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Hypermobility Syndrome (Joint Hypermobility Syndrome)

Hyperflexible joints are common and do not necessarily indicate that an individual has a Tensile Hereditary Connective Tissue Disease. Joint hypermobility decreases with age. Some studies suggest that 10% to 25% of the population may have hyperflexible joints and that 5% of individuals with hypermobility have symptoms. Symptoms caused by increased joint mobility can range from arthralgias to dislocation or injury. Individuals with severe hypermobility and recurrent dislocations may have Ehlers–Danlos syndrome (EDS).

The Beighton score for joint laxity and hypermobility uses a simple 9-point system. A score of 5 or more indicates hypermobility:

  1. Knee extension more than 10 degrees past 180 degrees: 1 point for each knee

  2. Extension of the elbow 10 degrees or more past 180 degrees: 1 point for each elbow

  3. Extension of the thumb to touch the flexor aspect of the forearm: 1 point for each thumb.

  4. Extension of the little (5th) fingers backward so that they are beyond parallel (over 90°) with the posterior forearm: 1 point for each little finger

  5. Forward trunk flexion (knees fully extended) so that the palms of the hands can be placed flat on the ground: 1 point

Brighton diagnostic criteria for benign joint hypermobility syndrome (BJHS):

Major criteria

  1. Beighton score of 4/9 or higher (see Question 5)

  2. Arthralgia for longer than 3 months in four or more joints

Minor criteria

  1. Beighton score of 1, 2, or 3/9

  2. Arthralgia (≥3 months) in one to three joints or back pain (≥3 months), spondylosis, spondylolysis/spondylolisthesis

  3. Dislocation/subluxation in more than one joint, or in one joint on more than one occasion

  4. Three or more soft-tissue lesions (epicondylitis, tenosynovitis, bursitis)

  5. Marfanoid habitus

  6. Abnormal skin: striae, hyperextensibility, thin, papyraceous scarring

  7. Eye signs: drooping eyelids, myopia, or antimongoloid slant

  8. Varicose veins or hernia or uterine/rectal prolaps





Hypermobility Association



Beighton Score - Physiopedia

Brighton Criteria

Juvenile Hypermobility