Hypermobility: Self-Assessment, Beighton Score, and When to Seek Help

How can I test myself for hypermobility?

Self-assessment for hypermobility commonly involves evaluating specific joint ranges of motion, with the Beighton Score being a widely recognized and simple method to screen for generalized joint hypermobility.

Understanding Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its normal range of motion. This increased flexibility can affect a single joint (localized hypermobility) or multiple joints throughout the body (generalized hypermobility). While some individuals with hypermobility experience no symptoms and might even benefit from their increased flexibility (e.g., dancers, gymnasts), others may develop symptoms such as joint pain, instability, frequent sprains, or even dislocations. When hypermobility is accompanied by systemic symptoms, it may be indicative of a Hypermobility Spectrum Disorder (HSD) or a specific genetic connective tissue disorder like Ehlers-Danlos Syndrome (hEDS). Self-assessment can be a valuable first step in understanding your body's unique joint mobility and determining if further professional evaluation is warranted.

The Beighton Score: A Standardized Self-Assessment Tool

The Beighton Score is a simple, quick, and widely used screening tool to assess generalized joint hypermobility. It evaluates five specific joint maneuvers, with a maximum possible score of 9 points. It's important to remember that the Beighton Score is a screening tool, not a diagnostic one for hypermobility conditions, but a higher score can indicate a predisposition to generalized hypermobility.

Performing the Beighton Score Tests

For accurate self-assessment, perform these tests carefully, ensuring you do not push beyond a comfortable range of motion, and ideally, have someone assist you with observation for the elbow and knee tests.

• Test 1: Little Finger (Fifth Metacarpophalangeal Joint) Extension

  • How to perform: Place your forearm on a flat surface with your palm facing down. Gently pull your little finger back towards the back of your hand.
  • Scoring: Score 1 point if your little finger extends backward beyond 90 degrees relative to the back of your hand.
  • Points: 1 point for the left hand, 1 point for the right hand (maximum 2 points).

• Test 2: Thumb Opposition to Forearm

  • How to perform: Extend your arm forward with your palm facing up. Bend your wrist and pull your thumb back towards your forearm.
  • Scoring: Score 1 point if your thumb can touch your forearm.
  • Points: 1 point for the left hand, 1 point for the right hand (maximum 2 points).

• Test 3: Elbow Hyperextension

  • How to perform: Stand with your arm fully extended and straight, palm facing forward. Have someone observe your elbow from the side.
  • Scoring: Score 1 point if your elbow joint hyperextends (bends backward) by more than 10 degrees.
  • Points: 1 point for the left arm, 1 point for the right arm (maximum 2 points).

• Test 4: Knee Hyperextension

  • How to perform: Stand tall with your knees fully extended and locked. Have someone observe your knees from the side.
  • Scoring: Score 1 point if your knee joint hyperextends (bends backward) by more than 10 degrees.
  • Points: 1 point for the left leg, 1 point for the right leg (maximum 2 points).

• Test 5: Trunk Forward Flexion

  • How to perform: Stand with your feet together and knees fully extended (do not bend your knees). Bend forward at your waist, attempting to touch the floor with your palms.
  • Scoring: Score 1 point if you can place your palms flat on the floor while keeping your knees completely straight.
  • Points: 1 point (maximum 1 point).

Interpreting Your Beighton Score

Once you've completed all five tests, sum up your total points.

• A score of 4 or more (for adults) is generally considered indicative of generalized joint hypermobility.
• For children and adolescents, a higher threshold (e.g., 5 or 6) may be used, as joint laxity naturally decreases with age.

It's crucial to understand that a high Beighton Score only indicates the presence of generalized hypermobility. It does not, by itself, diagnose a hypermobility spectrum disorder or any specific condition. Many individuals with a high score are asymptomatic.

Beyond the Beighton Score: Recognizing Symptoms

While the Beighton Score assesses joint range of motion, the clinical significance of hypermobility often depends on whether it's accompanied by symptoms. If you have a high Beighton Score, consider if you also experience any of the following:

• Chronic joint pain: Often widespread or migratory, not necessarily localized to one joint.
• Joint instability: A feeling that joints might "give way."
• Frequent sprains or strains: Ligaments and tendons may be more susceptible to injury.
• Recurrent dislocations or subluxations: Joints partially or fully coming out of alignment.
• Fatigue: Often disproportionate to activity levels.
• Proprioception deficits: Difficulty knowing where your limbs are in space without looking.
• Skin hyperextensibility: Skin that is unusually soft, stretchy, or fragile (less common but relevant for certain connective tissue disorders).
• Easy bruising: Skin that bruises easily without significant trauma.

These symptoms, especially in conjunction with hypermobility, warrant further investigation.

When to Seek Professional Advice

Self-assessment provides valuable personal insight, but it is not a substitute for professional medical evaluation. You should consult a healthcare professional if:

• Your Beighton Score is high, and you are experiencing chronic pain, joint instability, or frequent injuries.
• You suspect you may have a hypermobility spectrum disorder or other connective tissue disorder.
• You are experiencing any of the associated symptoms listed above (fatigue, easy bruising, etc.).
• You require personalized advice on managing hypermobility through exercise, physical therapy, or other interventions.

A general practitioner (GP) can provide an initial assessment and refer you to specialists such as a rheumatologist, physiotherapist, or occupational therapist, who can offer diagnosis, management strategies, and support.

Important Considerations and Limitations of Self-Assessment

• Subjectivity: Your self-assessment may not be as accurate as an evaluation by a trained healthcare professional.
• Age and Activity Level: Joint flexibility naturally decreases with age. Athletes, dancers, or gymnasts may have higher scores due to training, which may or may not be symptomatic.
• Incomplete Picture: The Beighton Score assesses only a limited number of joints and does not capture all aspects of hypermobility or its associated conditions. For instance, it doesn't evaluate spinal hypermobility or other systemic features.
• No Diagnosis: A high Beighton Score does not equate to a diagnosis of Hypermobility Spectrum Disorder (HSD) or Ehlers-Danlos Syndrome (hEDS). These diagnoses require a comprehensive clinical evaluation, often involving a detailed medical history, physical examination, and assessment of other diagnostic criteria.

Conclusion

Testing yourself for hypermobility using tools like the Beighton Score can be an empowering first step in understanding your body's unique joint mobility. This self-awareness can inform discussions with healthcare providers and guide your approach to exercise and daily activities. Remember, while hypermobility can be a benign trait, persistent symptoms warrant professional medical attention to ensure proper diagnosis and management, allowing you to live a healthy and active life with your unique joint structure.