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#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 ...
Gillette & Forward Flexion Test Signs of sacroiliac joint (SIJ) hyper-mobility (well reported in Osteopathic literature) unknown to most practicing Physicians. Most unfortunate because SIJ is largest joint in axial spine & disorder of which is key to #fibromyalgia evolution.
The sacroiliac joints (SIJ) are near vertical, connected by several ligament systems, & bear weight of entire upper body. A massive task. When sacroiliac joint ligaments are loose/hyper-flexible, they tether SIJ ineffectively & become exposed to mechanical injury.
An injured SIJ generates low back pain. The medical literature reports that 13-30% of persons with chronic low back pain experience pain generation from dysfunctional sacroiliac joints. The pattern of pain generated cannot be distinguished from lumbar-generated pain.
Unfortunately doctors are mostly ignorant about SIJ pain generation & how to diagnose it. They fault “DDD” when the Radiologist’s report says, “Degenerative Disk Disease”, which in truth does not generate pain; a concept unknown to most doctors.
The SIJ diagnostic dilemma is fostered by the fact that soft tissues & ligaments are mostly translucent to X-rays. As to MRIs, I have found that, excepting for vertebral disks, Radiologists mostly ignore ligaments and do not know how to read them.
The most accurate sign of sacroiliac joint (SIJ) instability is #Badgley Book Sign. After years of clinical investigations, I found that sitting upright on a firm chair with a firm 1” bolster (Guideon Bible works nicely) under butt bone (Ischium) reveals SIJ instability ...
#BADGLEY BOOK SIGN: On sciatica side book often forces SIJ into nutation, rotating SIJ slightly, causing upper leg to become longer than other leg (compared at front of knees). Then, when the book is placed under other butt bone, SIJ rotates slightly in other direction ...
Placing book on opposite side tips upper body weight over above loose SIJ, causing rotation of counter-nutation, & upper leg shortens compared to normal side. Both nutation & counter-nutation in same patient reflect severe SIJ injury in persons with “miserable” low back pain.
I first published these clinical findings of #Badgley Book Sign in Practical Pain Management (on-line) in September 2007 (“Sacroiliac Joint Disorder”). Title of the paper was originally, “Cause of #Fibromyalgia”, but editor changed it.
In 2013, I presented X-ray proof of the #Badgley Book Sign in Dubai, at the Interdisciplinary World Congress on Low Back & Pelvic Pain.
An unstable sacroiliac joint exposes upper body tower to tilting & causes chronic repetitive stress injury to soft tissues attempting to hold weighty tower upright against gravity; inciting myriad of ischemic anoxic pain foci throughout body (aka known as pain of #fibromyalgia).
So who is vulnerable to SIJ disorder? I suppose there is group widely dispersed within population (mostly women) with truly “benign” Joint Hyper-mobility; asymptomatic & commonly with “double jointedness”. I regard all potential set-ups for pelvic girdle injury & #fibromyalgia.
IMO, birthing can cause some with hyper-mobility to become injured & symptomatic. The medical literature reports that mundane bending & lifting events can cause permanent SIJ injury in vulnerable people. Practicing Physicians are mostly ignorant about ideas in this thread.
This physician ignorance is a major reason that causes & nature of #fibromyalgia have been overlooked, literally. Undress (to undies) persons with fibromyalgia & examine them standing & sitting is the way to see them. Scoliosis of hyper-mobility mostly resolves lying down.
Persons with #HSD & #hEDS are particularly stationed as potential set-ups for sacroiliac joint injury, crookedness of their upper body towers & evolution, over months & years, to #fibromyalgia. This is reason to identify these persons.
IMO: #hEDS patients need at least one consultation (for confirmation) by physician expert at tertiary tier medical center. #Fibromyalgia patients should have at least one second opinion by local community-based (second tier) Rheumatologist. I am primary tier in clinical trenches.
IMO, most #Fibromyalgia & all #HSD & all #hEDS exist somewhere along a spectrum of soft tissue (ligament) genetic disorder/penetrance; with most sufferers in a sphere of joint hyper-mobility. I always liked “Joint Hyper-mobility Syndrome” as a descriptor; but things change.
#Fibromyalgia (FM) occurs in some women/men absent genetic-inherited joint hyper-mobility, and these persons commonly have focal joint hyper-mobility (of sacroiliac joints), and due to bio-mechanical injury; especially in men with FM.
I am curious as to genetic nature of anyone who is hyper-mobile (Beighton) & symptomatic; no matter where they are on the hyper-mobility spectrum. I would like to refer these patients directly to a community-based lab for genetic testing for possible #hEDS diagnosis.
Do sufferers who have “just” Fibromyalgia (FM) have genetic variations reflected as hyper-mobility? Do purported genetic variations in FM differ from variations in persons with manifest #hEDS? Can FM be sorted out by genetic variations distinct from those of hEDS?
I need assistance to study these matters. Please Direct Mail (DM) me on Twitter identity of community-based CA lab where genetic testing is obtained. Also DM specific titles of separate lab terms for tests you might have had & for what diagnosis; t’is necessary for Med insurance.
My dreams would be to raise grant money for such a study. The US military harbors thousand of young people with treatable #fibromyalgia from pelvic girdle injuries. Application of my methods of diagnosis & #Prolotherapy could save billions of $. Take note @RegenexxCayman.
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