Beighton Score Test: Purpose, Test Details & Results

Purpose of Beighton Score Test

Understanding joint mobility is crucial for both clinicians and individuals, especially when it comes to detecting hypermobility that might impact health or athletic performance. The Beighton Score Test is a quick, widely used method to assess general joint hypermobility. Originally developed for large-scale epidemiological studies, it is now often used in routine clinical practice to help diagnose hypermobility spectrum disorders. But what is its true purpose? How well does it work, and what are its limitations? This section will introduce the Beighton Score’s intent, helping you understand why and when it’s used.

What is the Beighton Score Test Used For?

The Beighton Score Test is primarily designed to screen for Generalised Joint Hypermobility (GJH), a condition where multiple joints move beyond the normal range expected for an individual’s age, gender, or ethnicity. Its original role was in epidemiological studies, helping researchers estimate hypermobility prevalence in large groups, such as school-aged children or athletic populations 1 3.

Over time, the test has been adopted by clinicians to aid in the diagnosis of hypermobility disorders. When someone presents with joint pain, frequent injuries, or symptoms that could be related to hypermobility, the Beighton Score can provide a quick, objective measure to guide further assessment 3.

Strengths: Why is it Popular?

• Simplicity and Speed: The test is easy to perform and doesn’t require specialized equipment.
• Reproducibility: Studies show it has high interrater and intrarater reliability—meaning different clinicians (or the same one at different times) usually get similar results when performing the test correctly 4.
• Broad Use: Its standardized format makes it useful for comparing results across studies, clinics, and even countries.

Limitations and Controversies

Despite its strengths, the Beighton Score has notable limitations:

• Focuses on Specific Joints: The score evaluates a limited set of joints, mostly in the upper body, and doesn't assess all joints equally. This means some people with hypermobility in other joints might not be properly identified 2 3.
• Not a Standalone Diagnostic Tool: Experts caution against using the Beighton Score as the sole means to diagnose generalized hypermobility. It should be considered as part of a broader clinical assessment 3.
• Limited in Predicting Localized Laxity: For example, a high Beighton Score does not reliably predict instability or hypermobility in joints not included in the test, such as the shoulder 2.

When is the Beighton Score Most Useful?

• Screening in Children and Young Adults: It’s especially useful in pediatric and young adult populations to identify those who might need further evaluation 1.
• Establishing Baseline Mobility: Athletes, dancers, and individuals in physical training might use it to better understand their baseline joint mobility 5.
• Supporting Clinical Diagnosis: It serves as one piece of the puzzle when diagnosing conditions like Hypermobility Spectrum Disorder or Ehlers-Danlos Syndrome.

Beighton Score Test Details

The Beighton Score Test is straightforward but requires careful execution to ensure accurate results. This section will walk you through what the test involves, which joints are assessed, and how it’s scored. Understanding these details helps patients, clinicians, and researchers interpret and trust the results.

How is the Beighton Score Test Performed?

The Beighton Score consists of five maneuvers, scored across nine points. Each maneuver is designed to test the upper or lower body’s ability to move beyond typical anatomical limits.

The Five Maneuvers

1. Passive dorsiflexion of the little finger beyond 90 degrees (right and left)
2. Passive apposition of the thumb to the flexor aspect of the forearm (right and left)
3. Hyperextension of the elbow beyond 10 degrees (right and left)
4. Hyperextension of the knee beyond 10 degrees (right and left)
5. Forward flexion of the trunk with knees fully extended so that the palms rest flat on the floor (one point)

Each side (right and left) is tested separately for the fingers, thumbs, elbows, and knees, giving a maximum possible score of 9.

Scoring

• Each positive test = 1 point
• Maximum total = 9 points
• Higher scores indicate greater hypermobility

Who Performs the Test?

• Qualified health professionals, such as physiotherapists, doctors, and trained medical students, should perform the test for reliable results 1 4.
• While some self-assessment versions exist, these are not as reliable and are not recommended for clinical use 4.

