Medically reviewed by Assoc. Prof. Dr. Alan Hakim, MD MA FRCP · June 2026 · Source: ehlers-danlos.com
Hypermobility Spectrum Disorder (HSD) is a connective tissue disorder causing symptomatic joint hypermobility, instability, pain, and injury. Fatigue, gastrointestinal problems, and autonomic dysfunction are also frequently present.
HSD is diagnosed when symptomatic joint hypermobility cannot be explained by another condition — including any type of Ehlers-Danlos syndrome, Marfan syndrome, or other heritable connective tissue disorders. It is not a diagnosis of exclusion alone; HSD describes a real pattern of systemic symptoms caused by hypermobility.
HSD is not a lesser diagnosis than hEDS. Both conditions can be equal in severity and both benefit from the same management strategies. The Ehlers-Danlos Society states clearly: "An HSD diagnosis is not a consolation prize."
HSD is also a dynamic diagnosis. A person's diagnosis may change over time — for example, as symptoms evolve, new features develop, or updated diagnostic criteria are published.
Source: ehlers-danlos.com/what-is-hsd/
HSD produces a similar symptom profile to hypermobile EDS. Because connective tissue is found throughout the body, symptoms can affect multiple systems simultaneously. HSD is not limited to joint pain — it is a systemic condition.
Musculoskeletal
Systemic & Associated
HSD is not a linear mild-to-severe spectrum. Each person's experience is a unique combination of symptoms. Two people with HSD may have very different clinical pictures across the same domains.
Source: ehlers-danlos.com/what-is-hsd/
The cause or causes of HSD have not been identified. No genetic test exists for HSD. The inheritance pattern of HSD is not established.
HSD and hypermobile EDS share a similar clinical presentation, and research into the biological basis of symptomatic hypermobility applies to both conditions. The hEDS/HSD Criteria Review Study, which included 326 participants across 8 international sites in 6 countries, found that "hEDS and HSD exist on a shared biological spectrum with overlapping features." No single feature clearly separates hEDS from HSD.
New global diagnostic criteria for HSD are scheduled to be published in December 2026, as part of the Road to 2026 initiative. Management pathways are expected in March 2027.
Source: ehlers-danlos.com/what-is-hsd/ · ehlers-danlos.com/road-to-2026/
HSD is diagnosed by medical history and physical examination. There is no laboratory test or imaging study that can confirm or rule out HSD. A normal workup does not rule it out.
Two requirements must be established:
Evidence that joint hypermobility is causing problems.
Asymptomatic hypermobility is not a disorder. The clinician must confirm that hypermobility is causing at least one secondary musculoskeletal manifestation such as joint subluxations or dislocations, joint pain and loss of function, soft tissue damage, recurrent or chronic pain, or poor proprioception.
Exclusion of other conditions that explain the symptoms.
Before diagnosing HSD, other conditions must be ruled out — including all 13 EDS types, particularly hEDS.
Once these two requirements are met, the diagnosis is further classified by subtype based on the distribution of hypermobility and the clinical picture: G-HSD, P-HSD, L-HSD, or H-HSD.
Conditions to exclude before diagnosing HSD
Diagnostic flowchart
The Ehlers-Danlos Society provides a decision tree for HSD: Does the person have joint hypermobility? → Is it symptomatic? → Does it meet criteria for a well-defined syndrome (hEDS, cEDS, Marfan, etc.)? → If no: classify by type of hypermobility (generalized, peripheral, localized, historical) → Diagnosis is G-HSD, P-HSD, L-HSD, or H-HSD accordingly.
HSD as a Dynamic Diagnosis
A person's HSD diagnosis may change over time. A child diagnosed with HSD may later develop additional features that shift the diagnosis to hEDS. Similarly, HSD subtype classifications can change as hypermobility patterns evolve with age or deconditioning.
New global diagnostic criteria for HSD are scheduled for December 2026. The 2017 criteria remain the current standard until that date.
Source: ehlers-danlos.com/what-is-hsd/ · ehlers-danlos.com/road-to-2026/
HSD-specific prevalence data is limited because HSD was only formally classified in 2017 and population studies have not yet fully separated HSD from hEDS figures. However, the combined prevalence of HSD and hEDS together gives a meaningful picture of the scale of symptomatic hypermobility as a whole.
HSD affects people of all genders, races, and ethnicities. Like hEDS, it is likely significantly underdiagnosed, in part because symptomatic hypermobility continues to be missed or attributed to other conditions.
Source: ehlers-danlos.com/prevalence/
If you believe you may have HSD, the next step is a clinical evaluation with a physician knowledgeable in connective tissue disorders. The evaluation involves confirming symptomatic hypermobility, ruling out other conditions, and classifying the subtype. EDS Connective facilitates online diagnostic evaluations for both HSD and hEDS via independent, board-certified physicians in all 50 states, no referral needed.
Medically reviewed by
Assoc. Prof. Dr. Alan Hakim, MD MA FRCP
Medicine & Rheumatology. Biobank and DICE Registry Principal Investigator and Medical & Scientific Board Member, The Ehlers-Danlos Society · Member of the Steering Committee of The International Consortium on the Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders
Last reviewed: June 2026 · All clinical content sourced from ehlers-danlos.com
Still searching for an hEDS or HSD diagnosis? EDS Connective facilitates online diagnostic evaluations through independent, board-certified physicians in our provider network — nationwide, no referral needed.
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This page has been reviewed for medical accuracy by Assoc. Prof. Dr. Alan Hakim, MD MA FRCP. Dr. Hakim's review is limited to the accuracy of the educational content presented. It does not constitute individualized medical advice, does not create a provider-patient relationship with any reader, and does not constitute an endorsement of EDS Connective, its platform, or its commercial services.
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Disclosure: This content has been medically reviewed by Assoc. Prof. Dr. Alan Hakim, MD MA FRCP, who serves as an advisor to EDS Connective and may receive compensation or travel reimbursement. This financial and business relationship is disclosed in accordance with the FTC Endorsement Guides. The views expressed are those of the individual contributor and do not necessarily reflect the official positions of EDS Connective.
