Beighton v Brighton

Diagnosing EDS can be confusing. Here’s a little primer on two diagnostic tools for joint hypermobility with names that are way too similar.

The Beighton score
The Beighton score measures joint flexibility and consists of a series of nine tests. Each test carries a score of one point.

  • Hands flat on the floor with your knees straight?
  • Bend each elbow backwards? (1 pt each)
  • Bend your knee backwards? (1 pt each)
  • Bend your thumb back on to the front of your forearm? (1 pt each)
  • Bend your little finger 90 degrees, towards the back of the hand? (1 pt each)

Different rheumatologists interpret the score differently. In a survey of 319 rheumatologists 185 set the threshold at 5 while 92 found 3 sufficient, 3 required 1, while 35 would not commit.
The Brighton criteria
The Brighton criteria casts a wider net and incorporates the Beighton score while also accounting for other symptoms, such as joint pain, dislocated joints, and how long you have had symptoms. Diagnosing is something of a Chinese menu activity.

Joint hypermobility syndrome may be diagnosed if you have:

  • two major criteria or
  • one major criteria and two minor criteria or
  • four minor criteria or
  • two minor criteria and a close relative, such as a parent, who has been diagnosed with joint hypermobility syndrome

Major Brighton criteria

  • Having a Beighton score of four or more ever
  • having joint pain for longer than three months in four or more joints

Minor Brighton criteria

  • Having a Beighton score of one to three, or having a Beighton score of zero to three if you are over 50 years of age
  • having joint pain for longer than three months in one to three joints, or back pain for longer than three months, or spondylosis (spinal arthritis) or spondylolisthesis (where one small bone in your spine slips forward over another bone)
  • dislocating, or partially dislocating, more than one joint or the same joint more than once
    having three or more injuries to your soft tissues, such as tenosynovitis (inflammation of the protective sheath around a tendon) or bursitis (inflammation of a fluid-filled sac in a joint)
  • having Marfanoid habitus – being tall and slim and having long, slim fingers
  • having abnormal skin, such as thin and stretchy skin
  • having eye-related symptoms, such as droopy eyelids or short-sightedness, having swollen and enlarged veins (varicose veins), or a hernia (when an internal part of the body pushes through a weakness in the surrounding tissue wall) or a rectal or uterine prolapse (where an internal organ slips down from its usual position)

Hypermobility has a blurry boundary with EDS. Some say there is no boundary, others say there is one but just can’t tell you where it is.

For more information see this EDNF article or this NHS article.

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