The Beighton modification of the Carter & Wilkinson scoring system has been used for many years as an indicator of widespread hypermobility. However, it is more of a research tool and an indicator of generalized hypermobility. As a clinical tool it can be a quick and straightforward thing to do BUT there are two important things to realize:
i. A high Beighton score by itself does not mean that an individual has a hypermobility syndrome. Other symptoms and signs need to also be present.
ii. A low score should be considered with caution when assessing someone for widespread pain as hypermobility can be present at a number of sites that are not counted in the Beighton score. For example, this can be at the jaw joint (the ‘TMJ’), neck (cervical spine), shoulders, mid (thoracic) spine, hips, ankles and feet.
The Beighton score is calculated as follows:
- One point if while standing forward bending you can place palms on the ground with legs straight
- One point for each elbow that bends backwards
- One point for each knee that bends backwards
- One point for each thumb that touches the forearm when bent backwards
- One point for each little finger that bends backwards beyond 90 degrees.
Another quick tool to use is the hypermobility questionnaire. An answer of ‘Yes’ to 2 or more of the questions gives a very high prediction of the presence of hypermobility. Again, like the Beighton score, this does not mean that the person has a Hypermobility Syndrome.
- 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?
Dr Alan J Hakim MA FRCP
Consultant Physician and Rheumatologist, & Chief Medical Advisor and Trustee, HMSA
Updated: March 2017. V.2. Planned date of review March 2018
Beighton PH, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973; 32: 413-17
Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract 2003; 57: 163-6
Juul-Kristensen B, Schmedling K, Rombaut L, Lund H, Engelbert RHH. 2017. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility—A systematic review. Am J Med Genet Part C Semin Med Genet 175C:116–147