What is the difference between joint hypermobility, HSD and hypermobile EDS?
Hypermobility can be an isolated trait or part of a hypermobility spectrum disorder (HSD) or hypermobile EDS. Here is what sets them apart.
- 13 sources
- 6 min read
- Clinical review
- Verified 9 November 2026
Key points
- Generalized joint hypermobility (GJH) is a common physical trait; it can be asymptomatic and is not enough on its own to define a disease [2, 11, 10].
- Hypermobility spectrum disorders (HSD) refer to symptomatic hypermobility with musculoskeletal manifestations, when the criteria for hypermobile EDS or another identified condition are not met [2, 4].
- Hypermobile Ehlers-Danlos syndrome (hEDS) is one of the 13 types of EDS in the 2017 classification; its diagnosis is clinical, and no genetic test can currently confirm it [1, 5].
- HSD is not necessarily a “mild” form: in a large specialist clinic, patients with HSD reported as many or more symptoms than patients with hEDS [8].
- The prevalence of HSD and hEDS in the general population remains uncertain; a 2026 meta-analysis highlights the shortcomings of the available studies [10].
Joint hypermobility: a trait, not necessarily a disease
HSD: symptomatic hypermobility
The subtypes described in 2017 are as follows [4]:
| Subtype | Abbreviation | Summary description |
|---|---|---|
| Generalized HSD | G-HSD | Objectively assessed generalized hypermobility, with at least one secondary musculoskeletal manifestation |
| Peripheral HSD | P-HSD | Hypermobility limited to the hands and feet, with a musculoskeletal manifestation |
| Localized HSD | L-HSD | Hypermobility of a single joint or group of joints, with a manifestation in the same region |
| Historical HSD | H-HSD | Generalized hypermobility reported in the past (questionnaire), without a positive Beighton score on examination, with a musculoskeletal manifestation |
Hypermobile EDS (hEDS)
Practical differences, without a ranking of suffering
| Feature | Isolated hypermobility | HSD | hEDS |
|---|---|---|---|
| Joint hypermobility | Yes | Yes, current or past depending on the subtype | Generalized hypermobility required by the 2017 criteria |
| Musculoskeletal manifestations | Not necessarily | Yes, predominant | Common; they are among the possible criteria |
| Diagnosis | Clinical trait | Clinical diagnosis after other causes are ruled out | Clinical diagnosis based on the 2017 criteria, after other diagnoses are excluded |
| Confirmatory genetic test | Not applicable | No | None available to date |
Prevalence: what the figures can tell us
Reference frameworks by country
France. A French national diagnosis and care protocol (PNDS) for “non-vascular Ehlers-Danlos syndrome” was published online in 2020. It includes a chapter on the differential diagnoses of hEDS and states that hypermobility spectrum disorders are not covered. The French National Authority for Health (HAS) states that it was drawn up by the reference center for constitutional bone diseases (a French hospital center designated for rare diseases) under the OSCAR rare-disease network, following a methodology proposed by the HAS, but that it has not been validated by the HAS, which did not take part in drafting it [12].
United States. The literature search did not identify a federal guideline devoted specifically to hEDS/HSD. Clinical practice articles aimed at primary care, for example in American Family Physician or Missouri Medicine, offer reviews; these are clinical publications, not official guidelines [5, 6].
United Kingdom. The NHS publishes a public information page titled Joint hypermobility syndrome, which presents this term as part of a spectrum of hypermobility disorders that includes Ehlers-Danlos syndrome [13]. This vocabulary predates the 2017 HSD/hEDS nomenclature.
