Beighton scores and cut-offs across the lifespan: cross-sectional study of an Australian population

Singh, Harendra; McKay, Marnee J.; Baldwin, Jennifer; Nicholson, Leslie L.; Chan, Charles; Burns, Joshua; Hiller, Claire E.

doi:10.1093/rheumatology/kex043

Cited by 78 publications

(85 citation statements)

References 30 publications

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“…Hypermobility was assessed using nine tests to create a Beighton Score (from 0 to 9) with five or more indicating hypermobility ( 6 ). General joint hypermobility according to cutoff values stated by Singh was identified ( 7 ). Neurological assessment was done using discomfort drawings and quantitative sensory testing (QST).…”

Section: Methodsmentioning

confidence: 99%

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Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Bragée

Michos²,

Drum

et al. 2020

Front. Neurol.

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The pathophysiology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is unknown. In this study, we test the hypothesis that hypermobility, signs of intracranial hypertension (IH), and craniocervical obstructions may be overrepresented in patients with ME/CFS and thereby explain many of the symptoms. Our study is a retrospective, cross-sectional study, performed at a specialist clinic for referred patients with severe ME/CFS as defined by the Canada Consensus Criteria. The first 272 patients with ME/CFS were invited to participate, and 229 who provided prompt informed consent were included. Hypermobility was assessed using the Beighton Score. IH was assessed indirectly by the quotient of the optic nerve sheet diameter (ONSD)/eyeball transverse diameter on both sides as measured on magnetic resonance imaging (MRI) of the brain. We also included assessment of cerebellar tonsil position in relation to the McRae line, indicating foramen magnum. Craniocervical obstructions were assessed on MRI of the cervical spine. Allodynia was assessed by quantitative sensory testing (QST) for pain in the 18 areas indicative of fibromyalgia syndrome (FMS). A total of 190 women, mean age 45 years, and 39 males, mean age 44 years, were included. Hypermobility was identified in 115 (50%) participants. MRI of the brain was performed on 205 participants of whom 112 (55%) had an increased ONSD and 171 (83%) had signs of possible IH, including 65 (32%) who had values indicating more severe states of IH. Cerebellar tonsils protruding under the McRae line into the foramen magnum were identified in 115 (56%) of the participants. MRI of the cervical spine was performed on 125 participants of whom 100 (80%) had craniocervical obstructions. Pain at harmless pressure, allodynia, was found in 96% of the participants, and FMS was present in 173 participants or 76%. Compared to a general population, we found a large overrepresentation of hypermobility, signs of IH, and craniocervical obstructions. Our hypothesis was strengthened for future studies on the possible relation between ME/CFS symptoms and hypermobility, IH, and craniocervical obstructions in a portion of patients with ME/CFS. If our findings are confirmed, new diagnostic and therapeutic approaches to this widespread neurological syndrome should be considered.

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Section: Methodsmentioning

confidence: 99%

“…Neurological assessment was done using discomfort drawings and quantitative sensory testing (QST). Discomfort drawings were assessed for pattern of neuropathic pain and pattern of widespread pain ( 7 ). QST was performed using an electronic device, the Somedic® algometer, to establish the threshold for skin pressure pain.…”

Section: Methodsmentioning

confidence: 99%

Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Bragée

Michos²,

Drum

et al. 2020

Front. Neurol.

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“…This clinical judgment was based on a comprehensive history, the validated five-part historical hypermobility questionnaire [ 16 ], Beighton score, and the physical assessment of peripheral joints, not using the LLAS. Cut-off scores of ≥4/9 and ≥5/9 on the Beighton score were used for men and women respectively in the control and known hypermobile cohorts [ 2 ]. A higher score of ≥6/9 was considered GJH in the likely hypermobile cohort to account for the debated palms to floor measure in dancers [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…Hypermobility is present when a joint’s active or passive range exceeds that expected for an individual’s age, gender and ethnicity [ 1 ]. To be truly hypermobile, the range should, by definition, be in the uppermost 5% of the population [ 2 ]. Hypermobility may be localised to select joints or present in multiple body areas (typically greater than five sites) as Generalised Joint Hypermobility (GJH) [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying lower limb specific and generalised joint hypermobility in adults: validation of the Lower Limb Assessment Score

Meyer

Chan

Hopper

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe Lower Limb Assessment Score (LLAS) has only been validated in a paediatric population. The aim of this study was to validate the use of the LLAS in an adult population by: i) evaluating its ability to discriminate between different extents of lower limb hypermobility, ii) establishing a cut-off score to identify lower limb hypermobility, and iii) determining if the LLAS is able to identify Generalised Joint Hypermobility (GJH).MethodsParticipants were recruited across three groups representing varying degrees of hypermobility. They were assessed using the LLAS, Beighton score and clinical opinion. Pearson’s correlation coefficient and MANOVA were used to assess between-group differences in the LLAS. The cut-off score was determined using median and inter-quartile ranges and the Receiver Operator Characteristic Curve. The ability of the LLAS to identify GJH was assessed using percent agreement with clinical opinion.ResultsOne hundred twelve participants aged 18–40 years were recruited. The LLAS distinguished the control from the likely hypermobile and known hypermobile cohorts (both p < 0.001), as well as the likely hypermobile from the known hypermobile cohort (p = 0.003). The LLAS cut-off score for identifying lower limb hypermobility was ≥7/12 with a specificity of 86% and sensitivity of 68%. The LLAS accurately identified those with GJH with high percentage agreement compared to clinical opinion across all cohorts (69–98%).ConclusionsThe LLAS is a valid tool for identifying lower limb specific hypermobility and GJH in adults at a cut-off score of ≥7/12. It demonstrates excellent specificity and moderate sensitivity, and discriminates well between extents of hypermobility.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1875-8) contains supplementary material, which is available to authorized users.

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“…A number of studies were recently published that reported on the clinimetric properties of physical assessments for measuring GJH. 7 , 8 One of these studies concerned the 12-item Lower Limb Assessment Score (LLAS), 7 as mentioned in the letter by Nicholson and Chan. Hypermobility may be located all over the body in the case of GJH; therefore, the LLAS was designed to study GJH of the lower extremity of adults.…”

mentioning

confidence: 99%

No Effect of Generalized Joint Hypermobility on Injury Risk in Elite Female Soccer Players: Response

Thijs¹,

Blokland²,

Backx³

et al. 2018

Am J Sports Med

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Beighton scores and cut-offs across the lifespan: cross-sectional study of an Australian population

Cited by 78 publications

References 30 publications

Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Identifying lower limb specific and generalised joint hypermobility in adults: validation of the Lower Limb Assessment Score

No Effect of Generalized Joint Hypermobility on Injury Risk in Elite Female Soccer Players: Response

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