Exploration of Musculoskeletal Diseases

Table 1. Hypermobility Questionnaire.

Item	Question
The Hypermobility Questionnaire consists of 5 questions about current and past symptoms:
1	Can you, or have you ever been able to, place your hands flat on the floor without bending your knees?
2	Can you, or have you ever been able to, bend your thumb towards your forearm?
3	As a child, did you amuse your friends by contorting your body into strange shapes, or were you able to do the splits?
4	As a child or teenager, did you dislocate your shoulder or kneecap more than once?
5	Do you consider yourself twice as flexible as other people?

Return to article view

At least 2 positive answers are considered an indicator of JHS (sensitivity 80–85%) [5].

Declarations

Author contributions

BJ: Methodology, Writing—review & editing, Writing—original draft. The author read and approved the submitted version.

Conflicts of interest

Jürgen Braun, who is the Associate Editor of Exploration of Musculoskeletal Diseases, had no involvement in the decision-making or the review process of this manuscript. The author declares no other conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Tinkle BT. Symptomatic joint hypermobility. Best Pract Res Clin Rheumatol. 2020;34:101508. [DOI] [PubMed]

Blajwajs L, Williams J, Timmons W, Sproule J. Hypermobility prevalence, measurements, and outcomes in childhood, adolescence, and emerging adulthood: a systematic review. Rheumatol Int. 2023;43:1423–44. [DOI] [PubMed] [PMC]

Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413–8. [DOI] [PubMed] [PMC]

Grahame R. ‘The hypermobility syndrome’. Ann Rheum Dis. 1990;49:199–200. [DOI] [PubMed] [PMC]

Hakim A, Grahame R. A Simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract. 2003;57:163–6. [DOI]

Glans M, Humble MB, Elwin M, Bejerot S. Self-rated joint hypermobility: the five-part questionnaire evaluated in a Swedish non-clinical adult population. BMC Musculoskelet Disord. 2020;21:174. [DOI] [PubMed] [PMC]

Tofts L, Pacey V, Williams CM, Welch JJ, Shannon B, Chan C. Generalized Joint Hypermobility in Adults: A Systematic Review With Meta-Analysis to Identify Data-Driven Cut-offs Using the Beighton Score. Arthritis Care Res. 2026;78:987–97. [DOI] [PubMed] [PMC]

Remvig L, Flycht L, Christensen KB, Juul-Kristensen B. Lack of consensus on tests and criteria for generalized joint hypermobility, Ehlers-Danlos syndrome: Hypermobile type and joint hypermobility syndrome. Am J Med Genet A. 2014;164A:591–6. [DOI] [PubMed]

Grahame R, Hakim AJ. Hypermobility. Curr Opin Rheumatol. 2008;20:106–10. [DOI] [PubMed]

10.

Malfait F, Castori M, Francomano CA, Giunta C, Kosho T, Byers PH. The Ehlers-Danlos syndromes. Nat Rev Dis Primers. 2020;6:64. [DOI] [PubMed]

11.

Grahame R. Hypermobility: an important but often neglected area within rheumatology. Nat Clin Pract Rheumatol. 2008;4:522–4. [DOI] [PubMed]

12.

Nicholson LL, Simmonds J, Pacey V, De Wandele I, Rombaut L, Williams CM, et al. International Perspectives on Joint Hypermobility. J Clin Rheumatol. 2022;28:314–20. [DOI] [PubMed] [PMC]

13.

Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. 2017;175:148–57. [DOI] [PubMed]

14.

Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175:8–26. [DOI] [PubMed]

15.

Morlino S, Dordoni C, Sperduti I, Venturini M, Celletti C, Camerota F, et al. Refining patterns of joint hypermobility, habitus, and orthopedic traits in joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet A. 2017;173:914–29. [DOI] [PubMed]

16.

Hippokrates. In: On the Articulations. Scotland: Good Press; 2021.

17.

Denko CW. Chernogubov’s syndrome: a translation of the first modern case report of the Ehlers-Danlos syndrome. J Rheumatol. 1978;5:347–52. [PubMed]

18.

Jessee EF, Owen DS Jr, Sagar KB. The benign hypermobile joint syndrome. Arthritis Rheum. 2005;23:1053–6. [DOI] [PubMed]

19.

Beighton P, Grahame R, Bird H. Hypermobility in the Performing Arts and Sport. In: Hypermobility of Joints. London: Springer; 1983. pp. 97–121. [DOI]

20.

Parapia LA, Jackson C. Ehlers-Danlos syndrome—a historical review. Br J Haematol. 2008;141:32–5. [DOI] [PubMed]

21.

Carter C, Wilkinson J. Persistent joint laxity and congenital dislocation of the hip. J Bone Joint Surg Br. 1964;46-B:40–5. [DOI]

22.