What remains unknown
References and level of evidence
- Malfait F, Francomano C, Byers P et al. The 2017 international classification of the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C, 175(1):8–26 2017. DOI: 10.1002/ajmg.c.31552. PMID: 28306229.(guideline or consensus)Limitations: Classification consensus; not a prospective validation of each criterion. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read
- Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. American Journal of Medical Genetics Part C, 175(1):148–157 2017. DOI: 10.1002/ajmg.c.31539. PMID: 28145606.(guideline or consensus)Limitations: Classification framework proposed by consensus. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read
- Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. American Journal of Medical Genetics Part C, 175(1):48–69 2017. DOI: 10.1002/ajmg.c.31538. PMID: 28145611.(evidence synthesis)Limitations: Narrative review based on the literature available in 2017. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read
- Carroll MB. Hypermobility spectrum disorders: A review. Rheumatology and Immunology Research, 4(2):60–68 2023. DOI: 10.2478/rir-2023-0010. PMID: 37637226.(evidence synthesis)Limitations: Narrative, non-systematic review. Read: full text (PMC10457547).Declared conflicts of interest: The author declares no conflict of interest
- Yew KS, Kamps-Schmitt KA, Borge R. Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders. American Family Physician, 103(8):481–492 2021. PMID: 33856167.(evidence synthesis)Limitations: Clinical review for US primary care; recommendations rated C (consensus, expert opinion). Read: abstract and publisher text (aafp.org).Declared conflicts of interest: The authors declare no relevant financial relationships
- White L, Procknow SS. Hypermobile Ehlers Danlos for the Primary Care Provider. Missouri Medicine, 121(4):289–296 2024. PMID: 39575079.(expert opinion)Limitations: Clinical guidance article, not a national guideline. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read
- 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. American Journal of Medical Genetics Part A, 194(2):174–194 2024. DOI: 10.1002/ajmg.a.63426. PMID: 37774134.(observational study)Limitations: Retrospective, single-center; 327 patients from 213 families already diagnosed under earlier criteria (Villefranche, Brighton). Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read
- Darakjian AA, Bhutani M, Fairweather D et al. Similarities and differences in self-reported symptoms and comorbidities between hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Rheumatology Advances in Practice, 8(4):rkae134 2024. DOI: 10.1093/rap/rkae134. PMID: 39660107.(observational study)Limitations: 2,088 adult patients from a specialist EDS clinic (Mayo Clinic, Florida); self-reported intake questionnaire; recruitment bias. Read: full text (PMC11630848).Declared conflicts of interest: One author (F.A.F.) declares consulting work for industry, considered unrelated to the article; the other authors declare none
- 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, 9(11):e031365 2019. DOI: 10.1136/bmjopen-2019-031365. PMID: 31685485.(observational study)Limitations: Diagnostic codes combining EDS and JHS, period 1990–2017, before full implementation of the 2017 classification. Read: full text (PMC6858200).Declared conflicts of interest: No conflicts declared
- Carnerup I, Bondesson E, Ahl E, Schouenborg AT, Jöud AS. Prevalence of generalized joint hypermobility, hypermobility spectrum disorders and Ehlers-Danlos syndrome: systematic review and meta-analysis. Rheumatology International, 46(11):306 2026. DOI: 10.1007/s00296-026-06346-3. PMID: 42986321.(evidence synthesis)Limitations: 17 general-population studies (age 5 and older); very high heterogeneity; a single study for HSD and hEDS. Read: full text (PMC13739981).Declared conflicts of interest: The authors declare no conflict of interest; Swedish public funding
- Tofts LJ, Simmonds J, Schwartz SB et al. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet Journal of Rare Diseases, 18(1):104 2023. DOI: 10.1186/s13023-023-02717-2. PMID: 37143135.(guideline or consensus)Limitations: Consensus framework from the pediatric working group of the International Consortium; literature too heterogeneous for a systematic review, studies not quality-assessed; framework still to be tested prospectively. Read: full text (PMC10157984).Declared conflicts of interest: The authors declare no conflict of interest
- French reference center for constitutional bone diseases, OSCAR rare-disease network (published by HAS). Syndrome d'Ehlers-Danlos Non Vasculaire (SED NV) — Protocole national de diagnostic et de soins. 2020.(guideline or consensus)Limitations: The HAS states that this PNDS has not been validated by the HAS, which did not take part in drafting it. It does not cover hypermobility spectrum disorders. Read: institutional page and excerpts from the PDF.Declared conflicts of interest: Not reviewed in the part of the source that was read
- NHS. Joint hypermobility syndrome. 2023.(expert opinion)Limitations: Public information page (last review shown: August 30, 2023); uses the older JHS terminology.Declared conflicts of interest: Not applicable