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 and flexibility across nine joint movements, with a higher score indicating greater hypermobility (Castori and Hakim, 2017). In children, joint hypermobility alone without symptoms does not require referral; however, clinical judgement should be used to assess for symptoms such as pain, functional impairment, or red flag features that may necessitate specialist assessment ¹.

For children, the UK guidelines recommend that management in the community is appropriate if the child is well, has no severe pain, no significant functional impairment, and no signs of underlying connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome ¹. Referral to paediatric rheumatology is advised if there is diagnostic uncertainty, severe hypermobility impacting daily activities (e.g., subluxation or dislocation), symmetrical joint involvement, or systemic features including cardiovascular, respiratory, or ocular signs suggestive of connective tissue disease ¹.

In adults, diagnosis similarly relies on clinical assessment including the Beighton score, but also requires evaluation for symptoms such as joint pain, instability, and functional limitations. The presence of systemic features (e.g., skin fragility, easy bruising, family history of vascular complications) should prompt consideration of hypermobility spectrum disorders or hypermobile Ehlers-Danlos syndrome (hEDS) (Adam et al., 1993; Castori and Hakim, 2017). The diagnosis of hEDS is clinical, based on criteria that include generalized joint hypermobility, musculoskeletal complications, and exclusion of other connective tissue disorders (Castori and Hakim, 2017).

Recent literature emphasizes a diagnostic framework that integrates clinical history, physical examination including the Beighton score, and assessment of associated musculoskeletal symptoms and systemic features to differentiate benign joint hypermobility from hypermobility syndromes (Tofts et al., 2023). This approach aligns with UK guidance that highlights the importance of identifying red flags and systemic involvement to guide referral and management ¹.

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

• Use of the Beighton score to assess generalized joint hypermobility (score thresholds may vary by age and sex) (Castori and Hakim, 2017; Tofts et al., 2023).
• Assessment of symptoms such as pain, joint instability, functional impairment, and presence of red flag features (e.g., severe pain, symmetrical joint involvement, systemic signs) ¹.
• Consideration of family history and systemic features suggestive of connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndromes) (Adam et al., 1993; Castori and Hakim, 2017).
• Referral to specialist services (paediatric rheumatology or adult rheumatology) when diagnostic uncertainty exists or when hypermobility is associated with significant symptoms or systemic involvement ¹.