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Beighton Hypermobility Score

The Beighton score is a simple system to quantify joint laxity and hypermobility.

It uses a simple 9 point system, where the higher the score the higher the laxity.

The threshold for joint laxity in a young adult is ranges from 4-6. Thus a score above 6 indicates hypermobility, but not necessarily true BHJS (see below)

Joint

Finding

Points

left little (fifth) finger

passive dorsiflexion beyond 90°

1

 

passive dorsiflexion <= 90°

0

right little (fifth) finger

passive dorsiflexion beyond 90°

1

 

passive dorsiflexion <= 90°

0

left thumb

passive dorsiflexion to the flexor aspect of the forearm

1

 

cannot passively dorsiflex thumb to flexor aspect of the forearm

0

right thumb

passive dorsiflexion to the flexor aspect of the forearm

1

 

cannot passively dorsiflex thumb to flexor aspect of the forearm

0

left elbow

hyperextends beyonds 10°

1

 

extends <= 10

0

right elbow

hyperextends beyonds 10°

1

 

extends <= 10

0

left knee

hyperextends beyonds 10°

1

 

extends <= 10

0

right knee

hyperextends beyonds 10°

1

 

extends <= 10

0

forward flexion of trunk with knees full extended

palms and hands can rest flat on the floor

1

 

palms and hands cannot rest flat on the floor

0

 


DIAGNOSTIC CRITERIA FOR THE BENIGN JOINT HYPERMOBILITY SYNDROME (BJHS)

Major Criteria

  • A Beighton score of 4/9 or greater (either currently or historically) 
  • Arthralgia for longer than 3 months in 4 or more joints

Minor Criteria

  • A Beighton score of 1, 2 or 3/9 (0, 1, 2 or 3 if aged 50+) 
  • Arthralgia (> 3 months) in one to three joints or back pain (> 3 months), spondylosis, spondylolysis/spondylolisthesis. 
  • Dislocation/subluxation in more than one joint, or in one joint on more than one occasion. 
  • Soft tissue rheumatism. > 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis). 
  • Marfanoid habitus (tall, slim, span/height ratio >1.03, upper: lower segment ratio less than 0.89, arachnodactily [positive Steinberg/wrist signs]. 
  • Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring. 
  • Eye signs: drooping eyelids or myopia or antimongoloid slant. 
  • Varicose veins or hernia or uterine/rectal prolapse.

The BJHS is diagnosed in the presence two major criteria, or one major and two minor criteria, or four minor criteria. Two minor criteria will suffice where there is an unequivocally affected first-degree relative.
BJHS is excluded by presence of Marfan or Ehlers-Danlos syndromes


References:

  • Beighton PH Horan F. Orthopedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg [Br]. 1969; 51: 444-453.

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