Kirk JA, Ansell BM, Bywaters EG. The hypermobility syndrome. Musculoskeletal complaints associated with generalized joint hypermobility. Ann Rheum Dis. 1967;26:419–25. [DOI] [PubMed] [PMC]

23.

Beighton P, Grahame R, Bird H. In: Biomechanics of Hypermobility; Selected Aspects. London: Springer; 2011. pp. 49–64. [DOI]

24.

Morlino S, Castori M. Placing joint hypermobility in context: traits, disorders and syndromes. Br Med Bull. 2023;147:90–107. [DOI] [PubMed] [PMC]

25.

Demmler JC, Atkinson MD, Reinhold EJ, Choy E, Lyons RA, Brophy ST. Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: a national electronic cohort study and case–control comparison. BMJ Open. 2019;9:e031365. [DOI] [PubMed] [PMC]

26.

Juul-Kristensen B, Schmedling K, Rombaut L, Lund H, Engelbert RH. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility—A systematic review. Am J Med Genet C Semin Med Genet. 2017;175:116–47. [DOI] [PubMed]

27.

Remvig L, Jensen DV, Ward RC. Are diagnostic criteria for general joint hypermobility and benign joint hypermobility syndrome based on reproducible and valid tests? A review of the literature. J Rheumatol. 2007;34:798–803. [PubMed]

28.

Schlager A, Ahlqvist K, Rasmussen-Barr E, Bjelland EK, Pingel R, Olsson C, et al. Inter- and intra-rater reliability for measurement of range of motion in joints included in three hypermobility assessment methods. BMC Musculoskelet Disord. 2018;19:376. [DOI] [PubMed] [PMC]

29.

Remvig L, Duhn PH, Ullman S, Kobayasi T, Hansen B, Juul-Kristensen B, et al. Skin extensibility and consistency in patients with Ehlers-Danlos syndrome and benign joint hypermobility syndrome. Scand J Rheumatol. 2009;38:227–30. [DOI] [PubMed]

30.

Brady AF, Demirdas S, Fournel-Gigleux S, Ghali N, Giunta C, Kapferer-Seebacher I, et al. The Ehlers-Danlos syndromes, rare types. Am J Med Genet C Semin Med Genet. 2017;175:70–115. [DOI] [PubMed]

31.

Zschocke J, Demirdas S, van Dijk FS. Genetic diagnosis of the Ehlers-Danlos syndromes. Med Genet. 2024;36:235–45. [DOI] [PubMed] [PMC]

32.

Chiarelli N, Ritelli M, Zoppi N, Colombi M. Cellular and Molecular Mechanisms in the Pathogenesis of Classical, Vascular, and Hypermobile Ehlers-Danlos Syndromes. Genes. 2019;10:609. [DOI] [PubMed] [PMC]

33.

Arseni L, Lombardi A, Orioli D. From Structure to Phenotype: Impact of Collagen Alterations on Human Health. Int J Mol Sci. 2018;19:1407. [DOI] [PubMed] [PMC]

34.

Copetti M, Morlino S, Colombi M, Grammatico P, Fontana A, Castori M. Severity classes in adults with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders: a pilot study of 105 Italian patients. Rheumatology. 2019;58:1722–30. [DOI] [PubMed]

35.

Darakjian AA, Bhutani M, Fairweather D, Kocsis SC, Fliess JJ, Khatib S, et al. Similarities and differences in self-reported symptoms and comorbidities between hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Rheumatol Adv Pract. 2024;8:rkae134. [DOI] [PubMed] [PMC]

36.

Grahame R, Hakim AJ. Arachnodactyly—a key to diagnosing heritable disorders of connective tissue. Nat Rev Rheumatol. 2013;9:358–64. [DOI] [PubMed]

37.

Milewicz DM, Braverman AC, De Backer J, Morris SA, Boileau C, Maumenee IH, et al. Publisher Correction: Marfan syndrome. Nat Rev Dis Primers. 2022;8:3. [DOI] [PubMed]

38.

Chaugule S, Constantinou CK, John AA, Micha D, Eekhoff M, Gravallese E, et al. Comprehensive Review of Osteogenesis Imperfecta: Current Treatments and Future Innovations. Hum Gene Ther. 2025;36:597–617. [DOI] [PubMed] [PMC]

39.

Voermans NC, Bonnemann CG, Hamel BC, Jungbluth H, van Engelen BG. Joint hypermobility as a distinctive feature in the differential diagnosis of myopathies. J Neurol. 2009;256:13–27. [DOI] [PubMed]

40.

