Beighton Score Review Project

Project Summary

The Beighton Score is a scoring system used to identify the presence of generalised joint hypermobility in an individual. It was originally created as a screening tool, used to identify hypermobile people in a large population for research purposes. However, it is now used as a diagnostic tool to diagnose hypermobile patients. In this publication we question whether it is the most rational method to assess someone for generalised joint hypermobility. This is because most of the assessed joints in the Beighton Score are in the upper limbs and only a few of the major joints where hypermobility can occur are included. This is important because this may not truly reflect generalised joint hypermobility. Furthermore, the Beighton Score forms a core part of the diagnostic criteria for hypermobile Ehlers-Danlos syndrome (hEDS) and therefore, it raises concerns that patients could be denied a diagnosis of hEDS purely by the circumstantial location of their hypermobility, and not due to a true absence of the condition.

We decided to address this issue in an evidence-based manner and carried out an extensive literature review of the topic. There were several studies that showed statistically that the Beighton Score did not correlate with or reflect hypermobility present in the other joints not examined within the Beighton Score. This demonstrated that those with a negative Beighton Score could still have other hypermobile joints and generalised joint hypermobility. Hence, it could not be said that the Beighton Score was an appropriate method to rule out generalised joint hypermobility and a diagnosis of hEDS.

The paper also discusses other clinical aspects of the Beighton Score when used as a diagnostic tool, including its reliability, sensitivity and specificity. The full review can be read here. You can also read an interview we did with Massage and Fitness Magazine about this work, which you can read here.

It is based on the collective evidence presented in the review that we were able to make the following conclusions and recommendations:

  • Someone with a low Beighton Score might still have generalised joint hypermobility
  • The Beighton Score should NOT be used to rule out the presence of generalised joint hypermobility.
  • The Beighton Score should NOT be used to differentiate between localised and generalised hypermobility.
  • The Beighton Score SHOULD be used as an initial screening tool, after which, other joints should be examined to determine if generalised joint hypermobility is still present, but which may have been missed by the Beighton Score.

Citation: Malek, S., Reinhold, E.J. & Pearce, G.S. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol Int (2021). Read publication

Project Goals

Review the literature to assess the use of the Beighton Score in identifying generalised joint hypermobility
Facilitate patient diagnosis
Raise awareness


The Project Team

Sabeeha Malek

PhD Student

Sabeeha is a PhD student and researcher at the University of Warwick, and also interned at hEDStogether. Her research focuses on the role of cell adhesion and cell biomechanics in EDS.

Gemma Pearce

Dr. Gemma Pearce

hEDStogether lead

Gemma is the lead for this world-leading hEDS together research theme, she is involved in all of the featured research projects and has hEDS/HSD herself.

Dr Emma Reinhold

General Practitioner

Emma spearheaded the RCGP #EDSToolkit project. She is passionate about improving all aspects of the patient experience in hEDS/HSD through research and policy work.

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