Reliability and Standardization

The Beighton Score has been shown to be highly reliable when performed by trained professionals. Studies confirm both interrater reliability (different assessors get similar results) and intrarater reliability (the same assessor gets consistent results over time) 4. This reliability is a major reason for its continued use in clinics and research.

Is Measurement Equipment Needed?

• The test is primarily clinical and visual, but some studies also use goniometry (a device to measure joint angles) for greater precision, especially in research settings 1.

What is Considered “Hypermobility”?

• Cut-off values vary depending on age, sex, and the purpose of the assessment.
• In many studies, a score of 4 or more out of 9 is used as a threshold for hypermobility in adults, while in children, a higher cut-off (such as 5 or 6) is often used due to naturally higher flexibility 1 3.

Beighton Score Test Results & Follow-Up

Receiving a Beighton Score is just the beginning. What does your score mean? How should results be interpreted, and what happens next if you score high—or low? This section covers what the results can tell you, their limitations, and the recommended follow-up actions.

Interpreting Beighton Score Results

What Does Your Score Mean?

• Low Score (0–3): Most people score within this range, indicating typical joint mobility.
• Intermediate Score (4–6): This suggests increased mobility. If you have symptoms such as pain, instability, or frequent injuries, further evaluation is warranted.
• High Score (7–9): This is considered significant hypermobility, especially if accompanied by symptoms or family history of related disorders 1 3.

Symptoms and Clinical Context

• Joint Pain: Interestingly, studies show that the presence of joint pain does not always correlate with Beighton Score. Some children with high scores do not experience pain, and vice versa 1. Therefore, the score must be interpreted in the broader clinical context.
• Specific Joint Issues: A high Beighton Score does not necessarily predict laxity in all joints. For example, shoulder instability may not be reflected in the Beighton Score, so further, joint-specific testing may be needed 2 3.

What Should Happen After Scoring?

If you or your clinician identifies significant hypermobility:

• Further Assessment: A comprehensive clinical examination should follow, including a review of symptoms, family history, and possibly imaging or other specialized tests 3.
• Referral to Specialists: If hypermobility is accompanied by pain, recurrent injuries, or signs of associated conditions (like Ehlers-Danlos Syndrome), referral to a rheumatologist, geneticist, or physiatrist is often warranted.
• Management Strategies: Treatment is usually tailored to the individual, focusing on pain management, physical therapy, and injury prevention.
• Monitoring in Children: As flexibility decreases with age, children with high scores may “normalize” over time, but monitoring is still important, especially if symptoms persist 1.

Reliability of Results

The Beighton Score has demonstrated strong reliability (consistency) when performed by trained professionals 4. However, it should always be interpreted as part of a comprehensive evaluation, not in isolation.

Special Considerations for Dancers and Athletes

• Performance vs. Risk: In populations such as dancers, increased mobility may be seen as advantageous for performance, but it also raises the risk of injury. The Beighton Score, combined with other functional tests (like the Functional Movement Screen), provides a more nuanced understanding for these individuals 5.

Conclusion

The Beighton Score Test remains a foundational tool for assessing joint hypermobility, offering a standardized, reliable way to screen patients and research populations. However, its use requires thoughtful interpretation and should be part of a broader, patient-centered clinical approach.

Key Takeaways:

• The Beighton Score is a fast, reliable screening tool for generalized joint hypermobility 1 3 4.
• It is widely used in both research and clinical settings, especially for children and young adults 1.
• The test assesses a limited number of joints, so it may miss hypermobility in untested areas 2 3.
• High interrater and intrarater reliability make it dependable when performed by health professionals 4.
• The score alone should not be used to make or exclude a diagnosis—clinical judgment and further assessment are essential 3 4.
• Results should guide, not dictate, next steps: further testing and specialist referrals are key for symptomatic individuals.
• In athletes and dancers, the Beighton Score should be integrated with functional movement assessments to balance performance and injury risk 5.

By understanding both the strengths and limitations of the Beighton Score Test, patients and clinicians alike can use it more effectively to promote joint health and overall well-being.