Professional Documents
Culture Documents
The American Shoulder and Elbow Surgeons have adopted a standardized form
for assessment of the shoulder. The form has a patient self-evaluation section
and a physician assessment section . The patient self-evaluation section of the
form contains visual analog scales for pain and instability and an activities of
daily living questionnaire. The activities of daily living questionnaire is marked
on a four-point ordinal scale that can be converted to a cumulative activities of
daily living index. The patient can complete the self-evaluation portion of the
questionnaire in the absence of a physician. The physician assessment section
includes an area to collect demographic information and assesses range of
motion, specific physical signs, strength, and stability. A shoulder score can be
derived from the visual analogue scale score for pain (50%) and the cumulative
activities of daily living score (50%). It is hoped that adoption of this instrument
to measure shoulder function will facilitate communication between investigators,
stimulate multicenter studies, and encourage validity testing of this and other
available instruments to measure shoulder function and outcome.
(J SHOULDER ELBOW SURG 7994;3:347-52)
The
From the Research Committee, Amer icon Shoulder and Elbow Surgeons, Rosemont, III.
Reprint requests: Amer ican Shoulder and Elbow Surgeon s,
6300 North River Rd., Suite 727, Rosemont, IL 60018-4226.
Copyright 1994 by Journal of Shoulder and Elbow Surgery
Board of Trustees.
1058-2746/94/$3.00 + 0 3211/59628
347
Name:
Age:
Date
I Hand dominance:
L Ambi
Sex:
Diagnosis:
Initial Assess? Y
Procedure /Date:
Followup :
M'
All forms that existed at that time were reviewed by the Research Committee. 1,3,4,7.9, 12 A
draft form was presented to the membership at
the closed meeting held in Seattle, Washington,
in September 1991. The membership was encouraged to use the form and to offer constructive criticism. More than 70 suggestions for
change and improvement were made after distribution of the first ' draft. The suggested
changes were reviewed by a subcommittee of
the Research Committee in the summer of 1992.
The form was revised and redistributed after the
ASES closed meeting held in Vail, Colorado, in
September 1992 .
Another 15 suggestions were made, and most
were incorporated into the form that was
adopted by the membersh ip. It is the belief of
the Research Committee and the American
Shoulder and Elbow Surgeons that the shoulder
assessment form represents a state-of-the-art
assessment tool for patients with shoulder disorders. The form consists of a physician assessment section and a patient self-evaluation
section. The patient self-evaluation section can
be completed in approximately 3 minutes. The
presence of a physician or paramedical worker
is not required for the completion of the patient
self -evaluation portion of the form . Forms are
available from the ASES office in Chicago and
are also available on diskette (WordPerfect 5.1
WordPerfect Corp., Orem, Utoh), because it is
recognized that individual investigators may
wish to customize the form for their use. The
addition of other questions or specific maneuvers on physical examination is encouraged according to the distinctive needs of individuals
and groups working with specific subsets of patients. The ASES standardized shoulder assessment form is offered as a baseline measure of
shoulder function applicable to all patients regardless of diagnosis.
DEMOGRAPHIC INFORMATION
The patient's name, age, hand dominance,
sex, diagnosis, and procedure are noted (Figure 1). Spaces are available to note the date of
the assessment and the date of procedure, if an
operative procedure has been performed. An
annotation is also present to ind icate whether
the patient is being seen for the first time and,
if not, what the length of follow-up is. It is antic ipated that many clinicians will wish to "customize" this portion of the form according to
their needs and the format of patient demographic information at their parent institution.
PATIENT SELF-EVALUATION
The patient self-evaluation form is divided
into three sections.
Pain. The first section concerns pain (Figure 2). The patients are asked to identify
whether they are having pain in the shoulder
and are asked to record the location of their
pain on the pain dioqrom." Patients are asked
whether they have pain at night and whether
they take pain medication. The next question
identifies the use of a nonnarcotic analgesic.
Another question identifies the use of na rcotic
med ication . The patient is asked to record the
number of pills required each day. The severity
of pain is graded on a 10 cm visual analog scale
that ranges from 0 (no pa in at all) to 10 (pa in
as bad as it can be)." 13, ,.
