Symptomatic

The Symptom-Based Handbook for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders

1st Edition - December 5, 2023
Editors: Clair A. Francomano, Alan J. Hakim, Lansdale G.S. Henderson, Fraser C. Henderson Sr.
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 5 0 8 2 - 4
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 5 0 8 3 - 1

Symptomatic: The Symptom-Based Handbook for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders offers a novel approach to the subject, structured around the panoply of sy… Read more

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Symptomatic: The Symptom-Based Handbook for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders offers a novel approach to the subject, structured around the panoply of symptoms those with Ehlers-Danlos syndromes and hypermobility spectrum disorders may describe to their clinicians. The content is arranged intuitively from head to feet. Each chapter integrates a clinical case study with a concise discussion and two important tools: a simplified algorithm for diagnosing and managing each symptom; and differential diagnoses (i.e. alternative explanations) for the symptoms. Combining the expertise of some 70 leading clinicians representing more than 30 specialties, the content is suited for clinicians who need a concise presentation of the various and complex symptoms they confront in their practice. It also aims to inform and empower patients, helping them understand the nature of these concerns and their management. This handbook advances an integrative understanding of this emerging interdisciplinary field, bridging the gaps between the several dozen specialties germane to EDS and HSD.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
About the editors
Foreword
Preface
Acknowledgments
Chapter 1 Introduction: An overview of the Ehlers-Danlos syndromes and hypermobility spectrum disorders
References
Part I: Systemic Symptoms
Section I.I: General
Chapter 2 Generalized joint hypermobility and pain: When generalized joint hypermobility changes from an asset to a health concern
Editors' general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Further reading
Chapter 3 Chronic widespread pain: The holistic assessment and treatment approach in chronic widespread pain
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 4 Widespread pain in childhood: Hypermobile children may have multiple sources of pain
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 5 Myofascial pain: Myofascial knee pain in a young woman with hypermobile Ehlers-Danlos syndrome
Editors’ general overview
Case report
Discussion
Conclusion
References
Further reading
Chapter 6 Multiple unexplained symptoms: Living with multisystemic connective tissue complications in the absence of a known pathogenic gene variant
Editors’ general comments
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 7 Itchy rash and general malaise: Multiple seemingly disparate symptoms, referable to mast cell activation syndrome (MCAS), a subtype of mast cell activation disease (MCAD)
Editors’ general overview
Case report
Discussion
Conclusion
References
Section I.II: Fatigue
Chapter 8 Fatigue: With so many concerns, pain, and increased sympathetic activity, no wonder there is fatigue
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 9 Brain fog: “I feel like I’ve suddenly developed attention deficit”
Editors’ general overview
Case report
Discussion
Conclusion
References
Section I.III: Skin
Chapter 10 Stretched, unsightly scars: “I wish I’d known I had EDS before having surgery”
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 11 Bruising and bleeding: Excessive bleeding and bruising in a patient with hypermobile EDS
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 12 Poor wound healing: Prolonged wound healing in a hypermobile person
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 13 Repeated joint dislocation and bruising: Ehlers-Danlos syndrome and hypermobility spectrum disorder can mimic nonaccidental trauma (NAT)
Editors’ general overview
Case report
Discussion
Conclusion
References
Part II: Head and Neck
Section II.I: Psychological health
Chapter 14 Anxiety: Worry and beyond
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 15 Depression: Fear and depression
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 16 Posttraumatic stress disorder: “I wasn’t believed!”
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 17 Attention difficulties: The relationship between Ehlers-Danlos syndromes/hypermobility spectrum disorders and attention difficulties, “brain fog,” and attention-deficit hyperactivity disorder (ADHD)
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 18 Loneliness and social isolation: Physical symptoms leading to the erosion of a support network
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Section II.II: Head and neck
Chapter 19 Postural headache: Headache and nausea with upright posture due to spinal CSF leak
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 20 Persistent pressure headache: Persistent headache and brain fog from intracranial venous congestion due to jugular venous obstruction
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 21 Cough-induced headache: Cough-induced (ptussive) headache and dizziness due to Chiari malformation
