From the Guidelines
Hypermobility syndrome can be diagnosed using the Beighton score, a 9-point scoring system that evaluates joint flexibility, with a score of 4 or higher generally indicating hypermobility, as supported by the 2020 study published in Gut 1. The Beighton score assesses joint flexibility in specific areas, including:
- Passive extension of the little fingers beyond 90 degrees (1 point each)
- Passive thumb opposition to the forearm (1 point each)
- Hyperextension of the elbows beyond 10 degrees (1 point each)
- Hyperextension of the knees beyond 10 degrees (1 point each)
- Forward flexion of the trunk with knees straight and palms flat on the floor (1 point) Other tests, such as the Brighton criteria and the five-part questionnaire, can also be used to diagnose hypermobility syndrome, but the Beighton score is the most widely used assessment. It is essential to note that patients with hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobile Spectrum Disorders (HSD) may present with gastrointestinal associations, such as visceral hypersensitivity, and autonomic dysregulation, particularly postural tachycardia syndrome (PoTS) 1. Healthcare professionals should perform these tests and evaluate for related conditions like Ehlers-Danlos syndrome to guide appropriate management, including physical therapy, pain management, and lifestyle modifications to protect joints and prevent injuries. The diagnosis of hypermobility syndrome is crucial, as it can significantly impact the patient's quality of life, with patients with hEDS and HSD often experiencing a range of gut disorders, including acid reflux, abdominal pain, and constipation 1.
From the Research
Hypermobility Syndrome Tests
The diagnosis of hypermobility syndrome involves a comprehensive approach, considering multiple body systems and not just joints. The following are some key points to consider:
- The Beighton Score is a commonly used measure of generalized joint hypermobility, but its ability to truly reflect joint hypermobility remains controversial 2.
- The diagnostic classification for hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) was revised in 2017 to supersede previous diagnostic categories 3.
- A holistic approach is necessary for the management of HSD and hEDS, including physical therapy, occupational therapy, and patient education 3, 4, 5.
- The assessment and management of patients with hypermobility syndrome require a comprehensive patient-centered approach and coordinated input from a range of medical, health, and fitness professionals 4.
- Diagnostic criteria for hEDS include measures of joint hypermobility, skin and other connective tissue findings, and lack of evidence of a different type of Ehlers-Danlos syndrome 6.
Assessment and Management
The assessment and management of hypermobility syndrome involve:
- A comprehensive patient-centered approach 4
- Coordinated input from a range of medical, health, and fitness professionals 4
- Physical therapy and occupational therapy as the cornerstone of treatment 5
- Patient education and empowerment 6, 5
- Individualized treatment plans, considering the heterogeneity of patient presentations 5
Diagnostic Measures
Diagnostic measures for hypermobility syndrome include:
- The Beighton Score, although its limitations should be recognized 2
- Measures of joint hypermobility, skin and other connective tissue findings, and lack of evidence of a different type of Ehlers-Danlos syndrome for hEDS 6
- A comprehensive clinical evaluation, considering multiple body systems and not just joints 3