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The Beighton Score (BS) is a set of manoeuvres in a nine-point scoring system, used as the standard method of assessment for Generalised Joint Hypermobility (GJH). It was originally developed as an epidemiological tool used in screening large populations for GJH, but later adopted as a clinical tool for diagnostic purposes. Its ability to truly reflect GJH remains controversial, as joints within the scoring system are predominantly of the upper limb and disregard many of the major joints, preventing a direct identification of GJH. Furthermore, a consistent finding in the literature whereby the BS failed to identify hypermobility in joints outside the scoring system suggests its use as an indirect indicator of GJH is also not viable. As such, the collective findings of this review demonstrate a need for a change in clinical thinking. The BS should not be used as the principle tool to differentiate between localised and generalised hypermobility, nor used alone to exclude the presence of GJH. Greater emphasis should be placed on a clinician’s judgement to identify or exclude GJH, according to its full definition.

Background: The Beighton score is commonly used to assess the degree of hypermobility in patients with hypermobility spectrum disorder. Since proper diagnosis and treatment in this challenging patient population require valid, reliable, and responsive clinical assessments such as the Beighton score, studies must properly evaluate efficacy and effectiveness. Purpose: To succinctly present a systematic review to determine the inter- and intrarater reliability of the Beighton score and the methodological quality of all analyzed studies for use in clinical applications. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the MEDLINE, Embase, CINAHL, and SPORTDiscus databases was performed. Studies that measured inter- or intrarater reliability of the Beighton score in humans with and without hypermobility were included. Non-English, animal, cadaveric, level 5 evidence, and studies utilizing the Beighton score self-assessment version were excluded. Data were extracted to compare scoring methods, population characteristics, and measurements of inter- and intrarater reliability. Risk of bias was assessed with the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) 2017 checklist. Results: Twenty-four studies were analyzed (1333 patients; mean ± SD age, 28.19 ± 17.34 years [range, 4-71 years]; 640 females, 594 males, 273 unknown sex). Of the 24 studies, 18 reported raters were health care professionals or health care professional students. For interrater reliability, 5 of 8 (62.5%) intraclass correlation coefficients and 12 of 19 (63.2%) kappa values were substantial to almost perfect. Intrarater reliability was reported as excellent in all studies utilizing intraclass correlation coefficients, and 3 of the 7 articles using kappa values reported almost perfect values. Utilizing the COSMIN criteria, we determined that 1 study met “very good” criteria, 7 met “adequate,” 15 met “doubtful,” and 1 met “inadequate” for overall risk of bias in the reliability domain. Conclusion: The Beighton score is a highly reliable clinical tool that shows substantial to excellent inter- and intrarater reliability when used by raters of variable backgrounds and experience levels. While individual components of risk of bias among studies demonstrated large discrepancy, most of the items were adequate to very good.

Current international consensus of the appropriate Beighton score cut-off to define if a child has generalised joint hypermobile or not is based upon expert opinion. Our aim was to determine the prevalence of Beighton scores of children worldwide to provide a recommendation for establishing the Beighton score cut-off to identify generalised joint hypermobility in children. We used AMED, OVID Medline, Embase and CINAHL to find published articles from inception to April 2024 describing Beighton scores of children up to and including 18 years from the general population. We extracted study demographics including country of publication, total number of participants, summary data about the age and sex of participant, Beighton scores and any cut-off used where authors deemed children hypermobile and how many children were rated at the corresponding Beighton scores. There were 37 articles reporting on the prevalence or incidence of hypermobility at cut-off scores from 28,868 participants. Using the cut-off of ≥ 6 resulted in a prevalence of 6% for studies reporting male data and 13% for studies reporting female data. Limited data reporting availability precluded further sub-analysis at a Beighton score of ≥ 7, age, pubertal status and ethnicity.     Conclusion : The working threshold for identifying generalised joint hypermobility in children should be a Beighton score of 6 or more. Our analysis also suggests a Beighton score of 7 or greater may be appropriate in childhood, particularly for females. What is Known: • The working threshold for identifying generalised joint hypermobility in children previously was set based on expert opinion. What is New: • The threshold to identify hypermobility in children should be at a minimum of ≥ 6 on the Beighton score.

