Beighton's Score: Understanding Joint Hypermobility, Testing, and Interpretation

What is Beighton's Score?

Beighton's score is a widely used, rapid clinical assessment tool designed to quantify generalized joint hypermobility (GJH) across specific joints in the body. It serves as a screening instrument and a component of diagnostic criteria for conditions such as Hypermobility Spectrum Disorders (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS).

Understanding Joint Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its normal anatomical range of motion. This increased laxity can be localized to a single joint or generalized, affecting multiple joints throughout the body. While some degree of hypermobility can be asymptomatic and even advantageous in certain activities (e.g., dance, gymnastics), excessive or symptomatic hypermobility can lead to various musculoskeletal issues, including chronic pain, recurrent dislocations, sprains, and proprioceptive deficits. Understanding the extent of hypermobility is crucial for appropriate exercise prescription, injury prevention, and clinical management.

What is Beighton's Score?

Developed by Beighton, Solomon, and Sosner in 1973, the Beighton score is a simple, 9-point scale used to objectively measure the degree of generalized joint hypermobility. It assesses the range of motion in five specific maneuvers, with four of them evaluated bilaterally, contributing to a maximum score of nine points. The score is a quantitative measure, providing a snapshot of the body's overall joint laxity based on specific, easily reproducible movements. It is not a diagnostic tool on its own for complex conditions like Ehlers-Danlos Syndrome but rather a foundational component in their assessment.

How to Perform the Beighton Test

The Beighton score consists of five distinct tests, with four performed bilaterally, yielding a total of nine possible points. Each test is scored as either 0 (no hypermobility) or 1 (hypermobility present for that joint/action). For bilateral tests, each side contributes one point if positive.

Here are the maneuvers:

• Passive Dorsiflexion of the 5th Metacarpophalangeal Joint (>90 degrees):

  • Procedure: The examiner passively extends the little finger at the metacarpophalangeal joint.
  • Scoring: 1 point is awarded if the little finger can be bent backward beyond 90 degrees relative to the back of the hand. (1 point for each hand, max 2 points)

• Passive Apposition of the Thumb to the Forearm:

  • Procedure: The examiner passively moves the thumb to touch the ventral aspect of the forearm.
  • Scoring: 1 point is awarded if the thumb can touch the forearm. (1 point for each hand, max 2 points)

• Elbow Hyperextension (>10 degrees):

  • Procedure: With the arm extended, the examiner observes the elbow joint from the side.
  • Scoring: 1 point is awarded if the elbow extends beyond 10 degrees past a straight line. (1 point for each arm, max 2 points)

• Knee Hyperextension (>10 degrees):

  • Procedure: With the leg extended, the examiner observes the knee joint from the side, typically with the individual standing or lying supine.
  • Scoring: 1 point is awarded if the knee extends beyond 10 degrees past a straight line. (1 point for each leg, max 2 points)

• Forward Trunk Flexion with Palms Flat on the Floor:

  • Procedure: The individual stands with knees fully extended and bends forward at the waist, attempting to place the palms flat on the floor directly in front of their feet.
  • Scoring: 1 point is awarded if the palms can be placed flat on the floor without bending the knees. (Max 1 point)

The total score is the sum of points from all nine possible maneuvers, ranging from 0 to 9.

Interpreting the Beighton Score

The interpretation of the Beighton score varies slightly depending on age, sex, and ethnicity, though a common threshold is used for screening purposes.

• Generalized Joint Hypermobility (GJH): A Beighton score of 4 or more out of 9 is generally considered indicative of generalized joint hypermobility in adults.
• Age Considerations: For children and adolescents (pre-puberty), a lower threshold (e.g., 5 or 6) may be used, as joint laxity naturally decreases with age. In older adults, a score of 2 or 3 might still be considered significant due to age-related stiffening of connective tissues.
• Clinical Context: It's crucial to remember that the Beighton score only assesses joint range of motion. It does not account for pain, functional limitations, or other systemic manifestations that are critical for diagnosing Hypermobility Spectrum Disorders (HSD) or hypermobile Ehlers-Danlos Syndrome (hEDS). A high Beighton score indicates hypermobility, but not necessarily a disorder.

Clinical Significance and Applications

The Beighton score is a valuable tool in various clinical and fitness contexts:

• Screening for Hypermobility: It provides a quick and objective measure to identify individuals with generalized joint hypermobility, which can then prompt further investigation if symptoms are present.
• Part of Diagnostic Criteria: It is a key component of the diagnostic criteria for Hypermobility Spectrum Disorders (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS), as outlined by the International Classification of Ehlers-Danlos Syndromes. However, a diagnosis requires a comprehensive clinical evaluation, considering family history, systemic manifestations, and exclusion of other conditions.
• Guiding Exercise Prescription: For fitness professionals, identifying hypermobility is vital. Individuals with GJH may benefit from:
  • Focus on Stability and Strength: Emphasizing exercises that build muscular strength and endurance around joints to enhance stability, rather than focusing on increasing flexibility.
  • Proprioceptive Training: Incorporating balance and proprioceptive exercises to improve joint awareness and control, which can be diminished in hypermobile individuals.
  • Avoiding End-Range Passive Stretching: While maintaining functional range of motion is important, aggressive or passive stretching into extreme ranges should generally be avoided to prevent overstretching already lax ligaments and capsules.
  • Injury Prevention: Understanding joint laxity helps anticipate potential areas of vulnerability (e.g., shoulders, knees, ankles) and implement targeted strengthening or bracing strategies.
• Research: It is widely used in research studies investigating the prevalence and implications of joint hypermobility.

Limitations and Considerations

While valuable, the Beighton score has several limitations:

• Does Not Assess Pain or Function: It is purely a measure of passive range of motion and does not indicate whether the hypermobility is symptomatic (i.e., causing pain or functional impairment).
• Limited Joint Coverage: It only assesses a select few joints and does not provide a comprehensive picture of hypermobility across all joints (e.g., hips, spine, ankles are not fully represented).
• Age and Ethnic Variability: The prevalence of GJH and typical Beighton scores can vary significantly with age (decreasing with age) and across different ethnic groups.
• Inter- and Intra-Rater Reliability: While generally considered reliable, consistency in measurement can vary between different examiners and even for the same examiner over time if strict protocols are not followed.
• Not a Standalone Diagnosis: A high Beighton score alone does not diagnose a hypermobility disorder. It must be considered within a broader clinical context, including a thorough medical history, physical examination, and assessment of systemic features.

When to Seek Professional Advice

If you suspect you have joint hypermobility, especially if accompanied by symptoms such as chronic joint pain, frequent sprains or dislocations, fatigue, or other unexplained symptoms, it is advisable to consult a healthcare professional. This could include a general practitioner, a physical therapist, a rheumatologist, or a geneticist. They can perform a comprehensive assessment, interpret your Beighton score in context, and determine if further investigation or management is necessary. For fitness enthusiasts and trainers, recognizing the signs of hypermobility can inform safer and more effective exercise programming, highlighting the importance of a stability-first approach.