
Understanding the Beighton Score: A Key Tool in Hypermobility Assessment
Joint hypermobility, where the joint moves beyond its normal range, is a topic of increasing interest in both medical, allied health and fitness communities. Its assessment is crucial for proper diagnosis and management. One of the primary tools used in this assessment is the Beighton Score. In this blog post, we'll delve into what the Beighton Score is, how it's calculated, and its significance in hypermobility assessment.
What is the Beighton Score?
The Beighton Score, is a simple clinical tool used to assess joint hypermobility. It primarily focuses on the flexibility of certain joints in the body. The score ranges from 0 to 9, with higher scores indicating greater joint hypermobility.
The History & The Controversy
Malek, Reinhold & Pearce (2021) summarise this very well:
"Since its creation in 1973, the BS [Beighton Score] has remained unchanged, and adopted both for research purposes and as a clinical diagnostic tool. However, it was originally developed as an epidemiological tool, involved in screening large populations for GJH. Neither Carter and Wilkinson [4] nor Beighton et al. [5] provide any evidence-based justification for the selection of joints within the assessment method. It appears joints were not specifically selected to accurately reflect GJH or hypermobility present in other joints, but chosen instead on a functional basis, for ease of access and efficiency without the need for equipment. As a result, two thirds of the joints being assessed are located in the upper limbs and many of the major joints are disregarded, and with only a single plane of joint motion measured." 1
How is the Beighton Score Calculated?
The Beighton Score is calculated based on a series of five manoeuvres:
1. Passive Dorsiflexion of the 5th Fingers: The ability to bend the 5th fingers backward beyond 90 degrees.
2. Passive Apposition of the Thumb to the Flexor Aspect of the Forearm: The ability of the thumb to touch the forearm when passively bent towards the forearm
3. Hyperextension of the Elbows: The ability to hyperextend the elbows beyond 10 degrees.
4. Hyperextension of the Knees: The ability to hyperextend the knees beyond 10 degrees.
5. Forward Flexion of the Trunk with Knees Fully Extended and Palms Flat on the Floor: The ability to bend forward and place palms flat on the floor without bending the knees.
Each of these manoeuvres scores one point if the criterion is met, resulting in a maximum score of 9 if all criteria are fulfilled.
Significance in Hypermobility Assessment
The Beighton Score serves as a valuable tool in the assessment of joint hypermobility for several reasons:
1. Standardized Assessment: It provides a standardized and reproducible2 method for clinicians to evaluate joint hypermobility across different patients and settings.
2. Early Detection: By identifying young people with hypermobile joints, the Beighton Score facilitates early detection of hypermobility-related conditions such as Ehlers-Danlos syndrome and joint instability.
3. Risk Assessment: Individuals with higher Beighton Scores may be at an increased risk of musculoskeletal problems such as joint dislocations, sprains, and chronic pain. Assessing the Beighton Score helps in identifying individuals who may benefit from preventive measures or specific interventions, including additional care in Occupational Therapy sessions.
4. Treatment Planning: For individuals with hypermobility-related symptoms, knowing their Beighton Score can aid healthcare providers in designing appropriate treatment plans. This may include targeted exercises to strengthen muscles and stabilise joints, as well as strategies to manage pain and prevent injuries.
Learn more about all of these & so much more in the upcoming course: Hypermobility for Paediatric Occupational Therapists
Limitations and Considerations
While the Beighton Score is a valuable tool, it's important to acknowledge its limitations and consider other factors in hypermobility assessment. Not all hypermobile individuals will score high on the Beighton Scale, including if they have hypermobility of joints not included in the Beighton Score, have a history of surgical interventions or comorbidities that counteract or prevent assessment of hypermobility. Additionally, joint hypermobility can vary across different age groups, ethnicities, and genders, with some ethnic backgrounds being more likely to be hypermobile. Therefore, the Beighton Score should be interpreted in conjunction with clinical judgment and other relevant assessments.
Conclusion
In summary, the Beighton Score is a simple yet effective tool for assessing whether there is joint hypermobility. As clinicians we need to go beyond the Beighton Score and assess other joints for their range of motion (ROM). By evaluating the flexibility of joints, it helps clinicians identify individuals at risk of hypermobility-related complications and plan appropriate interventions. However, it's essential to recognise its limitations and use it in conjunction with other clinical assessments for comprehensive hypermobility evaluation. Ultimately, the goal is to improve the diagnosis, management, and quality of life for young people with hypermobility-related conditions.
References:
1. Malek, S., Reinhold, E. J., & Pearce, G. S. (2021). The Beighton Score as a measure of generalised joint hypermobility. Rheumatology international, 41(10), 1707–1716. https://doi.org/10.1007/s00296-021-04832-4
2. (Juul-Kristensen, B., Røgind, H., Jensen, D. V., & Remvig, L. (2007). Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology (Oxford, England), 46(12), 1835–1841. https://doi.org/10.1093/rheumatology/kem290)
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