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Category Medicine & Tests

Patient Age Group

5th Finger Extension ≥ 90° Left hand

5th Finger Extension ≥ 90° Right hand

Thumb to Forearm Left hand

Thumb to Forearm Right hand

Elbow Hyperextension ≥ 10° Left arm

Elbow Hyperextension ≥ 10° Right arm

Knee Hyperextension ≥ 10° Left leg

Knee Hyperextension ≥ 10° Right leg

Forward Trunk Flexion Palms flat on floor, knees locked

0 / 9

No hypermobility indicated Toggle criteria above to calculate the Beighton Score.

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About

The Beighton Score quantifies generalized joint hypermobility (GJH) across 9 binary assessment points distributed over 5 anatomical sites. Originally described by Beighton, Solomon, and Soskolne in 1973, it remains the standard clinical screening instrument referenced in the 2017 International EDS Classification and the Brighton Criteria. A threshold of S ≥ 4 out of 9 in adults (or ≥ 5 in children) suggests GJH, though the score alone does not diagnose Ehlers-Danlos Syndrome or any specific connective tissue disorder. Hypermobility declines with age; a score that is borderline in a 40-year-old patient may carry more clinical weight than the same score in an adolescent. This tool does not replace clinical examination. Passive range-of-motion assessment by a trained examiner is required for accurate scoring.

Failure to recognize GJH leads to missed diagnoses of joint instability, chronic pain syndromes, and delayed referral to rheumatology. Conversely, over-diagnosis creates unnecessary anxiety. The Beighton Score provides an objective, reproducible starting point. Note that the score does not capture temporomandibular, cervical spine, or shoulder hypermobility. Clinicians should combine this with patient history (e.g., dislocations, chronic pain, skin hyperextensibility) per the 2017 diagnostic checklist.

Formulas

The Beighton Score is a simple additive index. Each maneuver is scored as either 0 (negative) or 1 (positive).

S = 9∑i=1 c_i

where S = total Beighton Score (0 - 9), c_i ∈ {0, 1} = result of the i-th clinical maneuver.

Clinical interpretation thresholds:

{

GJH likely if S ≥ 4 (adults ≥ 18 yr)GJH likely if S ≥ 5 (children/adolescents < 18 yr)GJH unlikely if S < 4

The 2017 International EDS Nosology also uses an age-adjusted cut-off: ≥ 5 for pre-pubertal children, ≥ 4 for pubertal or post-pubertal adults, and ≥ 4 (historical) for those over 50 yr.

Reference Data

Criterion #	Maneuver	Side	Positive Finding	Points
1	Passive dorsiflexion of 5th MCP joint	Left	Extension ≥ 90°	1
2	Passive dorsiflexion of 5th MCP joint	Right	Extension ≥ 90°	1
3	Passive apposition of thumb to forearm	Left	Thumb touches volar forearm	1
4	Passive apposition of thumb to forearm	Right	Thumb touches volar forearm	1
5	Hyperextension of elbow	Left	Extension ≥ 10° beyond 180°	1
6	Hyperextension of elbow	Right	Extension ≥ 10° beyond 180°	1
7	Hyperextension of knee	Left	Extension ≥ 10° beyond 180°	1
8	Hyperextension of knee	Right	Extension ≥ 10° beyond 180°	1
9	Forward flexion of trunk	Bilateral	Palms flat on floor, knees locked	1
Maximum Total				9

Frequently Asked Questions

No. The Beighton Score screens for generalized joint hypermobility (GJH), which is one criterion for hypermobile EDS (hEDS) under the 2017 International Classification. Diagnosis of hEDS requires meeting all three criteria: GJH (Beighton ≥ 4 in adults), at least 2 of 3 systemic features (skin, musculoskeletal, family history), and exclusion of alternative diagnoses. The Beighton Score alone is insufficient.

Joint laxity is physiologically higher in children and decreases with age due to collagen cross-linking and soft tissue stiffening. A score of 4/9 in a 50-year-old patient is more clinically significant than 4/9 in a 10-year-old. The 2017 nosology recommends ≥ 5 for pre-pubertal children and adolescents, ≥ 4 for post-pubertal adults up to age 50, and a historical Beighton ≥ 4 (via 5-point questionnaire) for patients over 50 who may have lost range of motion.

Yes. Hypermobility declines with age, injury, surgery, and conditions like osteoarthritis. A patient who scored 7/9 at age 20 may score 3/9 at age 55. The 5-point historical hypermobility questionnaire (Hakim & Grahame, 2003) captures past flexibility. If the current Beighton Score is below threshold but the historical questionnaire is positive (≥ 2/5), GJH may still be present.

No. The Beighton Score evaluates only 5 anatomical sites: 5th metacarpophalangeal joints, thumbs, elbows, knees, and trunk flexion. It does not assess shoulders, hips, ankles, cervical spine, or temporomandibular joints. Patients can have clinically significant hypermobility at unstressed joints not captured by this instrument. Supplementary clinical assessment is necessary.

A goniometer is the standard instrument. The elbow is assessed with the arm in full extension and supination; any recurvatum beyond 180° is measured. For the knee, the patient stands with quadriceps contracted; hyperextension (genu recurvatum) ≥ 10° is positive. Without a goniometer, visual estimation introduces inter-rater variability of approximately ± 5°, which can shift borderline scores across the threshold.

The score may be artificially lowered if a joint has been surgically stabilized or is restricted by injury, casting, or pain-guarding. In such cases, score the contralateral side normally and note the limitation. The 2017 criteria allow use of the historical questionnaire to supplement current Beighton assessment when physical limitation prevents proper testing.