Hypermobility - Diagnosing joint hypermobility

If your doctor thinks that you may have joint hypermobility, the Beighton score is often used as a quick test to assess the range of movement in some of your joints.

However, this cannot be used to confirm a diagnosis, because it is important to look at all the joints.

Your GP may also carry out blood tests and X-rays to rule out other conditions associated with joint pains, such as rheumatoid arthritis.

If you have other symptoms in addition to hypermobile joints, your GP may carry out a further assessment of your condition using the Brighton criteria, which can help determine if you have joint hypermobility syndrome (JHS).

The Beighton score

The Beighton score consists of a series of five tests, the results of which can add up to a total of nine points.

The score is worked out as follows:

• one point if you can place your palms on the ground while standing with your 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

If your Beighton score is four or more, it is likely that you have joint hypermobility.

The Hypermobility Syndromes Association has images of the Beighton score tests, if you would like more information.

The Brighton criteria

The Brighton criteria take into account your Beighton score, but also consider other symptoms, such as joint pain and dislocated joints, and how long you have had them. There are major and minor Brighton criteria.

Major criteria

The major Brighton criteria are: 

• having a Beighton score of four or more – either now or in the past
• having joint pain for longer than three months in four or more joints

Minor criteria

The minor Brighton criteria are:

• having a Beighton score of one to three, or having a Beighton score of zero to three if you are over 50 years of age
• having joint pain for longer than three months up to three joints, back pain for longer than three months, or spondylosis (spinal arthritis) or spondylolisthesis (where a bone from the lower spine slips out of position)
• dislocation or partial dislocation of more than one joint, or the same joint more than once
• having three or more injuries to your soft tissues – such as tenosynovitis (inflammation of the protective layer surrounding a tendon) or bursitis (inflammation of a fluid-filled sac in a joint)
• having particular physical characteristics called Marfanoid habitus – this includes being tall and slim and having long, slim fingers
• having abnormal skin – such as thin and stretchy skin
• having eye-related symptoms – such as droopy eyelids or short-sightedness
• having swollen and enlarged veins (varicose veins), a hernia (when an internal part of the body pushes through a weakness in the surrounding tissue wall) or – in women – pelvic organ prolapse (where the organs inside the pelvis slip down from their normal position) 

According to the Brighton criteria, JHS may be diagnosed if you have:

• two major criteria
• one major criteria and two minor criteria
• four minor criteria
• two minor criteria and a close relative, such as a parent, who has been diagnosed with JHS

Assessing the impact of the condition

If you are diagnosed with JHS, it's important that your GP fully assesses the effect the condition is having.

JHS can cause a wide range of symptoms (read more about the symptoms of joint hypermobility) and it's necessary to assess the effect of your symptoms on your quality of life to determine the treatment and support you need.

Read more about treating joint hypermobility.