LAUSR

Dear Sir Thank you to RodneyGrahame and colleagues for their letter [1], published in this edition, concerning our systematic review of tissue mechanics in hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility syndrome disorders (HSD) [2]. It was very interesting to read that additional measures of ligamentous laxity are being considered in people with hEDS, HSD, and other connective tissue disorders who have suspected craniocervical instability, basilar invagination, or ventral brainstem compression. As highlighted in our review [2], the consensus statements agreed by their group reiterate the potential importance of using measures of soft tissue mechanics that are supplemental to the Beighton score. Their recommendation of dynamic imaging techniques is particularly interesting. We sincerely hope that their group is successful in identifying appropriate diagnostic measures for such cases. Yours faithfully, Shea Palmer Elise Denner Matthew Riglar Holly Scannell Sarah Webb Georgina Young