Beighton Score for Hypermobility

Many people become less flexible as they grow, but hypermobility means that a person’s joints have a greater range of motion than is expected or typical. Being “flexible,” “bendy,” or “double-jointed” is not usually a problem in itself, and for some, like dancers or gymnasts, it is an advantage. Hypermobility that does not cause pain or other symptoms is referred to as “asymptomatic joint hypermobility” and does not need to be treated.

The problem occurs when joints are not just hypermobile but are also unstable. Joint instability occurs when the bones of a joint aren’t held in place securely. The connective tissues holding joints together can become less stable the more they are hyperextended. Think of it like an old, overstretched rubber band. This can lead to joint subluxations, dislocations, sprains, and other injuries. Joint instability can cause both acute and chronic pain severe enough to interfere with every day life.

Hypermobility spectrum disorders (HSD) occur when a person has symptomatic joint hypermobility that cannot be explained by other conditions, such as types of Ehlers-Danlos syndromes (EDS), Marfan syndrome, or Down syndrome. A person with HSD may have joint instability as their only concern or may have other medical issues as well.

Two different people with HSD may experience very different symptoms. For example, one person with HSD may have severe joint instability, fatigue, and autonomic dysfunction. Another person with HSD may have mild joint instability but severe headaches and gastrointestinal issues. Both people experience HSD differently, but neither person has “more HSD” than the other. Therefore, HSD is a spectrum and not linear.

Many people can recognize that their joints are able to move more than other people’s. A doctor or physical therapist can evaluate a person’s joints to determine if they are hypermobile. For some joints, a tool called a goniometer is used to measure how far the joint can extend. An experienced clinician can determine whether other joints move more than the normal range of motion.

People may have joint hypermobility in one, a few, or many of their joints. Joint hypermobility is classified by which joints are affected:

• Generalized joint hypermobility: joint hypermobility present in many different joints throughout the body

• Peripheral joint hypermobility: joint hypermobility limited to the hands and feet

• Localized joint hypermobility: joint hypermobility in a single joint or group of joints in the same area

One way to assess hypermobility is with the Beighton Score, which measures joint hypermobility on a 9-point scale. One point is given for each of the following joints that show hypermobility on exam:

• Base of the right 5th (pinky) finger

• Base of the left 5th (pinky) finger

• Base of the right thumb

• Base of the left thumb

• Right elbow

• Left elbow

• Right knee

• Left knee

• Lower spine

A positive Beighton score is any score greater than or equal to 6/9 points in children (before puberty), 6/9 points in young adults, 5/9 points in adults aged 26 to 65, and 4/9 points in adults over age 65.