Beighton Score Calculator
The Beighton score is the gold-standard 9-point screening scale for generalised joint hypermobility (GJH), used in the 2017 International EDS/HSD diagnostic criteria. Check yes or no for each of the five movements (nine total points), enter your age, and get your score, the age-appropriate threshold, and a plain-English interpretation instantly. The joint-by-joint breakdown and the Hakim-Grahame 5-point questionnaire are built in for borderline cases.
What the Beighton score measures
The Beighton score is a 9-point physical examination scale designed to screen for generalised joint hypermobility (GJH). Introduced by Peter Beighton in 1973 as a modification of the Carter-Wilkinson scoring system, it has become the most widely used tool for assessing joint laxity in clinical and research settings. The scale tests five specific movements: passive extension of each little finger beyond 90 degrees (2 points), passive apposition of each thumb to the flexor surface of the forearm (2 points), active hyperextension of each elbow beyond 10 degrees (2 points), active hyperextension of each knee beyond 10 degrees (2 points), and forward trunk flexion with palms flat on the floor and knees straight (1 point), for a maximum of 9 points. Each bilateral maneuver scores 1 point per side; the trunk test is midline and scores 1 point total.
How to perform each maneuver correctly
For the little finger test, apply gentle passive pressure to extend the fifth finger at the knuckle (metacarpophalangeal joint) beyond 90 degrees from the palm plane. For the thumb test, passively press the thumb toward the forearm with the wrist in a neutral position; the test is positive if the thumb pad touches the forearm skin. For the elbow test, the person fully extends the elbow actively while you observe for recurvatum beyond the neutral 0-degree straight position; more than 10 degrees of hyperextension is positive. The knee test follows the same principle: stand the person on one leg and observe for backward bow (genu recurvatum) beyond 10 degrees. For the trunk test, ask the person to stand with feet together and knees locked, then bend forward to try to place both palms flat on the floor. The test is positive only if both palms are flat, not just fingertips. Accuracy matters: a study in Rheumatology found interobserver reliability correlations of about 0.78 for the full scale.
Age-adjusted cut-offs and the 5-point questionnaire
A single universal cut-off (historically 4/9) is now considered outdated. The 2017 International EDS/HSD classification criteria formalized age-specific thresholds because joint range of motion naturally decreases with age, making the same raw score mean very different things at age 12 versus age 60. The current recommended thresholds are 6/9 for children and adolescents, 5/9 for adults aged 18-50, and 4/9 for adults over 50. When a person scores exactly one point below the age-appropriate cut-off, the 5-point Hakim-Grahame questionnaire can supplement the assessment. This self-report tool asks five yes-or-no questions about current and historical flexibility and joint instability; a score of 2 or more is considered positive and, combined with a borderline Beighton score, may support a GJH diagnosis. The 5PQ has a reported sensitivity of about 91% and specificity of 75% against age-adjusted Beighton cut-offs.
What a positive score means and what it does not mean
Meeting the Beighton threshold for generalised joint hypermobility is a necessary but not sufficient condition for diagnosing hypermobility-associated disorders such as hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD). The 2017 criteria require three independent criteria to be met for hEDS, of which generalised joint hypermobility (via Beighton score or 5PQ) is only the first. Many people score positively on the Beighton scale and have no symptoms and no associated condition; GJH without symptoms is simply a normal variant of connective tissue flexibility. Conversely, clinically significant hypermobility-related problems can occur in people whose Beighton score has declined with age or injury, or who have localised rather than generalised hypermobility. The score is a screening tool, not a diagnostic test, and results should always be interpreted in the context of symptoms, clinical history, and full examination.
Associated conditions and when to seek medical assessment
Generalised joint hypermobility is associated with several heritable connective tissue disorders, including hypermobile Ehlers-Danlos syndrome (hEDS), hypermobility spectrum disorder (HSD), Marfan syndrome, Loeys-Dietz syndrome, and osteogenesis imperfecta. Many people with a positive Beighton score have none of these conditions; GJH is a common trait variant affecting roughly 10 to 20 percent of the general population. However, when hypermobility is accompanied by chronic pain, fatigue, joint instability, frequent sprains or dislocations, skin changes (easy bruising, stretchy or fragile skin), or autonomic symptoms (dizziness on standing, palpitations), a clinician familiar with connective tissue disorders should be consulted. Early diagnosis and appropriate physiotherapy-led management can significantly reduce pain and disability in people with symptomatic hypermobility.
