What is the relationship between the Beighton score (Beighton criteria) for hip joint hypermobility and shoulder instability?

From the Research

The Beighton score is a useful clinical tool for assessing joint hypermobility, which can be associated with shoulder instability, and patients with hypermobility-related shoulder instability often benefit from a conservative approach focusing on physical therapy to strengthen the rotator cuff and scapular stabilizers rather than immediate surgical intervention. When evaluating patients with shoulder instability, particularly those with atraumatic or multidirectional instability, the Beighton assessment should be included as part of the comprehensive examination. The nine-point Beighton scale includes passive extension of the fifth metacarpophalangeal joints beyond 90° (1 point each hand), passive thumb apposition to the flexor aspect of the forearm (1 point each thumb), hyperextension of the elbows beyond 10° (1 point each elbow), hyperextension of the knees beyond 10° (1 point each knee), and forward flexion of the trunk with knees extended so that the palms rest flat on the floor (1 point) 1.

According to the most recent study on the Beighton score as a measure of generalized joint hypermobility, the score should not be used as the principle tool to differentiate between localized and generalized hypermobility, nor used alone to exclude the presence of generalized joint hypermobility 1. However, a higher Beighton score (typically ≥4 out of 9 points) may indicate generalized joint hypermobility and predict an increased risk of shoulder instability.

The rehabilitation program for patients with hypermobility-related shoulder instability should emphasize proprioception, neuromuscular control, and strengthening exercises for at least 3-6 months before considering surgical options, as recommended by recent studies on rotator cuff-related shoulder pain and shoulder instability 2, 3. This approach is recommended because hypermobile patients have a higher risk of recurrent instability even after surgery due to their inherent tissue laxity, making strengthening of the dynamic stabilizers particularly important for long-term management.

Some key points to consider when evaluating and treating patients with shoulder instability include:

• The Beighton score is a useful tool for assessing joint hypermobility, but it should not be used alone to diagnose or exclude generalized joint hypermobility 1.
• Patients with hypermobility-related shoulder instability often benefit from a conservative approach focusing on physical therapy to strengthen the rotator cuff and scapular stabilizers rather than immediate surgical intervention 2, 3.
• The rehabilitation program should emphasize proprioception, neuromuscular control, and strengthening exercises for at least 3-6 months before considering surgical options 2, 3.
• Hypermobile patients have a higher risk of recurrent instability even after surgery due to their inherent tissue laxity, making strengthening of the dynamic stabilizers particularly important for long-term management 4.