Used for assessing hypermobility, in other words lax joints (“double jointed”).

1 for each side of passive dorsiflexion of 5th MCP to 90deg, opposition of thumb to volar aspect forearm, hyperextension of elbow/knee, and placing of hands flat on floor with straight knees.

4+ needed for hypermobility syndrome (for adults), other major criterion is arthralgia for 3+ months in 4+ joints.  Minor criteria include:

• 1st degree relative,
• recurrent dislocation,
• 3+ soft tissue lesions (eg bursitis, tenosynovitis),
• abnormal skin (striae),
• drooping eyelids,
• varicose veins,
• Marfanoid habitus
• etc.

Other features of hypermobility syndrome in childhood include late walking, poor ball catching and handwriting, tiring easily.

Adults often get autonomic dysfunction eg orthostatic intolerance, functional bowel problems. Chronic pain syndrome and downward spiral in mobility often seen.

Ehlers Danlos syndrome has many proposed subtypes, some of which are pure hypermobility, but in others hypermobility may not be very obvious at all (just fingers!?).  Some types have severe cardiac complications.