Beighton score cut-offs by age (2017 EDS/HSD criteria)
| Age group | Positive cut-off | Notes |
|---|---|---|
| Children and adolescents (under 18) | 6 / 9 | Higher baseline flexibility requires a stricter threshold |
| Adults aged 18-50 | 5 / 9 | Standard adult threshold; most widely cited |
| Adults over 50 | 4 / 9 | Flexibility naturally declines with age |
Recommended thresholds for a positive generalised joint hypermobility (GJH) diagnosis. A borderline score (1 below the cut-off) combined with a positive 5-point questionnaire may also support GJH.
Frequently asked questions
What is the Beighton score used for?
It is used as a standardized screening test for generalised joint hypermobility (GJH). Clinicians use it as part of the assessment for connective tissue disorders such as hypermobile Ehlers-Danlos syndrome (hEDS), hypermobility spectrum disorder (HSD), Marfan syndrome, and Loeys-Dietz syndrome. Researchers also use it to define and compare hypermobility prevalence across populations.
What cut-off score indicates hypermobility?
The 2017 International EDS/HSD classification criteria recommend age-adjusted cut-offs: 6/9 or more for children and adolescents, 5/9 or more for adults aged 18-50, and 4/9 or more for adults over 50. These replaced the older universal cut-off of 4/9 because joint laxity decreases with age, making a single threshold inaccurate across the lifespan.
Can I score myself at home?
You can perform a rough self-assessment for most of the five maneuvers, but the knee and elbow tests benefit from an observer watching for subtle recurvatum, and the goniometric precision needed for the 10-degree threshold is hard to judge without training. The trunk test and thumb/finger tests are easier to self-rate. A proper clinical assessment by a physiotherapist or rheumatologist is recommended before any medical decisions.
Does a negative Beighton score rule out hypermobility?
No. The Beighton scale tests only five specific joint movements. Shoulder, hip, ankle, and spinal hypermobility are not captured. Some people develop symptoms of connective tissue laxity despite a low Beighton score, particularly if their score has declined with age from a previously positive level. Historical hypermobility is one reason the 5-point questionnaire includes questions about past flexibility.
Is hypermobility always a problem?
No. Many people with a high Beighton score have no pain, no instability, and no associated medical condition. Generalised joint hypermobility is a normal trait variation, often inherited, and many gymnasts, dancers, and musicians have high scores with no adverse effects. It only becomes a medical concern when it is associated with pain, recurrent joint injuries, fatigue, autonomic symptoms, or other features of a connective tissue disorder.
How is the Beighton score different from an Ehlers-Danlos diagnosis?
The Beighton score is one component (Criterion 1) of the 2017 diagnostic criteria for hypermobile EDS (hEDS). Meeting the Beighton threshold is necessary but two more independent criteria must also be satisfied before an hEDS diagnosis can be made. These additional criteria include systemic features of connective tissue disorder and the exclusion of other conditions. The score alone is not a diagnosis.
What is the Hakim-Grahame 5-point questionnaire and when is it used?
The Hakim-Grahame 5-point questionnaire (5PQ) is a brief self-report screen that captures current and historical hypermobility through five yes-or-no questions. It is most useful in two situations: when a formal Beighton examination is not practical, and when someone scores one point below the age-appropriate Beighton cut-off (the borderline zone). Under the 2017 EDS/HSD criteria, a borderline Beighton score combined with a positive 5PQ (2 or more questions answered yes) may still support a generalised joint hypermobility diagnosis.
Sources
- Malfait F et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26.
- Singh H et al. Beighton scores and cut-offs across the lifespan: cross-sectional study of an Australian population. Rheumatology (Oxford). 2017;56(11):1857-1864.