Beighton Score

Score items

The nine activities that need to be tested during the Beighton score quantify joint laxity. The tool is a revised version of an older Carter/Wilkinson scoring system (1964) for hypermobility.

The scoring method was originally used only in epidemiologic studies, however, now it is recognized amongst the valid hypermobility diagnosis evaluations.

The flexibility testing movements that the patient is asked to perform are the following:

1. Placing flat hands on the floor with straight legs;

2. Left knee bending backward more than 10 degrees;

3. Right knee bending backward more than 10 degrees;

4. Left elbow bending backward more than 10 degrees;

5. Right elbow bending backward more than 10 degrees;

6. Left thumb touching the forearm;

7. Right thumb touching the forearm;

8. Left little finger bending backward past 90 degrees;

9. Right little finger bending backward past 90 degrees.

Result interpretation

The Beighton score result is defined as the number of positive signs/9, which means the number of actions from the 9 provided, which the patient is capable of performing.

There is not a set cut-off for diagnosis. In some cases, where the associated symptoms are severe, even a score of 1/9 can lead to diagnosis.

The most commonly applied thresholds are at 4/0 and 5/9. For example, the major criteria in the diagnosis of BJHS, the Benign Joint Hypermobility Syndrome requires a Beighton score of at least 4/9 and arthralgia present for longer than 3 months in four or more joints.

During diagnosis the score needs to be correlated to other examinations and patient history findings. In some cases, higher scores just reflect hypermobility and not necessary a developed syndrome.

A more modern mean of diagnosis is now being used, the Brighton criteria, however, this is not meant to replace but rather include the Beighton score in a more complex functional assessment.

About the study

During the original study conducted by Beighton and Horan in 1969, a cohort of 100 patients suffering from the Ehlers-Danlos syndrome (connective tissue disorder) were examined.

Examinations involved clinical, hematological, biochemical and radiological investigation, along with the performing of the above actions.

Subsequent validation studies found the score has:

■ Intraobserver correlation of 0.75;

■ Interobserver correlation of 0.78.

The main limitation of the Beighton score is the fact that it only accounts for a small number of joints. Similarly, it can be said that hypermobility severity is only highlighted and the score does not stratify it.

Joint hypermobility guidelines

Hypermobility means that the joints of the affected person can stretch beyond those of a most other people. This is a condition caused by misaligned joints, abnormally shaped osseous ends or by collagen or connective tissue defects.

The most common syndromes in which hypermobility is an important symptom are:

■ Ehlers-Danlos syndrome;

■ Loeys-Dietz syndrome;

■ Marfan syndrome.

People who suffer from hypermobility can bend their thumbs backwards to the wrist, can bend knees backwards or perform contortionist movements.

The following is a list of the most common signs and symptoms associated with hypermobility syndromes:

■ Joint pain, knee pain, back pain;

■ Frequent sprains due to joint instability;

■ Carpal tunnel syndrome;

■ Tendinitis and or bursitis caused by normal activities;

■ Early onset;

■ Shoulder subluxations or dislocations;

■ Proneness to spondylolisthesis, whiplash;

■ Temporomandibular joint syndrome.

Original source

Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br. 1969; 51(3):444-53.

Other references

1. Simpson MR. Benign joint hypermobility syndrome: evaluation, diagnosis, and management. J Am Osteopath Assoc. 2006; 106(9):531-6.

2. Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr. 2011; 158(1):119-23, 123.e1-4.