Hypermobility: Testing, The Beighton Score, and Comprehensive Assessment

How to test for hypermobility?

Testing for hypermobility primarily involves the Beighton Score, a standardized, nine-point assessment that evaluates the range of motion in specific joints, often supplemented by a comprehensive clinical examination.

Understanding Joint Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its normal anatomical range of motion. It's a common trait, often benign, and can be influenced by genetics, age (tends to decrease with age), gender (more common in females), and ethnicity. While many individuals with hypermobility experience no issues, for others, it can lead to symptoms such as chronic joint pain, instability, dislocations, and fatigue. When hypermobility is accompanied by systemic symptoms, it may be indicative of a Hypermobility Spectrum Disorder (HSD) or, in more severe cases, a heritable connective tissue disorder like Ehlers-Danlos Syndrome (hEDS).

The Beighton Score: The Gold Standard

The Beighton Score is the most widely used and recognized clinical tool for screening generalized joint hypermobility. It is a simple, quick, and non-invasive assessment that assigns a point for the presence of hypermobility in specific joints. The maximum score is 9 points.

Here's how each component of the Beighton Score is assessed:

• Elbow Hyperextension (2 points)

  • Assessment: With the arm extended and palm facing forward, observe if the elbow can hyperextend beyond 10 degrees.
  • Scoring: 1 point for each elbow that hyperextends beyond 10 degrees (maximum 2 points).

• Knee Hyperextension (2 points)

  • Assessment: Standing with knees fully extended, observe if the knee can hyperextend beyond 10 degrees. This is often assessed from the side.
  • Scoring: 1 point for each knee that hyperextends beyond 10 degrees (maximum 2 points).

• Thumb to Forearm Opposition (2 points)

  • Assessment: With the wrist flexed, attempt to touch the thumb to the forearm on the palmar side.
  • Scoring: 1 point for each thumb that can touch the forearm (maximum 2 points).

• Fifth Finger Hyperextension (2 points)

  • Assessment: Place the forearm flat on a surface with the palm down. Attempt to extend the little finger backwards beyond 90 degrees.
  • Scoring: 1 point for each little finger that hyperextends beyond 90 degrees (maximum 2 points).

• Palm-on-Floor Test (1 point)

  • Assessment: Standing with knees fully extended, bend forward at the waist and attempt to place the palms flat on the floor.
  • Scoring: 1 point if the palms can be placed flat on the floor with knees straight (maximum 1 point).

Scoring and Interpretation

The total Beighton Score ranges from 0 to 9. While there isn't a universally agreed-upon cut-off for "generalized joint hypermobility," common thresholds include:

• Adults: A score of 4/9 or 5/9 or higher is often considered indicative of generalized joint hypermobility.
• Children/Adolescents: Higher cut-offs (e.g., 6/9 or 7/9) may be used due to greater natural flexibility in younger individuals.

It's crucial to understand that a high Beighton Score indicates generalized joint hypermobility but does not, by itself, diagnose a hypermobility spectrum disorder or Ehlers-Danlos Syndrome. It is a screening tool that identifies individuals who may warrant further clinical investigation.

Other Assessment Tools and Considerations

While the Beighton Score is central, a comprehensive assessment of hypermobility often involves additional methods:

• Clinical Examination and History Taking: A healthcare professional will take a detailed medical history, inquiring about:

  • Recurrent joint pain, dislocations, or subluxations.
  • Fatigue, bruising, or skin elasticity issues.
  • Family history of hypermobility or connective tissue disorders.
  • Other systemic symptoms (e.g., gastrointestinal, cardiovascular, autonomic dysfunction) that may be associated with HSD or hEDS.
  • A physical examination will also assess joint stability, muscle strength, proprioception, and any signs of tissue fragility.

• Functional Movement Assessment: Observing how an individual moves during daily activities or specific exercises can reveal patterns of instability, compensatory movements, or inefficient motor control that may be related to hypermobility. This can include assessments of balance, gait, and specific exercise mechanics.

Who Should Be Tested?

Testing for hypermobility is generally recommended for individuals who:

• Experience unexplained chronic joint pain, especially widespread or migrating pain.
• Have a history of recurrent joint dislocations or subluxations.
• Exhibit signs of joint instability.
• Have a family history of hypermobility, Ehlers-Danlos Syndrome, or other connective tissue disorders.
• Present with symptoms commonly associated with hypermobility spectrum disorders, such as chronic fatigue, dysautonomia, or gastrointestinal issues.

Interpreting Results and Next Steps

If your Beighton Score is high or you consistently experience symptoms suggestive of hypermobility-related issues, it is essential to seek professional medical advice.

• Consult a Healthcare Professional: A general practitioner, rheumatologist, or a physical therapist with expertise in hypermobility can provide a definitive diagnosis and guide appropriate management.
• Differential Diagnosis: A professional can differentiate between benign joint hypermobility and more complex conditions like HSD or hEDS, which require specific management strategies.
• Personalized Management Plan: Based on the diagnosis, a tailored plan may include:
  • Physical Therapy: To strengthen stabilizing muscles, improve proprioception, and learn safe movement patterns.
  • Pain Management: Strategies to alleviate chronic pain.
  • Occupational Therapy: To adapt daily activities and protect joints.
  • Lifestyle Modifications: Guidance on exercise, activity levels, and supportive devices.
  • Referrals: To other specialists (e.g., cardiology, gastroenterology) if systemic symptoms are present.

Important Considerations for Self-Assessment

While the Beighton Score can be performed at home, it is crucial to approach self-assessment with caution:

• Not a Diagnostic Tool: The Beighton Score is a screening tool, not a diagnostic one. A high score indicates the presence of generalized joint hypermobility but does not diagnose a disorder.
• Professional Context is Key: A clinical diagnosis of HSD or hEDS requires a comprehensive evaluation by a healthcare professional, considering the Beighton Score in conjunction with a detailed medical history, physical examination, and assessment of other diagnostic criteria.
• Variability: Joint flexibility can vary based on factors like time of day, temperature, previous activity, and individual effort.
• Potential for Injury: Pushing joints beyond their comfortable range of motion during self-assessment can lead to injury if not performed carefully.

In conclusion, while the Beighton Score offers a valuable initial screening for hypermobility, a holistic understanding and appropriate management require the expertise of medical professionals.