12.2 The hand

Hand dysfunction is commonly linked to ligamentous laxity (Murray 2006). The carpometacarpal joint (CMCJ) of the thumb may be particularly susceptible to weakened ligamentous constraints in the Ehlers-Danlos syndrome (Moore et al 1985). Symptoms may only present if the joint has been subject to excessive trauma, overuse or misuse and thus strains of the surrounding muscles and ligaments may have developed (Wynn Parry 2000). In this chapter, assessment and treatment principles for the hypermobile hand will be discussed, including joint protection advice, energy conservation techniques, strengthening exercises, proprioceptive retraining and surgical principles. In particular, the impact of hypermobility in the hand is explored in relation to musicians, who are often hypermobile, and in relation to writing, which can also be significantly affected by the presence of hypermobility in both adults and children. Musical instrument modifications, writing retraining and the relationship between hypermobility and the development of osteoarthritis will be presented.