The few people out there who know anything about Ehlers Danlos Syndrome are unaware that it is possible to have this suffering without hypermobile limbs. We refer to them as stiff zebras. Hypermobility is not required. In the most severe form of Ehlers Danlos (a spectrum disorder), there are people who are hypermobile and people who are stiff. Some family members are hypermobile and others are not and they are all within the same subtype of EDS. The Brighton criteria discusses what requirements there are for joint hypermobility syndrome and EDS. They have to have hypermobility OR arthralgia. So, if you learn about somebody with Ehlers Danlos Syndrome who is not hypermobile know they are in an equal amount of pain as those who are.
What we do have in common in addition to daily muscle pulling, stretching, tearing, and pains is included below. Not everyone will have the same ones but this is a general list.
Joints:
• Different types of EDS have differing degrees of joint problems.
Joint dislocation and incomplete dislocation called subluxation is
common and recurrent.
• Spontaneous easy reduction or replacement of the finger digits
and shoulders occurs.
• Hypermobile joints cause pain, and sometimes the "cracking" or
"popping" of them feels like it relieves the pressure.
• ‘Pes planus’ or being flatfooted is common and feet can flatten
even more as one ages.
• EDSers can develop osteoarthritis earlier than typical, and they
often have difficulty or pain walking. They can appear klutzy.
• Some EDSers’ hands collapse from the pressure of a simple
handshake. It is difficult to write, and often finger splints help a
great deal.
• Cervical (neck) instability occurs in some types, and some people
may have trouble holding up their head. • Another frequent joint problem is fluid effusions into the knees,
ankles and elbows, primarily in Classical or Kyphoscoliosis types. (effusion: The escape of fluid from the blood vessels or lymphatics into the
tissues or a cavity)
• In the Kyphoscoliosis type, many infants have severe muscle
hypotonia (floppy babies), generalized joint laxity and scoliosis at
birth, or develop a progressive scoliosis (a curvature of the spine)
within their first year of life.
• With Vascular EDS, joint hypermobility may be limited to the small
joints of the feet and hands or may be very lax all over. As with
other types, VEDS patients often are first diagnosed as
hypermobile, only later learning that they have VEDS!
Skin:
General EDS skin traits include:
• Easy bruising, delayed wound healing, differing types of scarring.
• Thinner skin than normal, especially in the Vascular type.
• Those with VEDS have translucent skin where the blood vessels
below are clearly visible.
• Soft, velvety skin that is fragile and sometimes highly elastic
(stretchy) is found, especially in the Classical type.
• Classical type EDS may experience wounds that split open with
little bleeding and leave scars that widen over time to create
characteristic shallow "cigarette paper" scars.
• Surgical incisions may present problems with healing, with stitching
EDS skin sometimes described as "like sewing butter." often
requiring sutures being closer together and left in for a longer time
than usual.
• With severe CEDS, even just leaning on the table with your elbows
can cause the skin to split or may have molluscoid pseudotumors
on elbows and knees.
(molluscoid pseudotumors are small, spongy tumors consisting of fat surrounded
by a fibrous capsule found over scars and pressure points).
• Skin that sags and wrinkles is characteristic of the
Dermatosparaxis type of EDS. Extra (redundant) folds of skin may
be present as affected children get older.
• Skin hyperextensibility to some degree occurs in all types of EDS
except Vascular.
Cardiovascular:
• People with EDS tend to have low body temperatures, may have
trouble controlling their body temperatures when exposed to heat
or cold, and many have blood pressure problems.
• Some have dilated aortic roots, incompetent heart valves, and
autonomic dystonia or POTS (a syndrome where you have wide
and serious blood pressure swings with position changes).
• Many people with EDS bruise very easily and often severely. It can
be difficult for a medical professional to "feel" their pulse.
• Mitral valve prolapse is not a sign of EDS, though someone with
EDS may have MVP; it is not diagnostic for this syndrome.
Neurological Symptoms:
• Poor balance, severe headaches including migraines .
• Decreased deep tendon reflexes.
• Intracranial vascular abnormalities.
• Brain "fog", a sense of not being present; absence of focus or a
lack of clarity
• Spinal stenosis (narrowing of spinal column) and/or scoliosis. • Chiari malformation (the brain tonsils protrude down through the
forum at the base of the brain) occurs in some EDS patients.
Dental:
• Half of all EDS patients have a hypermobile tongue, and are able
to touch at least the end of their nose with it easily.
• A high palate and crowded baby and adult teeth are common,
even though many EDS patients have smaller than normal teeth.
The high palate and smaller teeth can make fitting dentures very
difficult even when explained to the dentist prior to the dentures
being made.
• Pre-molar and molar teeth often have high cusps and deep fissures
with root problems, and enamel hypoplasia can cause decay and
possible early extractions. Sometimes teeth actually crumble when
losing the enamel.
• Patients with Classical type offer suffer with juvenile periodontal
disease. All EDSers are cavity prone, and have increased bleeding
from anywhere in the oral cavity due to the fragility of tissues.
Braces can cause problems as they can damage the gums and
tongue while moving teeth quickly.
• TMJ (temporomandibular joint) pain and clicking occur in about 30%
of the general population, and about the same incidence occurs in
EDSers. Often if in a dental chair with your mouth open for an
extended period of time, the joint will repeatedly sublux. Taking a
pillow so you can prop your hand up to support your jaw during
the procedure will prevent it from happening and also reduce your
pain level from TMJ. • Studies have proven that lidocaine (a local anesthetic used during
dental procedures) often works poorly or not at all with EDS
patients.