Cazzato D, Castori M, Lombardi R, Caravello F, Bella ED, Petrucci A, et al. Small fiber neuropathy is a common feature of Ehlers-Danlos syndromes. Neurology. 2016;87:155–9. [DOI] [PubMed] [PMC]

41.

Di Stefano G, Celletti C, Baron R, Castori M, Di Franco M, La Cesa S, et al. Central sensitization as the mechanism underlying pain in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. Eur J Pain. 2016;20:1319–25. [DOI] [PubMed]

42.

Desai MJ, Brestle M, Jonely H. Evidence for central sensitization as classified by the central sensitization inventory in patients with pain and hypermobility. Pain Pract. 2024;25:e13411. [DOI] [PubMed]

43.

Clark NL, Johnson M, Rangan A, Kottam L, Swainston K. The biopsychosocial impact of hypermobility spectrum disorders in adults: a scoping review. Rheumatol Int. 2023;43:985–1014. [DOI] [PubMed] [PMC]

44.

Alsiri N, Alhadhoud M, Alkatefi T, Palmer S. The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review. Semin Arthritis Rheum. 2023;58:152127. [DOI] [PubMed]

45.

Eccles JA, Thompson B, Themelis K, Amato ML, Stocks R, Pound A, et al. Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study. Clin Med. 2021;21:53–58. [DOI] [PubMed] [PMC]

46.

Gajarawala SN, Pelkowski JN, Old EA, Ahmad R, Clarke S, Gehin J, et al. Complications and Management of Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders: A Literature Review. Orthop Nurs. 2026;45:23–32. [DOI] [PubMed]

47.

Voermans NC, Knoop H, van de Kamp N, Hamel BC, Bleijenberg G, van Engelen BG. Fatigue Is a Frequent and Clinically Relevant Problem in Ehlers-Danlos Syndrome. Semin Arthritis Rheum. 2010;40:267–74. [DOI] [PubMed]

48.

Chen G, Olver JS, Kanaan RA. Functional somatic syndromes and joint hypermobility: A systematic review and meta-analysis. J Psychosom Res. 2021;148:110556. [DOI] [PubMed]

49.

Cameron KL, Duffey ML, DeBerardino TM, Stoneman PD, Jones CJ, Owens BD. Association of Generalized Joint Hypermobility With a History of Glenohumeral Joint Instability. J Athl Train. 2010;45:253–8. [DOI] [PubMed] [PMC]

50.

Hudson N, Starr MR, Esdaile JM, Fitzcharles MA. Diagnostic associations with hypermobility in rheumatology patients. Rheumatology. 1995;34:1157–61. [DOI] [PubMed]

51.

Hudson N, Fitzcharles MA, Cohen M, Starr MR, Esdaile JM. The association of soft-tissue rheumatism and hypermobility. Rheumatology. 1998;37:382–6. [DOI] [PubMed]

52.

Rodgers KR, Gui J, Dinulos MB, Chou RC. Ehlers-Danlos syndrome hypermobility type is associated with rheumatic diseases. Sci Rep. 2017;7:39636. [DOI] [PubMed] [PMC]

53.

Shur NF, Shur JD, Rennie WJ, Moorthy A. Concurrent Joint Hypermobility Syndrome and Spondyloarthropathy: A New Spondyloarthropathy Subgroup With a Less Severe Disease Phenotype? J Clin Rheumatol. 2020;26:99–103. [DOI] [PubMed]

54.

Cambré I, Gaublomme D, Burssens A, Jacques P, Schryvers N, De Muynck A, et al. Mechanical strain determines the site-specific localization of inflammation and tissue damage in arthritis. Nat Commun. 2018;9:4613. [DOI] [PubMed] [PMC]

55.

Aydın E, Metin Tellioğlu A, Kurt Ömürlü I, Turan Y. Impact of Generalized Joint Laxity on Plantar Loading Patterns in Young Females. Foot Ankle Int. 2017;38:909–15. [DOI] [PubMed]

56.

Black WR, Singleton J, Wang X, Harris JG, Jones JT. Effect of joint hypermobility on outcomes of children with juvenile idiopathic arthritis. Clin Rheumatol. 2024;43:3449–55. [DOI] [PubMed]

57.

Jónsson H, Valtýsdóttir ST. Hypermobility features in patients with hand osteoarthritis. Osteoarthr Cartil. 1995;3:1–5. [DOI] [PubMed]

58.

Dolan AL, Hart DJ, Doyle DV, Grahame R, Spector TD. The relationship of joint hypermobility, bone mineral density, and osteoarthritis in the general population: the Chingford Study. J Rheumatol. 2003;30:799–803. [PubMed]

59.

Kraus VB, Li YJ, Martin ER, Jordan JM, Renner JB, Doherty M, et al. Articular hypermobility is a protective factor for hand osteoarthritis. Arthritis Rheum. 2004;50:2178–83. [DOI] [PubMed]

60.

