Hypermobility is tested primarily through the Beighton score, a simple nine-point physical exam that checks how far specific joints bend. You can do a preliminary version at home, but a full diagnosis requires a healthcare provider to rule out underlying conditions and assess whether your flexibility is causing problems that need management.
The Beighton Score: 9 Tests, 9 Points
The Beighton score is the standard clinical tool for measuring generalized joint hypermobility. It checks five types of movement, with bilateral tests (both sides) counted separately. You earn one point for each of the following:
- Pinky fingers (2 points): Rest your hand palm-down on a flat surface with fingers straight. If your little finger bends backward past 90 degrees at the knuckle, that’s one point per hand.
- Thumbs (2 points): With your arm out straight, bend your wrist downward. If your thumb can be pushed back to touch your forearm, that’s one point per side.
- Elbows (2 points): Hold your arms out with palms facing up. If your elbow bends backward more than 10 degrees past straight, that’s one point per arm.
- Knees (2 points): While standing with your knees locked back, if the lower leg angles forward more than 10 degrees beyond straight, that’s one point per leg.
- Spine (1 point): Bend forward and try to place both palms flat on the floor without bending your knees. If you can, that’s one point.
The maximum score is 9. A higher score means more generalized hypermobility, but the threshold for a “positive” result depends on your age and sex.
What Score Counts as Hypermobile
Joint flexibility naturally decreases with age, so the cutoff for hypermobility shifts downward over time. For the diagnosis of hypermobile Ehlers-Danlos syndrome (hEDS) specifically, the 2017 international criteria set these thresholds: 6 or higher for children and adolescents before puberty, 5 or higher for adults up to age 50, and 4 or higher for people over 50.
Research on a large Australian population found even more granular patterns. Women tend to score higher than men at every age. For women, the suggested cutoffs were 6 or higher for ages 3 to 7, 5 or higher for ages 8 to 39, 4 or higher for ages 40 to 59, 3 or higher for ages 60 to 69, and 2 or higher past 70. For men, the cutoffs were roughly one to two points lower in each bracket. A score of 4 in a 25-year-old man means something different than a 4 in a 65-year-old woman, which is why age-adjusted thresholds matter.
Trying It at Home
You can run through all five Beighton maneuvers on your own to get a rough sense of where you fall. The pinky, thumb, and forward-bend tests are straightforward to self-assess. The elbow and knee tests are trickier because judging 10 degrees of hyperextension without a trained eye or a goniometer (the angle-measuring tool clinicians use) is imprecise. Having someone else observe from the side helps.
If you score at or above the threshold for your age, that tells you something worth following up on. If you score below but still experience joint pain, frequent dislocations, or a feeling of instability, the Beighton score alone may not capture your situation. It only tests five joint types and misses hypermobility that’s concentrated in areas like the shoulders, hips, ankles, or wrists.
Beyond the Beighton: Other Assessment Tools
Because the Beighton score focuses heavily on a few joints, clinicians sometimes use supplementary tools. The Upper Limb Hypermobility Assessment Tool (ULHAT) is a 12-item test that measures mobility across multiple upper limb joints in all movement planes. A score of 7 or higher out of 12 identifies upper limb and generalized hypermobility with good reliability. This tool is particularly useful when someone’s hypermobility shows up mainly in the shoulders, wrists, or fingers rather than the knees and elbows the Beighton score emphasizes.
Clinicians may also assess skin extensibility. One validated technique involves marking two dots about 10 millimeters apart on the back of the hand, then gently pulling the skin taut and measuring how far it stretches. Unusually stretchy or soft skin can point toward a connective tissue disorder rather than simple joint flexibility, helping distinguish between different diagnoses.
What Happens During a Clinical Evaluation
A healthcare provider won’t just count your Beighton score and hand you a diagnosis. The Beighton score tells them whether you have generalized joint hypermobility, but that’s only the starting point. Many flexible people never develop symptoms. The clinical question is whether your hypermobility is connected to pain, instability, or other systemic features.
For a diagnosis of hypermobile Ehlers-Danlos syndrome, three criteria must all be met simultaneously. First, your Beighton score needs to hit the age-appropriate threshold. Second, you need at least two of three additional features: signs of a broader connective tissue issue (like unusually soft skin, unexplained stretch marks, hernias, dental crowding, or a high narrow palate, with at least five such signs present), a first-degree relative who independently meets hEDS criteria, or musculoskeletal complications like chronic widespread pain lasting more than three months or recurrent joint dislocations. Third, other possible explanations need to be ruled out, including other types of Ehlers-Danlos syndrome, Marfan syndrome, and conditions that cause joint laxity through low muscle tone.
If you have a positive Beighton score and musculoskeletal symptoms but don’t meet the full hEDS criteria, the diagnosis is typically Hypermobility Spectrum Disorder (HSD). The essential difference between HSD and hEDS is the stricter criteria required for hEDS. Both conditions can cause significant pain and functional limitations, and both benefit from similar management approaches.
Which Doctors Test for Hypermobility
Family physicians and general practitioners can perform the Beighton score and recognize hypermobility-related problems. They’re often the first point of contact and play a key role in initial diagnosis. Rheumatologists commonly evaluate joint hypermobility as part of their broader expertise in musculoskeletal conditions.
If the diagnosis is unclear or a connective tissue disorder is suspected, referral to a genetics specialist may be needed. Geneticists can order testing for other types of Ehlers-Danlos syndrome (several subtypes have identified genetic markers, though hEDS currently does not) and rule out related conditions. Physical therapists and occupational therapists often become part of the picture as well, both for assessing how hypermobility affects your daily function and for building stability through targeted exercise.
Many people with hypermobility-related conditions end up working with a multidisciplinary team over time, including physicians, physical therapists, occupational therapists, and sometimes psychologists or nutritionists. The coordination of that team often falls to the family physician, which is one reason starting with your primary care provider makes sense even if you suspect you’ll eventually need a specialist.