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Ehlers-Danlos syndrome, musculocontractural type is a congenital form of Ehlers-Danlos syndrome characterized by distinct craniofacial features, multiple contractures, progressive joint and skin laxity, adduction-flexion contractures of the thumbs, talipes equinovarus, bruisability and multisystem fragility-related manifestations.
No HPO annotations are available for this condition.
Age of onset: at birth, infancy, adolescence.
Musculocontractural Ehlers-Danlos syndrome (mcEDS) is characterized by multiple congenital contractures, progressive foot and ankle deformities, hypermobility of the small joints, recurrent dislocations, spinal deformities, characteristic craniofacial features, skin features (hyperextensibility, bruisability, delayed wound healing, and fragility with atrophic scars), large subcutaneous hematoma, and ocular abnormalities . Additional organ systems can be involved including genitourinary, cardiovascular, neurologic, and gastrointestinal. To date, 70 individuals from 51 families have been identified with biallelic pathogenic variants in CHST14 (mcEDS-CHST14) [, , , ] and 15 individuals from nine families have been identified with biallelic pathogenic variants in DSE (mcEDS-DSE) . The following description of the phenotypic features associated with this condition is based on these reports. Table 2. Musculocontractural Ehlers-Danlos Syndrome: Frequency of Select Features
Feature | % of All Persons w/Feature1 | Proportion of Persons w/Feature by Gene | Comment |
|---|---|---|---|
Skeletal | Characteristic finger shape | 100% | 61/61 |
Progressive foot ankle deformities | 98% | 52/53 | 12/12 |
Joint hypermobility | 93% | 44/44 | 9/13 |
Talipes equinovarus | 92% | 59/62 | 11/14 |
Multiple congenital contractures | 90% | 58/59 | 8/14 |
Spinal deformities | 85% | 41/47 | 10/13 |
Pectus deformities | 84% | 38/45 | 4/5 |
Adducted thumbs | 83% | 48/55 | 5/9 |
Recurrent/chronic joint dislocations | 83% | 47/52 | 1/6 |
Osteoporosis/ bone mineral density | 76% | 14/19 | 2/2 |
Marfanoid habitus/ slender build | 64% | 29/45 | 3/5 |
Craniofacial | Large fontanel w/delayed closure | 98% | 41/42 |
Hypertelorism | 93% | 57/62 | 12/12 |
Downslanted palpebral fissures | 95% | 58/61 | 13/14 |
Short palpebral fissures | 77% | 32/40 | 5/8 |
Blue sclerae | 87% | 48/56 | 7/7 |
Small mouth/micro-retrognathia | 88% | 36/41 | 8/9 |
High palate | 82% | 43/50 | 3/6 |
Ear deformity | 81% | 42/53 | 8/9 |
Slender face/ protruding jaw | 80% | 34/41 | 3/5 |
Crowded teeth | 79% | 19/25 | 4/4 |
Facial asymmetry | 57% | 22/37 | 2/5 |
Long philtrum | 75% | 44/55 | 7/13 |
Short nose w/hypoplastic columella | 69% | 40/54 | 3/8 |
Thin vermilion of upper lip | 66% | 36/55 | 8/12 |
Midface hypoplasia | 60% | 26/45 | 5/7 |
Brachycephaly/ flat occiput | 52% | 22/41 | 3/7 |
Skin | Fine palmar wrinkling | 97% | 54/55 |
Hyperextensibility | 84% | 51/51 | 3/13 |
Bruisability | 85% | 48/49 | 4/12 |
Delayed wound healing | 78% | 29/36 | 3/5 |
Hyperalgesia to pressure | 75% | 29/39 | 1/1 |
Fragility | 74% | 44/49 | 2/13 |
Atrophic scars | 72% | 41/49 | 2/11 |
Ophthalmologic | Refractive error | 93% | 40/43 |
Strabismus | 64% | 29/44 | 3/6 |
Glaucoma | 45% | 20/41 | 1/6 |
Retinal detachment | 32% | 15/43 | 0/4 |
Genitourinary | Cryptorchidism | 83% | 21/24 |
Hydronephrosis | 50% | 19/37 | 1/3 |
Bladder dysfunction | 48% | 14/28 | 1/3 |
Nephrolithiasis or cystolithiasis | 27% | 10/35 | 0/2 |
Cardiovascular | Large subcutaneous hematoma | 80% | 42/52 |
Cardiac valve abnormalities | 36% | 16/43 | 2/7 |
Congenital heart defects | 25% | 11/50 | 3/7 |
Neurologic | Gross motor delay | 78% | 48/55 |
Hypotonia | 76% | 36/42 | 3/9 |
Ventricular abnormalities | 45% | 15/30 | 0/3 |
Hypoplasia of septum pellucidum | 20% | 5/22 | 0/3 |
Dandy-Walker variant | 9% | 2/20 | 0/3 |
Source: GeneReviews — "Musculocontractural Ehlers-Danlos Syndrome"
No consensus clinical diagnostic criteria for musculocontractural Ehlers-Danlos syndrome (mcEDS) have been published.
