Beighton Score Calculator

How does this Beighton score calculator work?

This is a health tool that quantifies joint laxity and is clinically used in the diagnosis of hypermobility associated syndromes.

The score itself is a modification after the Carter/Wilkinson scoring system for hypermobility. Originally used just in epidemiologic studies, nowadays is a recognized easy to perform and highly specific diagnosis method.

The nine items present in the Beighton score calculator that require the subject to perform certain flexibility movements are described below:

■ Placing flat hands on the floor with straight legs;

■ Left knee bending backward more than 10 degrees;

■ Right knee bending backward more than 10 degrees;

■ Left elbow bending backward more than 10 degrees;

■ Right elbow bending backward more than 10 degrees;

■ Left thumb touching the forearm;

■ Right thumb touching the forearm;

■ Left little finger bending backward past 90 degrees;

■ Right little finger bending backward past 90 degrees.

The subsequent validation studies have revealed high kappa values, the intraobserver one being 0.75 while the interobserver correlation being 0.78.

The main criticisms received by the model involve the fact that it only covers a few types of joints and overlooks others and also the fact that it does not factor in hypermobility severity and does not stratify it in any way.

Beighton score interpretation

The nine items presented above are each assigned one point when positive. Therefore the Beighton score is usually interpreted as number of positive signs/9.

There are different cut offs for diagnosis, some even starting from 1/9 depending on associates symptoms but the most common thresholds in young adults are the 4/9 and the 5/9. The score is also correlated to other examination and patient history finding such as those effectuated in the EDS hypermobility diagnosis.

This means that even high Beighton scores might just reflect hypermobility rather than a developed syndrome.

There is also a new mean of diagnosis used currently: the Brighton criteria. This new method has yet to replace the Beighton scale entirely, because it is based on it, using the result in conjunction with physical exams and history of symptoms.

Joint hypermobility guidelines

Hypermobility is defined as joints that stretch to a further degree than it would be normal and can affect one or more joints. This condition is caused by misaligned joints, abnormally shaped osseous ends, collagen or connective tissue defect syndromes such as the Ehlers-Danlos syndrome, Loeys-Dietz syndrome or the Marfan syndrome.

Some examples of joint hypermobility include:

■ Bending thumbs backwards to the wrists;

■ Bending knee joints backwards;

■ Ability to perform contortionist movements.

Hypermobility in the hand is known as double-jointedness.

The most common signs and symptoms met in the hypermobility syndrome include:

■ Frequent sprains due to joint instability;

■ Tendinitis and or bursitis caused by normal activities;

■ Shoulder subluxations or dislocations;

■ Proneness to spondylolisthesis, whiplash;

■ Joint pain, knee pain, back pain;

■ Carpal tunnel syndrome;

■ Temporomandibular joint syndrome;

■ Early onset osteoarthritis.

The major criteria in the diagnosis of BJHS, the Benign Joint Hypermobility Syndrome requires a Beighton score of 4/9 or greater and arthralgia present for longer than 3 months in four or more joints.

Minor criteria accepts results of 1 to 3 in the Beighton score, present arthralgia and a history of any of the following: subluxation in more than one joint, soft tissue rheumatism, marfanoid habitus, varicose veins etc.

References

1) Grahame R. (2000) The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol; 27:1777–1779

2) Beighton PH Horan F. (1969) Orthopedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg [Br]; 51: 444-453.

3) Simpson MR. (2006) Benign joint hypermobility syndrome: evaluation, diagnosis, and management. J Am Osteopath Assoc; 106(9):531-6.

4) Smits-Engelsman B, Klerks M, Kirby A. (2011) Beighton score: a valid measure for generalized hypermobility in children. J Pediatr;158(1):119-23, 123.e1-4.