Beighton Scale
What is the Beighton scale?
The Beighton scale is a standardized scoring system used to assess generalized joint hypermobility (GJH) — meaning how easily a person’s joints can move beyond the normal range.
It is simple, quick, and non-invasive, making it a favored first-line assessment in many clinical settings.
Who uses the Beighton scale?
Several medical specialists and healthcare professionals utilize the Beighton scale, including:
Rheumatologists — to evaluate joint hypermobility when assessing patients with chronic joint pain, suspected connective tissue disorders, or unexplained musculoskeletal complaints.
Geneticists — to help in diagnosing hereditary connective tissue disorders, such as different types of Ehlers-Danlos syndrome (EDS) and other heritable syndromes involving hypermobility.
Neurologists — in cases where joint hypermobility might contribute to neurological symptoms (e.g., frequent subluxations causing nerve entrapment, proprioceptive difficulties, or autonomic dysfunction like POTS).
Orthopedic surgeons and sports medicine physicians — to evaluate athletes with recurrent joint injuries or instability.
Physiotherapists and occupational therapists — to guide rehabilitation strategies and prevent further joint damage in hypermobile patients.
Why is the Beighton scale used?
Doctors use the Beighton scale for several reasons:
✅ Screening for generalized joint hypermobility — to identify individuals who may have underlying connective tissue disorders.
✅ Diagnostic support — as part of broader diagnostic criteria for conditions such as:
Hypermobility spectrum disorders (HSD)
Ehlers-Danlos syndromes (especially hypermobile type)
Marfan syndrome (although Marfan requires other systemic assessments)
✅ Assessing injury risk — hypermobile joints are more prone to dislocations, sprains, and soft tissue injuries.
✅ Guiding treatment plans — determining the need for joint protection strategies, bracing, or tailored physical therapy.
How is the Beighton scale performed?
The Beighton scale consists of five clinical maneuvers, with a maximum score of 9 points. Each maneuver evaluates the range of motion at specific joints.
Detailed maneuvers:
1️⃣ Passive dorsiflexion of the fifth (little) finger beyond 90°
Check each hand separately.
1 point per side.
Test: The examiner gently bends the little finger backward while the palm is flat on a surface.
2️⃣ Passive opposition of the thumb to the flexor aspect of the forearm
Check each thumb separately.
1 point per side.
Test: The patient attempts to touch their forearm with their thumb while keeping the arm straight.
3️⃣ Hyperextension of the elbow beyond 10°
Check each elbow separately.
1 point per side.
Test: The patient fully extends the arm; the examiner measures the angle.
4️⃣ Hyperextension of the knee beyond 10°
Check each knee separately.
1 point per side.
Test: The patient stands with knees locked; hyperextension is measured.
5️⃣ Forward flexion of the trunk with knees straight, palms flat on the floor
1 point total.
Test: The patient bends forward from standing without bending the knees, aiming to touch the floor with palms.
Scoring and interpretation
0–3 points: Usually considered normal flexibility.
4–6 points: Suggests increased flexibility; interpreted cautiously depending on age, sex, and symptoms.
7–9 points: Strongly suggests generalized hypermobility.
Important considerations:
Age dependence: Younger people (especially children and adolescents) are naturally more flexible; thus, higher scores are more common in these groups. In older adults, a lower score may still indicate hypermobility if there is a history of greater flexibility in youth.
Ethnic variation: Certain populations have naturally higher flexibility norms.
Gender differences: Females generally have greater joint laxity than males.
Clinical limitations
The Beighton scale only evaluates a few joints, and may miss hypermobility in other important joints (e.g., shoulders, hips, ankles, cervical spine).
It does not assess current symptoms, such as pain, dislocations, or functional instability — it only screens for joint range of motion.
A high score alone is not diagnostic for connective tissue disorders; it must be interpreted within a comprehensive clinical assessment, including family history, skin features, and other systemic signs.
Conclusion
The Beighton scale is a valuable tool used by various specialists to quickly assess generalized joint hypermobility, guide further diagnostic workup, and plan management strategies.
However, it is only one piece of the puzzle — it should always be combined with a detailed history, physical examination, and sometimes genetic evaluation when connective tissue disorders are suspected.