Musculocontractural EDS should be suspected in probands with two major criteria; the presence of any additional minor criteria supports the diagnosis .
Major criteria
Source: GeneReviews — "Musculocontractural Ehlers-Danlos Syndrome"
In newborns and young infants with characteristic craniofacial features and multiple congenital contractures, the differential diagnosis of musculocontractural Ehlers-Danlos syndrome (mcEDS) includes arthrogryposis syndromes (e.g., Freeman-Sheldon syndrome) and some hereditary connective tissue disorders (e.g., Loeys-Dietz syndrome, early-onset Marfan syndrome, spondylodysplastic EDS, kyphoscoliosis EDS , and Shprintzen-Goldberg syndrome ). In individuals with joint hypermobility/dislocation, skin hyperextensibility, and easy bruisability, the differential diagnosis of mcEDS includes other types of EDS. Typically joint hypermobility in individuals with mcEDS is limited to small joints, whereas generalized joint hypermobility is a hallmark of classic EDS and hypermobile EDS. Table 3. Genes of Interest in the Differential Diagnosis of Musculocontractural Ehlers-Danlos Syndrome
Gene(s) | Disorder | MOI | Clinical Features of Disorder |
|---|---|---|---|
FBN1 |
Biomarker and diagnostic research for Ehlers-Danlos syndrome, musculocontractural type has been reported in the published literature.
No approved treatments are currently available for Ehlers-Danlos syndrome, musculocontractural type. The disease remains an area of unmet medical need.
Health care guidelines for musculocontractural Ehlers-Danlos syndrome (mcEDS) have been proposed . The following recommendations are based on these reports and the authors' personal experience managing individuals with mcEDS.
To establish the extent of disease and needs in an individual diagnosed with mcEDS, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended.
Table 4.
Musculocontractural Ehlers-Danlos Syndrome: Recommended Evaluations Following Initial Diagnosis
System/Concern | Evaluation | Comment
| Orthopedic eval w/radiographs as needed | To assess for congenital contractures foot, spine, pectus deformities
| Ophthalmologic eval incl slit lamp fundus exam | To assess for refractive errors strabismus
| • Assessment for cryptorchidism in males
Kidney US for hydronephrosis
|
| Cardiology eval for valve abnormality congenital heart defect |
| • Assessment of tone motor development
Cranial US, followed by brain MRI as needed
|
| Assessment for constipation inguinal umbilical hernias |
| Audiology eval (ABR, ASSR) |
| Clinical exam to assess for cleft palate cleft soft palate |
| By genetics professionals1 | To obtain a pedigree inform affected persons their families re nature, MOI, implications of mcEDS to facilitate medical personal decision making
| Social support and re...
Source: GeneReviews — "Musculocontractural Ehlers-Danlos Syndrome"
Avoid the following:
Contact or competitive sports
Upper arm sphygmomanometer and use of a tight tourniquet during blood collection in individuals with hyperalgesia to pressure
Source: GeneReviews — "Musculocontractural Ehlers-Danlos Syndrome"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Musculocontractural Ehlers-Danlos Syndrome"
View trials for Ehlers-Danlos syndrome, musculocontractural type
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the evaluations summarized in are recommended. Table 6. Musculocontractural Ehlers-Danlos Syndrome: Recommended Surveillance
System/Concern | Evaluation | Frequency |
|---|---|---|
Foot deformities | Orthopedic eval (physical exam, radiologic exam) | In infancy (after treatment for clubfeet), every 3 mos; In childhood, every 6 mos; In adolescence adulthood, annually as needed Spine deformities |
Osteoporosis | Bone density scan | Annually beginning in adulthood |
Crowded teeth | Orthodontic eval | Annually beginning in childhood |
Ophthalmologic (e.g., refractive errors, strabismus, glaucoma, retinal detachment) | Ophthalmologic eval (incl vision, intraocular pressure, fundus exam) | Annually beginning in infancy Genitourinary (e.g., cryptorchidism, hypogonadism, hydronephrosis, nephrolithiasis) |
Gross motor delay | Assessment of gross motor skills | Every 3 mos beginning in infancy; Every 6 mos through childhood OAEs = otoacoustic emissions; US = ultrasound |
Source: GeneReviews — "Musculocontractural Ehlers-Danlos Syndrome"
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).
