01/20/2024
Excellent post. If you suspect you have EDS, let’s talk about it. Our doctor has personal experiences with it herself, so don’t feel like you are alone in this.
How is joint hypermobility assessed❓
🔵The Beighton Score
The Beighton Scoring System measures joint hypermobility on a 9-point scale. The joints assessed are:
Knuckle of both little/fifth/pinky fingers
Base of both thumbs
Elbows
Knees
Spine
Where applicable, the range of movement is measured using a goniometer, an instrument that measures the joint angle.
The movements that make up the Beighton score are shown in the illustration below and can be found here: https://www.ehlers-danlos.com/assessing-joint-hypermobility
🔵The 5-part Questionnaire for Hypermobility
The 5-part Questionnaire for Hypermobility was designed as a quick check to see if someone has or may have had hypermobility (Hakim and Grahame, 2003). It has been used in clinics and in research and has been translated for use in several languages and tested in several countries (G***s et al., 2020).
It was tested and designed as an alternative to the Beighton score. If you answer ‘yes’ to two or more of the questions, it strongly predicts a Beighton score of 4 or more, 4 being the cut-off point in criteria at the time the questionnaire was published.
Can you now [or could you ever] place your hands flat on the floor without bending your knees?
Can you now [or could you ever] bend your thumb to touch your forearm?
As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?
As a child or teenager, did your kneecap or shoulder dislocate on more than one occasion?
Do you consider yourself “double-jointed”?
Answering yes to 2 or more of these questions suggests hypermobility (sense 85%, spec 90%)
🔵Upper Limb and Lower Limb Assessment Tools for Hypermobility
There are two other tools that clinicians use in contemporary clinical practice and research. One assesses hypermobility in the arm (Nicholson and Chan, 2018), and the other hypermobility in the leg and foot (Ferrari et al., 2005 (children), Myer et al., 2017 (adults)).
These tools require a detailed examination of joints. In the arm, this includes several ranges of motion at the shoulder, elbow, and wrist. In the leg, this includes several ranges of movement at the hip, knee, ankle, heel, and toes.
🔵Looking For Hypermobility in Clinical Practice
Experts encourage clinicians to look more broadly than just testing the Beighton Score in a person presenting with local or widespread injuries and joint pain that they suspect may be related to hypermobility. However, while tools like the upper and lower limb assessments are important and helpful to the more expert clinician or researcher, they are complex and require skill. Most clinicians wishing to screen someone for hypermobility need quicker and more simple guidance.
Recently the hEDS/HSD Working Group of the International Consortium on Ehlers-Danlos syndromes and hypermobility spectrum disorders (IC-EDS and HSD, 2022) did an audit to determine which tests in the upper and lower limb tools most strongly suggest generalized joint hypermobility. Their findings are currently being studied in more detail. The aim is to determine whether adding specific extra tests (particularly ones that assess the shoulder, wrist, ankle, and toes) helps clinicians identify people with generalized hypermobility in ways that are better than only relying on the Beighton score.
Read in detail at: https://www.ehlers-danlos.com/assessing-joint-hypermobility
