Clinical calculator
Beighton Calculator
Beighton Score for Joint Hypermobility
The Beighton score measures generalised joint hypermobility with nine bedside manoeuvres scored one point each, giving a total from 0 to 9, where 4 or more is the conventional adult threshold and 6 or more the threshold in children.
What the Beighton score means
Beighton scores run from 0 to 9, where a lower score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.
- Not hypermobile by the adult threshold0–3
Below the conventional adult cut-off of 4. Note that the paediatric threshold is 6 and the threshold for post-pubertal men is sometimes set lower.
- Generalised joint hypermobility (adult threshold met)4–5
Meets the conventional adult cut-off of 4 or more. Does not by itself indicate a heritable connective tissue disorder.
- Marked generalised joint hypermobility6–9
Meets the paediatric threshold of 6 as well as the adult threshold. Consider assessment against the hypermobile Ehlers-Danlos criteria if there are supporting systemic features.
Published criteria and reliability
The published cut-offs that define this instrument, and the measured agreement between observers using it. Each is reported with the population it was derived in.
| Type | Value | Subscale | Population | Follow-up | Source |
|---|---|---|---|---|---|
| Criterion | ≥ 4 defines generalised joint hypermobility in adults | — | Adults | — | Beighton P 1973 |
| Criterion | ≥ 6 defines generalised joint hypermobility in children and adolescents | — | Pre-pubertal children and adolescents | — | Malfait F 2017 |
| Criterion | ≥ 5 used in adults over 50 in the hEDS criteria | — | Adults over 50, 2017 international hEDS criteria | — | Malfait F 2017 |
Criterion is a published cut-off, definition or performance figure belonging to a classification or decision rule — it is not a change score and should not be read as one.
How the score is calculated
Stated in full so the calculation can be independently checked, and reproduced by hand if needed.
Nine manoeuvres are tested and each positive finding scores one point: passive dorsiflexion of the fifth metacarpophalangeal joint beyond 90 degrees (one point per hand), passive apposition of the thumb to the flexor aspect of the forearm (one point per thumb), hyperextension of the elbow beyond 10 degrees (one point per elbow), hyperextension of the knee beyond 10 degrees (one point per knee), and forward flexion of the trunk with the knees extended so the palms rest flat on the floor (one point). The total ranges from 0 to 9. A score of 4 or more is the conventional adult threshold for generalised joint hypermobility, and 6 or more is used in pre-pubertal children and adolescents.
Missing data
All nine manoeuvres are required. There is no substitution rule, and an incomplete examination cannot be compared against the published thresholds.
Instrument profile
- Developer
- Peter Beighton, building on the Carter and Wilkinson criteria
- Institution
- University of Cape Town, South Africa
- First published
- 1973
- Items
- 9
- Response format
- Nine yes/no manoeuvres, 1 point each
- Score range
- 0 to 9
- Direction
- Lower score = better
- Recall period
- Current examination
- Completion time
- About 3 minutes
- Age range
- Children and adults, with different thresholds by age
- Regions
- General Health, Paediatric
- Conditions
- Generalised joint hypermobility, Hypermobile Ehlers-Danlos syndrome, Hypermobility spectrum disorder, Recurrent joint instability
- Observer agreement
- Interobserver ICC typically 0.72–0.87 for the total score
- Validity
- Correlates with connective tissue laxity and is embedded in the 2017 international criteria for hypermobile Ehlers-Danlos syndrome, where it forms the first of three required criteria.
- Reliability
- Reliability is good for the total but weaker for individual manoeuvres, particularly fifth finger dorsiflexion, where goniometry improves agreement over visual estimation. Hypermobility also decreases with age, so a score taken decades apart is not comparable.
Normative values
Reference values from published cohorts, for comparison against the score you calculated.
| Population | Age | Mean | SD |
|---|---|---|---|
| General adult population | — | Roughly 10–15% score 4 or more | — |
| Children aged 6–12 | — | Roughly 25–35% score 6 or more | — |
When to use the Beighton
Well suited to
- Screening for generalised joint hypermobility in patients with recurrent joint instability, dislocations or unexplained musculoskeletal pain.
- As the first criterion when assessing against the 2017 hypermobile Ehlers-Danlos syndrome criteria.
Limitations and poor fits
- As a diagnosis in itself — hypermobility is common and usually benign.
- In patients with joint contracture, prior surgery or acute injury at the tested joints, which invalidates the manoeuvre.
- As a complete assessment of hypermobility, since it tests only four joint regions and misses shoulder, hip, ankle and spinal laxity.
Beighton compared with other instruments
Instruments measuring a related construct, with the practical difference between them.
| Instrument | Items | Range | What it adds |
|---|---|---|---|
| Kellgren-Lawrence | 1 | 0–4 | The Kellgren-Lawrence classification grades radiographic osteoarthritis from 0 to 4 based on osteophyte formation, joint space narrowing, subchondral sclerosis and bone contour deformity, with grade 2 conventionally taken as the threshold for definite radiographic osteoarthritis. |
Copyright and permitted use
Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.
A published clinical examination method. The manoeuvres and scoring are freely reproducible and no licence is required.
References
- Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Annals of the Rheumatic Diseases. 1973.PMID 4751776
- Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. Journal of Rheumatology. 2007.PMID 17407233
- Malfait F, Francomano C, Byers P, et al.. The 2017 international classification of the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C. 2017.PMID 28306229
Editorial status
Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.