Instability. The patient is asked to identify
whether he or she experiences symptoms of instability (Figure 3). The sensation of instability
experienced by the patient is assessed quantitat ively according to a visual analog scale. A
higher score is given, if the shoulder feels very
unstable.
Activities of daily living. Ten activities of
daily living are assessed on a four-point ordinal
scale (Figure 4).2 The patients are asked to cir-
Richards et al.
349
PATIENTSEU-EVALUATION
Are you havlng pain In your ahouldfJI7 (circle oomIct
No
Yes
No
Yes
No
Yes
Of
atronger)?
No
pills
No pain at all
,10
Figure 2 Patient self-evaluation : pain questionnaire. (Advil, WhitehallRobins lnc., Madison, N .J.; Tylenol, McNeil Consumer, Pleasantville, N .J.)
Yes
No
Very stable
PHYSICIAN ASSESSMENT
The physician assessment portion of the form
consists of the following sections.
Range of motion. Total (combined glenohumeral and scapulothoracic) shoulder motion is measured, because the ability to differentiate glenohumeral from scapulothoracic rno-
350
Richards et
01.
Cirde the number in the box that indicates your ability to do the following aetMties:
VfKY dilli<:ult to do ; 2 Somewhat difficult; 3 Not diffICUlt
o Unable to do ; 1
RIGHT ARM
ACTIVITY
LEFT AR M
1. Put on a coat
0 1 2 3
0 t 2 3
0 t 2 3
o
o
o
o
o
1 2 3
o
o
o
o
1 2 3
0 1 2 3
1 2 3
1 2 3
0 1 2 3
1 2 3
I
I
1 2 3
0 1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
o
o
o
1 2 3
1 2 3
1 2 3
PHYSICIAN ASSESSMENT
RIGHT
RANGE OF MOTION
T_ should """"'"
AaMl
~~ed
FOI'Ward elevation
p......,.
LEFT
p......,.
AaMl
0IlQI0)
(Mulmum _
(ItgI.- _ _ _
Crossbody adduction
.. _
........-)
SIGNS
o
SIGN
Right
Left
AC joint tenderness
o
o
0 123
o
o
o
0 1 2 3
0 123
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
Subacromial crepitus
Scars location
....._
In oIg/It .........
(Puoivo _ _ .."
f1t1' Oodonl
-"" ...)
Atrophy location:
Deformity : describe
Richards et al.
351
STRENGTH
(record MAC grade)
Forward elevation
Abduction
External rotation
Internal rotation
(Arm comIot1obIy
o.
aIdo )
left
012345
012345
o
o
o
o
1 2 3 4 5
1 234 5
012345
1 234 5
1 234 5
012345
INSTABIUlY
o - none; t mild (0 - 1 em tr811SlalJon)
2 moderate (1 2 em translation Ot Iran sletos 10 gleno id rlm)
o 1 2 3
o 1 2 3
Posterior translation
o 1 2 3
o 1 2 3
o 1 2 3
o 1 23
Antetlor apprehension
o 1 2 3
o 1 2 3
Reptoduces symptOtnS?
Voluntary Inslability?
Examiner's name:
Date
352
Richards et
01.
outcome measurement
shoulder.
instruments
for
the
1982;9 :768-9.
7. Lippitt SB, Harryman DT II, Matsen FA 1111. A practical
tool for evaluation function : the simple shoulder test. In:
Matsen FA III, Fu FH, Hawkins RJ, edi to rs. The shoulde r:
a balan ce of mob ility and sta bility. Rosemont : American
A cademy of Orthopaedic Surgeons, 1993:501- 18.
The authors acknowledge the support, encouragement, and counsel of American Soc iety of Shoulder and Elbow Surgeons past presidents Frederick
A. Matsen III, MD, Richard J. Hawkins, MD, FRCS(C),
Robert J. Neviaser, MD, Russell F. Warren, MD, and
president Harvard Ellman, MD.
8. Me lzack R. The McGill pain questionna ire: major properties and scori ng method . Pain 1975; 1:277-99.
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