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 1
the forearm
cannot passively dorsiflex thumb to flexor 0
aspect of the forearm
right thumb passive dorsiflexion to the flexor aspect of 1
the forearm
cannot passively dorsiflex thumb to flexor 0
aspect of the forearm
left elbow hyperextends beyond 10° 1
extends <= 10 0
right elbow hyperextends beyond 10° 1
extends <= 10 0
left knee hyperextends beyond 10° 1
extends <= 10 0
right knee hyperextends beyond 10° 1
extends <= 10 0
forward flexion of trunk with palms and hands can rest flat on the floor 1
knees full extended
palms and hands cannot rest flat on the 0
floor
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.

cigarette-paper scars: atrophic scars in the skin at sites of minor lacerations over the knees, shins, and
elbows of persons with Ehlers-Danlos syndrome.

Synonym(s): papyraceous scars

Examples of cutaneous and articular manifestations of Ehlers-Danlos syndrome (EDS).

Papyraceous scars at knees in a adult man (A) and woman (B) with classic EDS. Various degrees
of skin hyperextensibility (C, D). Extensive easy bruising due to capillary fragility in a adult (E)
and child (F). Joint hypermobility at fingers (G). Genu recurvatum (H)
Antimongoloid Slant:
Steinberg Sign: