Hypermobility spectrum disorders

Your hypermobility causes you pain, but you don’t meet all the criteria for hypermobile EDS? You may have a hypermobility spectrum disorder. In French it is called TSH; in English, HSD (Hypermobility Spectrum Disorders). On this site we use HSD, the most widely used acronym. Your symptoms are just as real.

What are HSD?

Hypermobility spectrum disorders were described in 2017, at the same time as the international classification of EDS. They concern people whose joint hypermobility causes symptoms (pain, instability, repeated sprains or dislocations…), without their meeting all the criteria for hypermobile EDS or for another connective tissue disorder.

The diagnosis is clinical: there is no genetic test. It is made by a doctor, after ruling out other causes.

2017 classification

The four forms of HSD

They differ according to the joints involved.

Generalised

Hypermobility of many joints (positive Beighton score), with musculoskeletal symptoms.

Peripheral

Hypermobility mainly limited to the hands and feet.

Localised

Hypermobility of a single joint or a single group of joints.

Historical

Hypermobility present in the past, which may no longer show today (flexibility decreases with age).

Hypermobile EDS or HSD?

The doctor relies on three criteria, defined in 2017 for hypermobile EDS.

1. Generalised hypermobility

Measured with the Beighton score, out of 9 points. The threshold depends on age: at least 6 in children, 5 in adults up to 50, 4 after 50.

2. Associated signs

Skin features, family history, chronic joint pain or instability.

3. No other explanation

Other connective tissue disorders and other possible causes must be ruled out.

What if not all are met?

If hypermobility causes symptoms but the three criteria are not all met, it is called a hypermobility spectrum disorder (HSD).

New criteria expected on 1 December 2026. An international group of experts brought together by The Ehlers-Danlos Society will publish on that day a new classification of all types of EDS and of hypermobility spectrum disorders, replacing the 2017 one. This page will be updated as soon as they are published.

The same care as hypermobile EDS

Adapted rehabilitation, joint supports, managing pain and fatigue, everyday adjustments: the guidance is the same as for hypermobile EDS.

If there are also associated conditions (digestive problems, dysautonomia, fatigue…), they are looked for and treated in the same way.

Sources and resources

The Ehlers-Danlos Society What is HSD? ↗ Castori et al., 2017 A framework for the classification of joint hypermobility and related conditions (scientific article) ↗ Haute Autorité de Santé (HAS, French National Authority for Health) French national diagnosis and care protocol (PNDS): non-vascular Ehlers-Danlos syndromes (2020, in French) ↗ SED Gastroparésie N’Cie The EDS reference and competence centres →

Medical information

The content of this page is provided for information only. It does not replace a consultation, a diagnosis or personalised advice from a healthcare professional.

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