Chen HC, Shah SH, Li YJ, Stabler TV, Jordan JM, Kraus VB. Inverse association of general joint hypermobility with hand and knee osteoarthritis and serum cartilage oligomeric matrix protein levels. Arthritis Rheum. 2008;58:3854–64. [DOI] [PubMed] [PMC]

61.

Jónsson H, Elíasson GJ, Jónsson A, Eiríksdóttir G, Sigurdsson S, Aspelund T, et al. High hand joint mobility is associated with radiological CMC1 osteoarthritis: the AGES-Reykjavik study. Osteoarthr Cartil. 2009;17:592–5. [DOI] [PubMed] [PMC]

62.

Flowers PPE, Cleveland RJ, Schwartz TA, Nelson AE, Kraus VB, Hillstrom HJ, et al. Association between general joint hypermobility and knee, hip, and lumbar spine osteoarthritis by race: a cross-sectional study. Arthritis Res Ther. 2018;20:76. [DOI] [PubMed] [PMC]

63.

Goode AP, Cleveland RJ, Schwartz TA, Nelson AE, Kraus VB, Hillstrom HJ, et al. Relationship of joint hypermobility with low Back pain and lumbar spine osteoarthritis. BMC Musculoskelet Disord. 2019;20:158. [DOI] [PubMed] [PMC]

64.

Gullo TR, Golightly YM, Flowers P, Jordan JM, Renner JB, Schwartz TA, et al. Joint hypermobility is not positively associated with prevalent multiple joint osteoarthritis: a cross-sectional study of older adults. BMC Musculoskelet Disord. 2019;20:165. [DOI] [PubMed] [PMC]

65.

Golightly YM, Hannan MT, Nelson AE, Hillstrom HJ, Cleveland RJ, Kraus VB, et al. Relationship of Joint Hypermobility with Ankle and Foot Radiographic Osteoarthritis and Symptoms in a Community-Based Cohort. Arthritis Care Res. 2019;71:538–44. [DOI] [PubMed] [PMC]

66.

Santore RF, Gosey GM, Muldoon MP, Long AA, Healey RM. Hypermobility Assessment in 1,004 Adult Patients Presenting with Hip Pain. J Bone Jt Surg. 2020;102:27–33. [DOI] [PubMed]

67.

Steinberg N, Hershkovitz I, Zeev A, Rothschild B, Siev-Ner I. Joint Hypermobility and Joint Range of Motion in Young Dancers. J Clin Rheumatol. 2016;22:171–8. [DOI] [PubMed]

68.

Skwiot M, Śliwiński G, Milanese S, Śliwiński Z. Hypermobility of joints in dancers. PLOS ONE. 2019;14:e0212188. [DOI] [PubMed] [PMC]

69.

Beighton P, De Paepe A, Steinmann B, Tsipouras P, Wenstrup RJ. Ehlers-Danlos syndromes: revised nosology, Villefranche, 1997. Ehlers-Danlos National Foundation (USA) and Ehlers-Danlos Support Group (UK). Am J Med Genet. 1998;77:31–7. [DOI] [PubMed]

70.

Ritelli M, Chiarelli N, Cinquina V, Vezzoli M, Venturini M, Colombi M. Looking back and beyond the 2017 diagnostic criteria for hypermobile Ehlers-Danlos syndrome: A retrospective cross-sectional study from an Italian reference center. Am J Med Genet A. 2023;194:174–94. [DOI] [PubMed]

71.

Ritelli M, Chiarelli N, Cinquina V, Bertini V, Piantoni S, Caproli A, et al. Bridging the Diagnostic Gap for Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders: Evidence of a Common Extracellular Matrix Fragmentation Pattern in Patient Plasma as a Potential Biomarker. Am J Med Genet A. 2024;197:e63857. [DOI] [PubMed]

72.

Baraliakos X, Regel A, Kiltz U, Menne HJ, Dybowski F, Igelmann M, et al. Patients with fibromyalgia rarely fulfil classification criteria for axial spondyloarthritis. Rheumatology. 2017;57:1541–7. [DOI] [PubMed]

73.

Calabrese LH, Calabrese C. Long COVID for the Rheumatologist: Current Understanding and Approach to Management. Rheum Dis Clin North Am. 2025;51:29–43. [DOI] [PubMed]

74.

Boucher L, Nestler B, Groepper D, Quillin J, Deyle D, Halverson CME. An evaluation of practices and policies used in genetics clinics across the United States to manage referrals for Ehlers-Danlos and hypermobility syndromes. Genet Med Open. 2025;3:101960. [DOI] [PubMed] [PMC]