The Beighton Score: How to Assess Your Own Joint Hypermobility
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions.
The Beighton Score: How to Assess Your Own Joint Hypermobility
The Beighton Score is a nine-point clinical scoring system used to assess generalized joint hypermobility (GJH). It is one of the primary criteria in the 2017 International Classification for hypermobile Ehlers-Danlos Syndrome (hEDS) and is also used in the diagnosis of Hypermobility Spectrum Disorder (HSD). Understanding how to perform and interpret the Beighton Score can help you prepare for a clinical evaluation and better understand your own body.
The Nine-Point Beighton Scale
The Beighton Score tests five movements, with bilateral tests counting as two points each (one per side) and one unilateral test counting as one point. The maximum score is 9.
| Test | Points Possible | What to Do |
|---|---|---|
| Little finger extension | 2 (1 per side) | Passively extend the little finger to ≥90° from the back of the hand |
| Thumb to forearm | 2 (1 per side) | Passively flex the thumb to touch the forearm |
| Elbow hyperextension | 2 (1 per side) | Extend the elbow fully — a positive result is >10° beyond straight |
| Knee hyperextension | 2 (1 per side) | Extend the knee fully — a positive result is >10° beyond straight |
| Forward trunk flexion | 1 | With knees straight, place palms flat on the floor |
How to Perform Each Test
Little Finger Extension: Rest your hand flat on a table, palm down. Using your other hand, gently push your little finger backward (away from the table). If it bends to 90° or beyond — forming a right angle or more with the back of your hand — this is a positive result. Test both hands.
Thumb to Forearm: Hold your arm out with the palm facing up. Using your other hand, gently press your thumb toward your forearm. If your thumb touches (or nearly touches) the inner forearm, this is positive. Test both sides.
Elbow Hyperextension: Extend your arm fully and look at the elbow from the side. If the elbow bends backward beyond a straight line by more than 10 degrees, this is positive. This is often called "double-jointed" elbows. Test both sides.
Knee Hyperextension: Stand with your legs straight and look at your knees from the side (or have someone observe). If the knee bends backward beyond straight by more than 10 degrees, this is positive. Test both sides.
Forward Trunk Flexion: Stand with your feet together and knees fully extended (straight). Bend forward and try to place your palms flat on the floor. If you can do this without bending your knees, this is positive. This is a single point.
Interpreting Your Score
The threshold for a "positive" Beighton Score varies by age and sex:
| Age Group | Positive Threshold |
|---|---|
| Children and adolescents | ≥6 out of 9 |
| Adults under 50 | ≥5 out of 9 |
| Adults 50 and older | ≥4 out of 9 |
These thresholds are used in the 2017 hEDS criteria. A score at or above the threshold indicates generalized joint hypermobility — but it is important to understand that the Beighton Score alone does not diagnose hEDS or HSD.
Important Limitations
The Beighton Score is a screening tool, not a diagnosis. A high score confirms generalized hypermobility but does not tell you whether that hypermobility is causing symptoms or meets the criteria for a specific condition. Conversely, a low score does not rule out hypermobility-related conditions — some patients with hEDS or HSD have scores below the threshold, particularly older patients whose hypermobility has decreased with age.
Historical hypermobility matters. The 2017 hEDS criteria allow for a positive result based on historical hypermobility — joints that were hypermobile in the past but have stiffened due to age, injury, or deconditioning. If you were extremely flexible as a child or teenager but have lost that range of motion, this should be documented and discussed with your clinician.
The five-part questionnaire (5PQ) is an alternative. For patients who cannot perform the physical tests (due to pain, injury, or deconditioning), the five-part questionnaire asks about historical hypermobility and can substitute for the Beighton Score in some clinical contexts.
What to Do With Your Score
If your score is at or above the threshold, bring this information to your next medical appointment. Document your score, note which tests were positive, and mention any symptoms you experience related to your joints — instability, subluxations, dislocations, chronic pain, fatigue, or autonomic symptoms like dizziness on standing.
Ask your doctor whether a referral to a connective tissue specialist, rheumatologist, or geneticist is appropriate. If you also experience symptoms of POTS or MCAS, mention these as well — the triad of hypermobility, dysautonomia, and mast cell activation is increasingly recognized as a common clinical pattern.
A high Beighton Score combined with significant symptoms is a strong signal that you deserve a thorough evaluation. Do not let a clinician dismiss your score as "just being flexible."
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