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 22 Excruciating headache on the side of the head: “The worst headache of my life,” due to carotid dissection
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 23 Headache with shaking episodes and “brain fog”: Craniocervical instability with multiple symptoms of cervical medullary syndrome
Editors’ general overview
Summary of case report
Chief complaint
Relevant history
Physical findings
Imaging, tests, and lab studies
Differential diagnosis
Working diagnosis
Treatment
Follow-up
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 24 Skull-base headache with fainting and intermittent burning limb pain: Headache, syncope, “brain fog,” tinnitus, and neck and limb pain due to atlantoaxial instability (AAI)
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 25 Fainting, headache, and “bobble head”: Headache, syncope (fainting), and associated symptoms of atlantoaxial instability (AAI) and Chiari malformation
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 26 Pressure headache and blurry vision: Evaluation and treatment of idiopathic intracranial hypertension (IIH)
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 27 Head, neck, and shoulder pain: Cervicogenic headache and neck pain due to subluxation of the upper cervical spine
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Further reading
Chapter 28 Headache with pain and stiffness in the neck: This headache is a “pain in the neck”—when muscles “try their best,” but don’t succeed
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Further reading
Chapter 29 Migraine: Headache with nausea and light sensitivity
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Section II.III: Eyes
Chapter 30 Difficulty reading: Convergence fatigue and reduced near vision endurance
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 31 Blurry and double vision: Objects appear blurry, have “ghosting” around them, or are double
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Section II.IV: Mouth and voice
Chapter 32 Temporomandibular joint (TMJ) pain and headache: TMJ pain, clicking jaw joint, headache, and neck muscle pain
Editors’ general overview
Case study
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Further reading
Chapter 33 Gum bleeding and early tooth loss: Periodontal disease and dental implants in Ehlers-Danlos syndrome
Editors’ general overview
Case reports
Discussion
Conclusion
Algorithm
References
Chapter 34 Difficulty swallowing: “I find it hard to eat,” “things go down the wrong way,” “I choke on food/liquid”
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 35 Voice change and vocal fatigue: “I keep losing my voice.”
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Part III: Torso
Section III.I: Upper and lower back
Chapter 36 Upper back pain: Adult spinal deformity (kyphoscoliosis)
Editors’ general overview
In memoriam
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 37 Low back pain: “My back is always going out”; sacroiliac joint dysfunction
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 38 Progressive leg weakness and urinary incontinence: I have leg weakness and numbness, low back pain, and urinary incontinence
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 39 Sacral and buttock pain: Unable to sit due to Tarlov cyst syndrome
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Section III.II: Rib cage
Chapter 40 Posterior rib cage and shoulder blade pain: Posterior thoracic musculoskeletal pain
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 41 Chest wall pain: Anterior rib subluxation
Editors’ general overview
Case report
Discussion
Conclusion
Algorithm
References
Section III.III: Lungs
Chapter 42 Shortness of breath: Multiple causes of dyspnea in a woman with Ehlers-Danlos syndrome
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 43 Still tired after sleeping: Obstructive sleep apnea (OSA) secondary to hypermobile Ehlers-Danlos syndrome (hEDS)
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithms
References
Section III.IV: Heart and cardiovascular system
Chapter 44 Palpitations: Heart racing and feeling faint on standing
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 45 Feeling shaky with palpitations: Hypertension, tachycardia, dizziness, and near syncope
Editor's general overview
Case report
Discussion
Conclusion
References
Chapter 46 Severe abdominal pain and a cold leg: An arterial dissection or tear can mimic many other conditions in the region of the body affected
Editors’ general comments
Case report
Discussion
Conclusion
References
Further reading
Section III.V: Abdomen
Chapter 47 Abdominal pain and feeding intolerance in a child: Food allergies and eosinophilic esophagitis—Culprits in a pediatric patient with suspected hEDS
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 48 Chronic constipation and nausea in a child: Constipation and nausea in a child with hEDS leading to severe weight loss
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 49 Failure to thrive in a young child: The evolution of gastrointestinal symptoms is like a “whack-a-mole” game
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 50 Heartburn and feeling full, even after a small meal: Gastric reflux and medical management in a person with hypermobile Ehlers-Danlos syndrome and gastroesophageal reflux disease (GERD)
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 51 Stomach pain and reflux failing medical management: Persistent gastroesophageal reflux requiring surgical intervention
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 52 Sluggish stomach: Upper gastrointestinal symptoms of fullness after eating, epigastric pain, nausea, and vomiting due to delayed gastric emptying
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 53 Persistent nausea: Constant, daily, and unrelenting nausea with weight loss in an adolescent
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 54 Constipation: Hard stools associated with incomplete evacuation
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 55 Severe abdominal pain after eating, and weight loss: Severe abdominal and pelvic pain from vascular compression
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 56 Unrelenting stomach and midback pain, particularly when eating: Epigastric pain and nausea with eating in a person with median arcuate ligament syndrome (MALS)
Editors’ general overview
Summary of case report
Chief complaint
Relevant history
Physical findings
Imaging, tests, and lab studies
Differential diagnosis
Working diagnosis
Treatment
Follow-up
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Section III.VI: Pelvis
Chapter 57 Bladder pain with urinary frequency and urgency: Multiple urinary symptoms and bladder pain due to interstitial cystitis
Editors’ general overview
Case report
Discussion
Conclusion
Algorithm
References
Chapter 58 Bulging of the bladder and vagina, with difficulty urinating: Prolapse of pelvic organs due to a weak pelvic floor, with associated urinary and rectal dysfunction
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 59 Rectal bulging, hemorrhoids, and difficulty emptying the bowel: Multiple lower gastrointestinal concerns related to pelvic floor collapse
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Further reading
Part IV: Limbs
Section IV.I: Movement disorders
Chapter 60 Twitching: Dystonia presenting as involuntary muscle movements
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 61 Uncontrolled spasms triggered by exercise: An unrecognized traumatic stress disorder manifesting as abnormal and painful movement (dystonia)
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Section IV.II: Shoulder/upper limb
Chapter 62 Neck pain and tingling in the arm and hand: Surgical management of thoracic outlet syndrome (TOS) due to compression of the brachial (nerve) plexus, worsened by reaching overhead
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 63 Shoulder pain and/or instability: Shoulder problems in EDS patients
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 64 Painful shoulder blade: Poor scapular biomechanics causing regional pain in a man with a hypermobility spectrum disorder
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 65 Intermittent pain and weakness in the arm and hand: Long-standing forearm and hand pain with weakness from thoracic outlet compression of the arteries, veins, and nerves: Nonsurgical management
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
Reference
Chapter 66 Pain in the hands and reduced grip strength: Simultaneous joint laxity and myofascial shortening (tissues “too tight and too loose” at the same time)
Editors’ general overview
Case report
Discussion
Conclusion
Further reading
Chapter 67 Pain and weakness in the hand, wrist, and forearm: Progressive hand and forearm pain and weakness due to nerve compression near the elbow
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Further reading
Section IV.III: Lower limb
Chapter 68 Hip pain: Surgical treatment of an unstable hip: Labral and ligamentum teres reconstruction and periacetabular osteotomy (PAO)
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 69 Wobbly kneecap and a painful knee: Progressive knee pain and knee collapsing from an unstable kneecap and arthritis
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
Reference
Chapter 70 Swelling and redness in both feet: Swollen and red (plethoric) lower legs and feet when standing or hot, associated with feeling faint
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 71 Leg swelling and pain: Leg swelling and pain while sitting or standing, associated with abdomino-pelvic venous compression diseases
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 72 Weakness and painful numbness in the arms and legs: Thiamine/Vitamin B1 deficiency exacerbating neurological symptoms in hypermobile Ehlers-Danlos syndrome
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 73 Burning pain of the feet: Pedal dysesthesia (burning sensation) in the context of small fiber neuropathy
Editors’ general overview
Case report
Discussion
Conclusion
References
Chapter 74 Foot pain and repeated ankle sprains: Ankle instability, foot pain and joint deformities, treated by surgery
Editors’ general overview
Case report
Discussion
Conclusion
Diagnostic and treatment algorithm
References
Chapter 75 Painful heels, and tired and clumsy feet: Poor biomechanics in the feet causing localized pain, poor gait, and fatigue when walking
Editors’ general overview
Case report
Discussion
Conclusion
References
Appendix Patient resources
A
B
C
D
E
F
G
H
I
J
K
M
N
O
P
R
S
T
W
Z
Index

