Question 1

What is Hypermobility Spectrum Disorder (HSD)?

Accepted Answer

Hypermobility Spectrum Disorder (HSD) is a connective tissue disorder causing symptomatic joint hypermobility, instability, pain, and injury. It is diagnosed when symptomatic joint hypermobility cannot be explained by hEDS or another condition. HSD is not a lesser diagnosis than hEDS — both can be equal in severity and benefit from the same management strategies.

Question 2

What are the four types of HSD?

Accepted Answer

HSD is classified into four subtypes: G-HSD (Generalized) — hypermobility throughout the body with a positive Beighton score; P-HSD (Peripheral) — hypermobility limited to the hands and feet; L-HSD (Localized) — hypermobility in a single joint or regional group; and H-HSD (Historical) — past history of generalized hypermobility without current exam evidence, proposed for older adults.

Question 3

How is HSD diagnosed?

Accepted Answer

HSD is diagnosed by medical history and physical examination. Two requirements must be established: evidence that joint hypermobility is causing problems, and exclusion of other conditions that explain the symptoms — including all 13 EDS types, Marfan syndrome, osteogenesis imperfecta, Loeys-Dietz syndrome, autoimmune rheumatic conditions, and neuromuscular disorders. There is no laboratory test or imaging study that can confirm or rule out HSD.

Question 4

What is the difference between HSD and hEDS?

Accepted Answer

HSD and hypermobile EDS (hEDS) share the same core feature — symptomatic joint hypermobility — and a very similar clinical presentation. The distinction is diagnostic: hEDS requires meeting all three criteria of the 2017 international classification simultaneously. HSD is diagnosed when hypermobility is symptomatic but the full hEDS criteria are not met. Both conditions can be equal in severity.

Question 5

Can an HSD diagnosis change over time?

Accepted Answer

Yes. 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. HSD subtype classifications can also change as hypermobility patterns evolve with age or deconditioning. New global diagnostic criteria for HSD are scheduled for December 1, 2026.

Question 6

Is there a genetic test for HSD?

Accepted Answer

No. There is no genetic test for HSD and no identified genetic cause. The inheritance pattern of HSD is not established. Diagnosis is clinical.

Question 7

Are the HSD diagnostic criteria changing?

Accepted Answer

Yes. New global diagnostic criteria for HSD are scheduled to be published on December 1, 2026, in the American Journal of Medical Genetics, as part of the Road to 2026 initiative. Management pathways are expected in March 2027. The 2017 criteria remain the current global standard until that date.

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