Generalized Joint Hypermobility (GJH) is characterized by increased joint mobility and may lead to proprioceptive deficits and altered muscle function. To investigate the relationship between Beighton scores and grip strength, elbow and knee proprioception, and upper and lower extremity performance and to compare hypermobile and non-hypermobile individuals in these domains. Eighty-three participants were classified as hypermobile (n = 46, Beighton 4–9) or non-hypermobile (n = 37, Beighton 0–3). Grip strength, elbow and knee joint position sense, and functional stability (CKCUEST, CKCLEST) were assessed. Pearson correlation and independent t-tests were used. Hypermobile individuals demonstrated significantly poorer proprioception at the elbow and knee (p < 0.05) but no differences in grip strength or functional performance. In the hypermobile group, Beighton scores positively correlated with grip strength and proprioception at 30° and 60° joint angles (r = 0.422–0.674, p < 0.05). GJH is associated with proprioceptive deficits, though joint mobility may improve grip strength. Functional stability was not compromised, indicating compensatory strategies may play a role. These findings underscore the importance of neuromuscular training in hypermobile individuals.

The aim of this study was to investigate the anatomical and physiological ocular parameters in adolescents with myopia and to examine the relations between refractive error (SER), ocular biometry, body size and flexibility parameters in myopic adolescents. A cross-sectional study of 184 myopic adolescents, aged 15 to 19 years was conducted. Refractive error and corneal curvature measures of the eye were evaluated using an autorefractometer under cycloplegia. Central corneal thickness was determined by contact pachymetry. The ocular axial length, anterior and vitreous chamber depth, and lens thickness were measured using A-scan biometry ultrasonography. Height and body weight were measured according to a standardized protocol. Body mass index (BMI) was subsequently calculated. Beighton scale was used to measure joint flexibility. Body stature was positively correlated with ocular axial length (r = 0.39, p  < 0.001) and vitreous chamber depth (r = 0.37, p  < 0.001). There was a negative correlation between height and SER (r = − 0.46; p  < 0.001). Beighton score and body weight had weak positive correlations with axial length and vitreous chamber depth, and a weak negative correlation with SER. A significantly more negative SER was observed in the increased joint mobility group ( p  < 0.05; U = 5065.5) as compared to normal joint mobility group: mean − 4.37 ± 1.85 D (median − 4.25; IQR − 6.25 to − 3.25 D) and mean − 3.72 ± 1.66 D (median − 3.50; IQR − 4.75 to − 2.25 D) respectively. There was a strong association between height and axial length, as well as SER. Higher degree of myopia significantly correlated with greater Beighton score (increased joint mobility).

Joint hypermobility shows considerable variability across populations, yet validated screening tools for Mandarin-speaking cohorts are lacking. The Five-Part Questionnaire (5PQ) is widely used internationally, but its properties have not been evaluated in Chinese populations. This study assessed the validity and reliability of the Chinese version of the 5PQ (5PQ-CN) in a cohort of young Chinese university students. Participants completed the 5PQ-CN and underwent clinician-administered Beighton Score (BS) assessment, using the internationally recommended cut off of ≥ 5 to identify generalised joint hypermobility (GJH). Diagnostic validity was examined using sensitivity, specificity, predictive values, accuracy, and the area under the receiver operating characteristic curve (AUC). Test-retest reliability was evaluated using Cohen’s kappa (κ) and intraclass correlation coefficients (ICC). A total of 1,910 participants were recruited; 615 were included in the validity analysis and 325 in the reliability subgroup. The 5PQ-CN showed 78.6% sensitivity, 65.8% specificity, 72.2% accuracy, and an AUC of 0.722. Test-retest reliability demonstrated substantial agreement (κ = 0.703) and moderate consistency for the total score (ICC = 0.707). The 5PQ-CN is a valid and reliable self-report instrument for screening GJH in young Chinese adults within a university setting. Its high feasibility and sensitivity make it a useful complement to clinician-based assessments, particularly in large-scale or resource-limited epidemiological settings.

