What clinical criteria should I use to diagnose joint hypermobility in adults and children?

Clinical criteria for diagnosing joint hypermobility in adults and children involve a combination of clinical assessment tools and consideration of associated symptoms or features suggestive of underlying connective tissue disorders.

In both adults and children, the Beighton score is widely used as a primary clinical tool to assess generalized joint hypermobility. This score evaluates hyperextension of the knees and elbows, passive dorsiflexion of the fifth finger, thumb apposition to the forearm, and forward flexion of the trunk with palms on the floor. A higher Beighton score indicates greater hypermobility, with cut-offs adjusted for age and sex.

In children, joint hypermobility alone without symptoms does not require referral; management focuses on education about normal activity and monitoring for symptoms or complications. Referral to specialist services is advised if there are red flag features such as severe pain, functional impairment, symmetrical joint involvement, or signs suggestive of connective tissue disorders (e.g., cardiovascular, ocular, or skin features) ¹.

In adults, diagnosis also involves clinical history and examination to identify symptomatic hypermobility and to exclude other causes. The Brighton criteria, which incorporate the Beighton score along with symptoms such as arthralgia, dislocations, and skin features, are often used to diagnose hypermobility spectrum disorders or hypermobile Ehlers-Danlos syndrome (hEDS) (Adam et al., 1993; Castori and Hakim, 2017).

Recent literature emphasizes a comprehensive diagnostic framework that integrates clinical assessment with detailed history, including family history and systemic features, to differentiate benign joint hypermobility from heritable connective tissue disorders (Tofts et al., 2023; Castori and Hakim, 2017). This approach supports the UK guideline recommendations to consider referral when systemic features or significant functional impairment are present ¹.

In summary, the clinical criteria for diagnosing joint hypermobility in both adults and children include:

• Use of the Beighton score to assess generalized joint laxity.
• Assessment of symptoms such as pain, dislocations, and functional impairment.
• Evaluation for systemic features suggestive of connective tissue disorders (e.g., skin, cardiovascular, ocular signs).
• Consideration of family history of connective tissue disorders or related complications.
• Referral for specialist assessment when red flags or diagnostic uncertainty exist, or when hypermobility significantly impacts daily activities ¹ (Adam et al., 1993; Castori and Hakim, 2017; Tofts et al., 2023).