Beighton Score

Description

The Beighton Score is a simple, numerical index which is used to express the range and severity of joint movements in normal and affected persons. [Greta and Peter Beighton 1971]

History of the Beighton Score

1964 – A standardised method for the clinical assessment of joints at the following anatomical sites was proposed by Carter and Wilkinson. A five-point score was proposed in order to provide a numerical perspective of the degree of joint hypermobility:

1. Passive dorsiflexion of the little fingers beyond 90 degrees.
2. Passive apposition of the thumb to the flexor aspect of the forearm.
3. Hyperextension of the elbows beyond 10 degrees.
4. Hyperextension of the knee beyond 10 degrees.
5. Forward flexion of the trunk with knees fully extended so that the palms of the hands rest flat on the floor.

1967 – Kirk, Ansell and Bywaters introduced he term “Hypermobility Syndrome”.

1967-1968 Peter Beighton undertook a survey of 100 persons and families with the Ehlers-Danlos Syndrome at St Thomas’ Hospital, London. Affected families were seen in their homes throughout southern England and PB was accompanied and assisted on this Doctoral project by a nursing sister, Greta Winch. The patients’ join movements were assessed using the method and the 5-point scale proposed by Carter and Wilkinson, 1964.

1970 – Peter and Greta Beighton (now married) travelled to South Africa to undertake an epidemiological investigation of bone and joint disorders, based at the University of the Witwatersrand. An initial recognisance was undertaken in a semi-nomadic Bushmen community in the Kalahari Desert. Project plans were discussed while sitting around the camp fire. Greta had a flash of insight and suggested that although the limbs and digital joins were paired, they were not necessarily symmetrical and that a 9-point score would be appropriate.

1971 – Greta’s 9-point score was successfully used in a formal epidemiological survey of 1081 persons in a Tswana community in the Transvaal, South Africa. Details of the project were presented by Peter Beighton at a meeting of the Herberden Society in London in Nov 1972. The results were published under the names Beighton, Solomon and Soskolne in 1973

• Fig 1: Hyperextension of the fifth finger [In this particular illustration, the extension angle does not reach the required 90^o
• Fig. 2 Apposition of the thumb to the ventral aspect of the forearm
• Fig 3. Hyperextension of the elbow joint beyond 10^o
• Fig 4. Hyperextension of the knee joint beyond 10^o
• Fig 5. Placing the palms of the hands flat on the floor while maintaining the knees in full extension

The method of assessing joint mobility by means of a score based upon the range of movements of certain joints has proved its value in previous investigations. Although the great majority of normal adults score values of 0, 1, or 2 on the mobility scale, individuals with inherited hypermobility syndromes achieve scores at the top end of the scale (Beighton and Horan, 1969). It is therefore reasonable to conclude that the scale is valid for the measurement of joint mobility.

The results which were obtained demonstrate that the range of movements decreases with age, falling rapidly during childhood, and more slowly throughout adult life. However, at any age, females are consistently more hypermobile than males.

Beighton et al 1973

2020 – Peter Beighton comments:

Following her initial suggestion in 1971 concerning the 9-point score, Greta Beighton retained her involvement in the elucidation and publication of research material in the broad field of hypermobility for almost 50 years.

During this period, she typed and compiled ten books and more than 400 articles in medical journals. As a matter of principle, rightly or wrongly, het name was deliberately withheld from the deserved co-authorship in order to avoid any suggestion of nepotism. This article is essentially a posthumous attempt to ensure the eponymous recognition that she richly deserves.

Peter Beighton 2020, personal communication

Associated Persons

• Peter Beighton (1934 – )
• Greta Janet Beighton (1939 – 2017)
• Frank Horan (1933 – 2015); Orthopaedic Surgeon, UK

References

Historical references

• Key JA. Hypermobility of joints as a sex-linked hereditary characteristic. JAMA. 1927; 88: 1710-1712
• Carter C, Wilkinson J. Persistent Joint Laxity and Congenital Dislocation of the Hip. Journal of Bone and Joint Surgery, 1964; 46(1): 40-45
• Kirk, JA, Ansell, BM, Bywaters EG. The hypermobility syndrome. Musculoskeletal complaints associated with generalised joint hypermobility. 1967: 26: 419-425
• Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br. 1969; 51(3): 444-453
• Beighton PH, Horan FT. Dominant inheritance in familial generalised articular hypermobility. J Bone Joint Surg Br. 1970; 52(1): 145-147.
• Horan FT, Beighton PH. Recessive inheritance of generalized joint hypermobility. Rheumatol Rehabil. 1973; 12(1): 47-49.
• Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973; 32(5): 413-418.

Eponymous term review

• Beighton P, de Paepe A, Danks D, Finidori G, Gedde-Dahl T, Goodman R, Hall JG, Hollister DW, Horton W, McKusick VA, Opitz JM, Pope FM, Pyeritz RE, Rimoin DL, Sillence D, Spranger JW, Thompson E, Tsipouras P, Viljoen D, Winship I, Young I. International Nosology of Heritable Disorders of Connective Tissue, Berlin, 1986. Am J Med Genet  1988; 29(3): 581-594 [OMIM 124490]
• Bird HA. Joint hypermobility in children. Rheumatology (Oxford). 2005; 44(6): 703-704.
• Lamari NM, Chueire AG, Cordeiro JA. Analysis of joint mobility patterns among preschool children. Sao Paulo Med J. 2005; 123(3): 119-123

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