, which incite tilted body tower, begin secondary to innate ligament laxity &/or injury.
Read 19 tweets
A query was offered about my comment that ligament laxity was common to #TMJ & #IBS: “So, you would say the two are not connected other than the fact that the person has joint laxity.” My response to this comment is as follows: t.co/tNubAPSukU
In patients with only complaint of TMD (Temporal Mandibular Joint, TMJ, Disorder) there seems to be near universal generalized joint hypermobility (#HSD). TMD seems to occur mostly in women.
In persons who complain only of symptoms that prove to be #IBS, the near universal finding is sacroiliac joint (SIJ) hypermobility.
Read 6 tweets
DIAGNOSIS: FM, hEDS, & HSD
#Fibromyalgia, #HSD, & #hEDS are subjects of this Twitter Thread. I am a General Medical Doctor who encounters these types of patients.
Undoubtedly, #HSD & #hEDS have genetic underpinnings. My speculation is that the majority, but not all, of the #fibromyalgia patients have clinically manifest joint hyper-mobility & genetic variations as part-cause of their disorders. Below I suggest a study of this matter.
Besides the usual Beighton hyperextensions, clinical manifestations of hyper-mobility include scoliosis (vertebral spine disks are specialized ligaments) & Genu valgus & varum, but that is not all ...
Read 25 tweets

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