No clinical trials have been registered for Ehlers-Danlos syndrome, musculocontractural type.
182 publications have been identified in PubMed for Ehlers-Danlos syndrome, musculocontractural type. Research spans Review / Meta-Analysis (47%), Epidemiology / Natural History (19%), and Basic Science / Preclinical (12%).
Research Type | Count | % of Total |
|---|---|---|
Research summaries | 86 | 47% |
Disease patterns and progression | 35 | 19% |
Laboratory research | 22 | 12% |
Patient case studies | 14 | 8% |
Testing and diagnosis research | 11 | 6% |
Clinical study results | 10 | 5% |
Other research | 2 | 1% |
New treatment approaches | 2 | 1% |
Di Michele S (2026). [PMID: 41563503](https://pubmed.ncbi.nlm.nih.gov/41563503/). *Archives of gynecology and obstetrics*. [Review / Meta-Analysis]
Benistan K (2026). [PMID: 40887396](https://pubmed.ncbi.nlm.nih.gov/40887396/). *La Revue de medecine interne*. [Review / Meta-Analysis]
Kumskova M (2026). [PMID: 41284637](https://pubmed.ncbi.nlm.nih.gov/41284637/). *Blood*. [Basic Science / Preclinical]
Gajarawala SN (2026). [PMID: 41603659](https://pubmed.ncbi.nlm.nih.gov/41603659/). *Orthop Nurs*. [Review / Meta-Analysis]
Li Q (2026). [PMID: 41167430](https://pubmed.ncbi.nlm.nih.gov/41167430/). *Journal of affective disorders*. [Review / Meta-Analysis]
Dodd DR (2026). [PMID: 41708269](https://pubmed.ncbi.nlm.nih.gov/41708269/). *Psychiatr Clin North Am*. [Review / Meta-Analysis]
Fan X (2026). [PMID: 41308886](https://pubmed.ncbi.nlm.nih.gov/41308886/). *Journal of affective disorders*. [Epidemiology / Natural History]
Kahveci S (2026). [PMID: 42036701](https://pubmed.ncbi.nlm.nih.gov/42036701/). *J Eat Disord*. [Epidemiology / Natural History]
Lian T (2026). [PMID: 41905459](https://pubmed.ncbi.nlm.nih.gov/41905459/). *Ann Vasc Surg*. [Review / Meta-Analysis]
Haig AJ (2026). [PMID: 41686757](https://pubmed.ncbi.nlm.nih.gov/41686757/). *J Back Musculoskelet Rehabil*. [Review / Meta-Analysis]
Data assembled from 4 of 12 sources · Last updated Sep 20, 2026, 8:44 AM UTC
European rare disease database
Genetic and Rare Diseases Info Center
Common questions about Ehlers-Danlos syndrome, musculocontractural type
AD |
Craniofacial features; Slender fingers |
Loeys-Dietz syndrome | ADAR1 | joint mobility, esp of hands (camptodactyly) feet (clubfeet) in some persons; Easy bruising | Progressive cardiovascular lesions; Absence of skin fragility |
MYH3 | Freeman-Sheldon syndrome (OMIM 193700) | AD | Multiple congenital contractures |
Shprintzen-Goldberg syndrome | AD | Craniofacial features; Hypotonia; Inguinal or umbilical hernia; Skeletal manifestations (pectus deformity, camptodactyly, scoliosis, joint hypermobility) | ID behavioral abnormalities in 80%2 Other types of EDS3 |
ADAMTS2 | Dermatosparaxis EDS (OMIM 225410) | AR | Atrophic scarring; Easy bruising; Skin hyperextensibility; Soft, doughy skin |
AEBP1 | Classic-like EDS type 2 (OMIM 618000) | AR | Easy bruising; Skin hyperextensibility |
SLC39A13 | Spondylodysplastic EDS (OMIM 130070, 612350, 615349) | AR | Joint hypermobility (distal joints); Kyphoscoliosis (B3GALT6) |
COL1A2 | Arthrochalasia EDS (OMIM 130060, 617821) | AD | Atrophic scarring; Easy bruising; Skin hyperextensibility; Recurrent joint subluxations/dislocations |
Source: GeneReviews — "Musculocontractural Ehlers-Danlos Syndrome"