Clair A. Francomano

Clair Francomano received her M.D. degree from Johns Hopkins University School of Medicine and completed her training in Internal Medicine and Medical Genetics at Johns Hopkins. She served on the full-time faculty at Johns Hopkins, and then as Clinical Director for the National Human Genome Research Institute at the National Institutes of Health, where she was also Chief of the Medical Genetics Branch and directed the residency program in Medical Genetics. Subsequently, she became Director of Adult Genetics at the Harvey Institute for Human Genetics in Baltimore. In 2019, she became Professor of Medical and Molecular Genetics and Director of the Residency Training Program in Medical Genetics at Indiana University School of Medicine. Dr. Francomano has been involved in the care of patients with Ehlers-Danlos syndrome and other Heritable Disorders of Connective Tissue throughout her career. She served on the Professional Advisory Board for the Marfan Foundation and is a long-standing member of the Medical Advisory Board for the Little People of America. She has been a member of the Medical and Scientific Board of the Ehlers-Danlos Society since 2016 and is currently Chair of that Board. From 2021-22, Dr. Francomano was a member of the Committee on Selected Heritable Connective Tissue Disorders and Disability for the National Academies of Science, Engineering and Medicine. She serves on the Steering Committee for the International Consortium on the Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders.

Affiliations and expertise

•Professor of Medical and Molecular Genetics at the Indiana University School of Medicine, Indianapolis, IN, United States •Chair of the Medical and Scientific Board of The Ehlers-Danlos Society, New York City, NY, United States

Alan J. Hakim

Alan Hakim received his bachelor’s and master’s degrees in medical sciences from Cambridge University and completed his training in Internal Medicine at Addenbrooke’s Hospital, Cambridge, and Rheumatology training at University College London Hospitals (UCLH), London UK. He received his consultant certification and fellowship from the Royal College of Physicians, UK in 2000 and 2005, respectively, and gained postgraduate certification in Translational Medicine from Edinburgh University in 2011. As a senior researcher, consultant, and clinical director he has practiced at Guy’s and Thomas’ Hospital, and Whipps Cross Hospital and Barts Health NHS Trust, London. He currently practices at The Harley Street Clinic, HCA Healthcare UK and is an honorary consultant in research at UCLH, London. He is also an Adjunct Associate Professor in Medicine, The School of Medicine, Hershey, Penn State, USA. Publishing widely in research and education, Dr. Hakim has co-authored and edited five other medical books and contributed many chapters and articles to major textbooks and online resources in Rheumatology and Internal Medicine. With several decades’ commitment to charitable organizations, most recently his focus has been support of the Ehlers-Danlos Society as their Chief Medical Officer, Director of Education and Director of Research, and Lead for their EDS ECHO portfolio. As a member of the International Consortium on the Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders, he sits on the consortium Steering Committee and has chaired its Working Group on Hypermobile EDS/HSD since 2018.

Affiliations and expertise

• Rheumatologist at The Harley Street Clinic, HCA Healthcare, United Kingdom • Honorary consultant at University College London Hospitals, London, United Kingdom • Adjunct Associate Professor in Medicine at Penn State University, United States • Chief Medical Officer, Director of Research, and Director of Education at The Ehlers-Danlos Society, New York City, NY, United States

Lansdale G.S. Henderson

Lansdale Henderson earned his bachelor’s degree with distinction in neuroscience as an Echols Scholar at the University of Virginia. He studied adult neurogenesis in laboratories at the University of Virginia School of Medicine, the National Institutes of Health, and the Pasteur Institute, co-authoring publications in the Journal of Neuroscience and elsewhere. He engaged with health and science policy as a John Jay Fellow for two U.S. Senators and subsequently staffed the Maryland Senate President. He earned honors for his thesis in political philosophy at St. John’s College Graduate Institute, and a second master’s degree from the Johns Hopkins School of Advanced International Studies (SAIS), including coursework as the Longvue Fellow at the Paris School of International Affairs (Sciences Po). Since 2020, he has co-founded two pre-clinical biotech startups while serving as Director of Research for The Metropolitan Neurosurgery Group.

Affiliations and expertise

Director of Research at the Metropolitan Neurosurgery Group, Silver Spring, MD, USA

Fraser C. Henderson Sr.

Fraser Henderson, Sr. earned his degree in medicine at the University of Virginia. During his tour with the United States Navy, he was decorated for treatment of mass casualties during the 1983 Beirut terrorist bombings. He completed his residency as Chief Resident at the Medical University of South Carolina, then served as Director of Neurosurgery at the Veterans Medical Center in Charleston, South Carolina, before returning to active duty as Director of Neurosurgery of the Craniocervical Junction and Spine at the National Naval Medical Center, Bethesda. He deployed as Neurosurgeon to the 4th Marine Expeditionary Brigade during the Desert Shield/Desert Storm campaigns of the First Gulf War (1990-91). Commander Henderson was then the International Fellow for Craniospinal Surgery at The National Hospitals for Neurology and Neurosurgery, Queen Square, London. Recruited to Georgetown University as Director of Neurosurgery of the Craniocervical Junction and Spine, he later served as Co-Director of Neuro-Oncology, and was promoted to Professor of Neurosurgery and Associate Professor of Radiation Medicine in 2005. Entering private practice in 2008, he became Director of The Metropolitan Neurosurgery Group and Chief of Neurosurgery at Doctor’s Community Hospital. He is now Adjunct Clinical Professor of Neurosurgery at the University of Maryland Capital Region Medical Center. He serves on both the Executive Committee of the Bobby Jones Chiari Syringomyelia Foundation and the Medical and Scientific Board of The Ehlers-Danlos Society. He has published extensively on neurological and spinal disorders, co-edited four books regarding the craniocervical junction and Ehlers-Danlos syndromes, and he has hosted numerous conferences to promote understanding of these issues.

Affiliations and expertise

•Adjunct Clinical Professor of Neurosurgery at the University of Maryland School of Medicine, Baltimore, MD, United States •Director of The Metropolitan Neurosurgery Group, Silver Spring, MD, United States •Member of the Executive Committee of the Bobby Jones Chiari Syringomyelia Foundation, Staten Island, NY, United States •Member of the Medical and Scientific Board of The Ehlers-Danlos Society, New York City, NY, United States

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Symptomatic

The Symptom-Based Handbook for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders

Purchase options

Innovate. Sustain. Transform.

Institutional subscription on ScienceDirect

Clair A. Francomano

Alan J. Hakim

Lansdale G.S. Henderson

Fraser C. Henderson Sr.

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