The objective of this study was to investigate the prevalence of generalized joint hypermobility (GJH) in a university-aged population, whether young adults (aged 18–25 years) with GJH are prone to sustain more musculoskeletal injuries, and are more likely to suffer from chronic musculoskeletal pain. The study used an interactive survey to gather data; GJH was assessed using a cut-off Beighton score of ≥5 in accordance with the 2017 International Classification of EDS criteria. The analyzed sample consisted of 482 female and 172 male participants from Florida Gulf Coast University (USA). The prevalence of GJH in a university-aged population can be estimated at 12.5%. Women did not have higher rates of GJH than men. However, female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints. The Beighton scores did not differ by ethnicity/race. Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant. There was no difference in the proportion of all participants classified within different categories (0; 1–4; 5–9) of Beighton scores and whether or not they reported having been injured. Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories. Female participants, however, reported higher pain intensity for chronic neck and back pain. This study increases knowledge about a correlation between GJH, musculoskeletal injuries, and chronic pain of joints, neck, and back in a university-aged population.

Purpose To investigate positional lumbar changes by weight-bearing MRI in low back pain (LBP) patients with hypermobile joints (Beighton score ≥ 4). Methods Patients referred to weight-bearing MRI went through a clinical examination, including Beighton’s test, answered back pain-related questionnaires, and were hereafter imaged in supine and standing in a 0.25-T MRI unit. All MRI exams were evaluated for degenerative findings i.e., herniations, disc degeneration, spinal stenosis, disc degeneration, and spondylolisthesis. Subsequently, the lumbar lordosis angle, the sacral angle, and all spondylolisthesis’ slippages were measured for both positions. Results Of 257 LBP patients, Beighton score ≥ 4 were seen in 48 patients, and these included more females (81.3% vs. 51.7%), younger patients (mean difference [MD]: −8.1 years), and had less degenerated lumbar discs (sum-score MD: −0.9). No difference between groups in degenerative MRI findings was found, although, a non-significant tendency ( p  = 0.072) to a higher number of anterolisthesis in the hypermobile patients. The hypermobile patients had a greater lordosis angle both during supine and standing and a greater sacral angle in supine, however, changes in the angles between supine and standing were without difference between groups. A sensitivity analysis adjusted for gender and age confirmed these findings. Conclusion Hypermobility in LBP patients was associated with being female, younger, having increased lumbar lordosis both during standing and in supine, however, was not associated with increased back pain, anterolisthesis grade or more severe lumbar changes between positions.

Purpose To investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees. Methods A total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0–4) or high (5–9) Beighton Score groups. Alpha was set at < 0.05. Results Ninety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system ( r  = 0.235, p  < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10–3.17, p  < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established. Conclusion The findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees. Level of evidence Prospective cohort study; level of evidence, 2.

Background Nocturnal Enuresis (NE) is a prevalent childhood condition with a multifactorial pathogenesis comprising genetic, neurological, and connective tissue factors. Recent evidence points toward a possible link between joint hypermobility and NE, but the underlying mechanisms remain unclear, and existing data are limited. The objective of this study is to determine the prevalence of joint hypermobility in patients with primary nocturnal enuresis (PNE) relative to healthy controls and investigate potential correlations between these conditions. Methods This cross-sectional study was conducted in 2024 at Imam Reza Clinic, the largest pediatric outpatient clinic affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. A total of 180 children aged 6–13 years were recruited, including 90 children with primary nocturnal enuresis (study group) and 90 healthy children without nocturnal enuresis (control group). Participants were assessed for generalized joint hypermobility (GJH) using the Beighton score (≥ 6 indicating hypermobility). Demographic and clinical information was gathered on structured checklists. Statistical tests, such as chi-square tests, t-tests, and logistic regression, were carried out using SPSS (version 25) at a significance level of p  < 0.05. Results The prevalence of joint hypermobility was significantly higher in children with NE (87.8%) than in controls (28.9%) ( p  < 0.0001). Conversely, NE was present in 75.2% of hypermobile children compared with 14.7% of non-hypermobile children ( p  < 0.0001). Logistic regression analysis revealed that children with nocturnal enuresis were 19.87 times more likely to have joint hypermobility compared to non-enuretic children following the adjustment for age, gender, and BMI ( p  < 0.05). Gender-specific analysis indicated that hypermobile girls with nocturnal enuresis at a greater likelihood of suffering from urinary incontinence and frequent urinary tract infections (UTIs), whereas hypermobile boys with nocturnal enuresis had increased rates of constipation and urinary symptoms during the day. Conclusion This study shows a strong association between GJH and PNE. Further research is needed to determine causal direction and underlying mechanisms.