Toolbox - The Beighton score
Consultant rheumatologist Dr Alan Hakim with his guide to using the Beighton score in primary care
The Beighton score is a set of manoeuvres used to judge if there is evidence of joint hypermobility. There are 9 points, and a score of 4 or more is considered a sign of there likely being generalised joint hypermobility present.
The 9 points are made up of the following:
- One point if, while standing and bending forward, the individual can place their palms on the ground with the legs straight
- One point for each elbow that extends more than 10 degrees
- One point for each knee that extends more than 5 degrees
- One point for each thumb that, with the wrist flexed, can be manipulated to the forearm
- One point for each fifth finger that extends beyond 90 degrees.
Another quick tool allied to the Beighton score is the hypermobility questionnaire, which can be used instead of a physical examination.1 An answer of ‘yes’ to two or more of the questions gives a very high prediction of the presence of hypermobility, with 85% sensitivity and specificity against the Beighton score.
The five questions are:
- Can you now (or could you ever) place your hands flat on the floor without bending your knees?
- Can you now (or could you ever) bend your thumb to touch your forearm?
- As a child did you amuse your friends by contorting your body into strange shapes OR could you do the splits?
- As a child or teenager did your shoulder or kneecap dislocate on more than one occasion?
- Do you consider yourself double-jointed?
It is important to note that the Beighton score is best used as a screening tool. Thereafter other sites should be examined for hypermobility, such as the temporomandibular joint, cervical spine, shoulders, thoracic spine, hips, ankles and feet.
When to use it
Hypermobility should be looked for in anyone with mechanical joint pains or recurrent soft tissue injuries, including ligament and tendon strains and joint dislocations. It is a risk for musculoskeletal injury that is often overlooked.
Managing the condition is difficult to discuss in a short paragraph, but the Hypermobility Syndromes Association website has produced a great guide for clinicians on the subject, including management and further treatment.
Hypermobility is also a feature of the hereditary disorders of connective tissue, including joint hypermobility syndrome, Ehlers Danlos syndrome, Marfan syndrome and Stickler syndrome. It is a diagnostic criterion for the joint hypermobility syndrome and Ehlers Danlos syndrome hypermobility subtype (formerly classified as type III).
The Beighton score is modification of the Carter & Wilkinson scoring system previously used as an indicator of widespread hypermobility, and reduced the number of sites needing to be examined.1 It was intended as a research tool and is still very much used for epidemiological and clinical studies in current practice.2
Dr Alan Hakim is a consultant rheumatologist at Whipps Cross Hospital, Barts Health NHS Trust, a fellow of the Royal College of Physicians and member of council for the British Society for Rheumatology. He is also the chief medical advisor and a trustee of the UK charity The Hypermobility Syndromes Association, and a trustee of the Arthritis and Musculoskeletal Alliance (ARMA).
- Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. International Journal of Clinical Practice, 2003; 57 (3): 163-166
- Carter C, Wilkinson J. Persistent joint laxity and congenital dislocation of the hip. Journal of Bone and Joint Surgery, 1964; 46-B: 40-45
- Beighton PH, Solomon L, Soskolne CL. Articular mobility in an African population. Annals of the Rheumatic Diseases, 1973; 32 (5): 413-17