Learning outcome
Able to perform a clinical examination to determine the degree of joint hypermobility using the Beighton score.
Standard tests
- Little finger can be extended more than 90 degrees (2 points if on both arms)
- Thumb can oppose to the forearm (2 points if on both sides)
- Elbow more than 10 degrees hyperextension (2 points if both)
- Knee more than 10 degrees hyperextension (2 points if both)
- Palms on the floor (without difficulty) 1 point
Case 5
You work as a first-year resident doctor at a general practitioner office. The next patient is a 15-year-old girl. Student in secondary school. In her free time, she participates in handball and football. Over the past year, she has noticed increasing pain in her knee and elbow joints. No injury. No signs of redness, warmth, or swelling in the joints have been recorded.
Hypermobility examination
Perform a clinical examination with regard to hypermobility.
Inspection hypermobility
Active movement hypermobility
Passive movement hypermobility
Clinical findings
- You find that the patient has pain when overstretching the elbow joints (> 10° hyperextension) and pain in the elbow and knee joints but with normal range of motion.
- You examine the hand and find that the patient can place both thumbs against the radius and both little fingers are possible and can extend to 90 degrees.
- Make an assessment of whether the patient has hypermobility and what Beighton score the patient has.
What is wrong with the patient?
- The patient has hypermobility with a Beighton score of 6/9. A Beighton hypermobility score over 4/9 points indicates generalized hypermobility.
- For hypermobility syndrome, in addition to hypermobility, there should be symptoms such as joint or muscle pain or sensitive skin.
- Active and passive movement of a hypermobile joint must trigger pain that the patient recognizes as their problem.
- Recommended measures:
- It is important to maintain physical strength and fitness to reduce the risk of injuries.
- Regular exercise, possibly under the guidance of a physiotherapist.
- Avoid maximal range of motion and hyperextension
- Adapted to everyday life and work that does not overload joints, back, and muscles