• Some people with EDS complain of always feeling like there is a
lump in their throat when swallowing, and often have other
swallowing and voice problems.
GI system:
Gastrointestinal complications of EDS run literally from one end to the
other. Frequently EDSers suffer from reflux and GERD, stemming from an
incompetent esophageal sphincter that allows stomach acid to backflow
up the esophagus and cause burns in it. Diverticula have been seen
throughout the G.I. tract.
• Tissue extensibility and laxity can also cause lack of contraction of
the stomach, causing food to not move down into the intestines.
• Megacolon and rectal prolapse may also occur, primarily in
childhood but megacolon is also seen in adults.
(Megacolon is an abnormal dilatation of the colon (a part of the large
intestines) that is not caused by mechanical obstruction. The dilatation is often
accompanied by a paralysis of the peristaltic movements of the bowel.)
• Irritable bowel syndrome is a common co-diagnosis. Constipation
can result from the flaccidity of the large bowel, more water being
pulled from the stool the longer it remains in the colon, and from
pain medications.
Eyes:
An EDSer may have many different eye problems depending on the type
of Ehlers-Danlos they have including blue sclera, microcornea (very
small cornea), epicanthic folds, and wide-spaced eyes. Other common
problems are:
• Many EDSers are photophobic, some squint causing an "angry"
appearance and angiod streaks.
• Loose tendons and ligaments around the eye create hard working
muscles that get tired. Strabismus is the medical terms for eye
conditions commonly called by these various names: eye turns,
crossed eyes, cross-eyed, wall-eyes, wandering eyes, deviating
eye.
• Myopia (near-sightedness), astigmatism, and early presbyopia (a
vision condition in which the crystalline lens of your eye loses its
flexibility, making it difficult to focus on close objects.) occur often
in EDS patients.
• Dry eyes are a common and uncomfortable problem.
• Other EDS related problems are detached retinas and ectopia
(displaced) lenses.
• Persons with Ehlers-Danlos syndrome should see an
Ophthalmologist annually so the internal eye can be checked for
retinal and lens problems among other things. This is not an O.D, a
Doctor of Optometry, but an MD with a specialty in eye issues.
Pain:
Pain with Ehlers-Danlos syndrome can range from none to chronic
debilitating pain. It is subjective, individual, and different for each of us.
For many patients, this is the worst symptom of all! Causes of this pain
can be repeated trauma of constant instability from recent subluxations
and dislocations as well as degenerative joint disease. Sometimes poor
posture brought on by lax ligaments and weak abdominal muscles cause
increased pressure on the spinal joints. Some with EDS do not have
pain; others develop it later in life, and others begin to suffer severe
pain as children.
• Many things are useful in treating EDS pain such as heated pools
(92-94 degrees), gentle stretching, walking (if your joints allow),
and emotional support that recognizes the degree of your pain
and is non-judgmental.
• Occupational Therapists who make splints and assess what you
may need may help to make daily life easier. Heat and cold packs
help a lot. Always use cold for the first 24 hours after an injury to
decrease swelling and limit bleeding into the area, and then switch
to heat.
• Other possibly helpful things are yoga, relaxation therapy,
massage, acupuncture or acupressure, diversion, TENS units and
chiropractic maneuvers by a knowledgeable chiropractor.
• Common pain management problems are related to medications
either in a too low a dose or prescribing the wrong medication,
overemphasizing risks, using a "cookbook" approach, patients
refusing helpful medications because they worry about addiction,
and doctors afraid of prescribing because of their
misunderstanding of the DEA laws.
• Often pain is undertreated in children, the elderly, and minorities.
Less than 2% of all chronic pain patients (not just EDS patients)
using pain medications correctly for pain become addicted. One
can become dependent, but can be easily weaned off narcotics in
a short amount of time. • Medications often used with EDS are: muscle relaxants, NSAIDS,
steroids, lidocaine patches, antidepressants, narcotic and nonnarcotic
pain medications. Remember that over 4,000 mg. of
Tylenol daily causes liver damage. Different combinations of
medications work for each individual.
• Pain can be completely debilitating and keep you from needed
sleep. Often family and friends don't believe you ... the worst part
of all.
Emotional Effects of EDS:
Should either physical disability or chronic debilitating pain make your
life feel destroyed, feelings of worthlessness and profound depression
may set in; often talking to a counselor or medical professional will
help. Regrettably, a tragedy occurs when we not only have to contend
with no longer being able to do the things that we have loved doing, but
also has to battle for family and friends' belief, respect and
understanding. It appears that everyone with an invisible disability sadly
experiences this.
While someone with EDS is mourning their loss of ability and freedom,
others often accuse them of just being lazy, malingering, or becoming
an addict to the pain medications that allow them to live their life.
Because of this, we should not confuse their endeavors to live life and
be positive with assuming they are feeling well or doing better. Knowing you have EDS doesn't suddenly make things worse for you
physically, but may allow for better physical management, and ideally
allow for the prevention of any real problems, even if none exist
currently. So knowing you have it is not necessarily a bad thing.
Personal doubt about one's mental and physical abilities can add to the
fear that others can't possibly believe or understand what you're going
through. Inability to cope with daily tasks or mental confusion can have
a demoralizing effect.
Reference Citation Crediting to EDNF
Among ourselves we have thought of other ideas that could be added to this list but may be brought up during future posts or just elaborating on these.
If you would like to help please see The Full Blog
and The Trickle Effect