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This combined criterion must be present together with the other major criterion, i.e., generalized JHM (gJHM) assessed with the Beighton score (BS) [15], and/or with at least three of the following minor criteria: easy bruising, soft, doughy skin, skin fragility, molluscoid pseudotumors, subcutaneous spheroids, hernia (or a history of thereof), epicanthal folds, JHM complications (sprains, luxation/subluxation, pain, flexible flatfoot), and family history of a first degree relative who meets clinical criteria [1, 16]