Generalized joint hypermobility (GJH) describes a condition where joints can move beyond the typical range expected for a person’s age and sex. This increased flexibility, often referred to as being “double-jointed,” is a natural variation in the population, but it can also be associated with certain medical conditions. To objectively measure the extent of this generalized flexibility, clinicians and researchers rely on a standardized assessment tool called the Beighton Score. This quick, nine-point system provides a consistent way to quantify the degree of joint hypermobility present in an individual.
The Purpose of the Beighton Score
Developed in the 1970s, the Beighton Score provides a simple, reproducible, and objective method for standardizing the assessment of joint flexibility across clinical and research settings. Before this system, assessing hypermobility was often subjective, making it difficult to compare findings between different practitioners or studies.
This tool functions primarily as a screening instrument to determine the presence of generalized joint hypermobility, which is a common feature in many heritable connective tissue disorders. It offers a clear, numerical value (zero to nine) representing the degree of laxity in select peripheral joints and the spine. This objective data helps clinicians decide if a patient warrants a more comprehensive evaluation for an underlying hypermobility-related condition.
The Nine-Point Assessment Method
The Beighton Score calculates nine points based on five specific maneuvers, four of which are tested bilaterally. The score is a simple tally, with one point awarded for each positive test. The first four tests assess hypermobility in the limbs, while the final test evaluates the flexibility of the spine.
The assessment begins by checking the hands for the ability to hyperextend the fifth finger backwards beyond a 90-degree angle. One point is given for each hand that achieves this movement, totaling up to two points.
The second maneuver involves the hands and is positive if the thumb can be passively bent back to touch the forearm on the same side. This scores one point per side, for a maximum of two points.
Moving to the larger limb joints, the elbows are tested for hyperextension. A point is given if the joint extends more than 10 degrees beyond the normal straightened position. This bilateral test accounts for two potential points. A similar test is performed on the knees, with one point awarded for each knee that hyperextends more than 10 degrees backward when fully extended.
The final point of the assessment is a single maneuver that evaluates the trunk’s flexibility. The patient attempts to bend forward at the waist while keeping the knees completely straight. This movement scores one point if they can place the palms of both hands flat on the floor directly in front of the feet.
Interpreting the Results and Clinical Significance
The Beighton Score is not a diagnosis on its own, but the resulting number is a major criterion for determining generalized joint hypermobility. A higher score indicates a greater degree of joint laxity, though the interpretation of a “positive” result varies based on demographics. Current guidelines suggest that for adults between puberty and 50 years of age, a score of five out of nine or greater indicates generalized joint hypermobility.
Since joint flexibility naturally decreases over time, the threshold is often lowered for older adults; a score of four or greater is typically used for those over 50 years old. Conversely, children and adolescents often have naturally higher flexibility, so a score of six or greater is usually required to be considered positive before puberty.
The score’s primary clinical significance lies in its use as a major criterion for diagnosing Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS). For hEDS, the Beighton Score is a mandatory component, serving as a quantifiable measure of underlying connective tissue laxity. A positive score, combined with systemic symptoms like chronic pain, skin texture changes, and a family history of connective tissue disorders, helps confirm a diagnosis of HSD or hEDS. The presence of generalized joint hypermobility provides objective evidence that directs the physician toward a full evaluation.