CONSTANT SCORE METHODOLOGY

BACKGROUND

The European Society for Shoulder and Elbow Surgery (ESSES) adopted the scoring system of C Constant and A Murley [1, 2, 3, 4, 5].
This scoring system consists of four variables that are used to assess the function of the shoulder. The right and left shoulders are assessed separately.
The subjective variables are pain and ADL (sleep, work, recreation / sport) which give a total of 35 points.
The objective variables are range of motion and strength which give a total of 65 points.

RANGE OF MOTION

Active range of motion should always be measured as part of the Constant Score.

ESSES recommends measuring range of motion with the patient sitting on a chair or bed, with weight even distributed between the ischial tuberosities. No rotation of the upper body may take place during the examination.
In the case of active motion, the patient  lift his arm to a painfree level. Note that the number of degrees at which the pain starts determines the range of motion. If one measures the active range of motion with pain, this should be stated. The Constant score cannot then be applied beyond the initiation of pain.

The most important thing is that range of motion is performed and measured in a standardised way.

In the Constant score system there is precise information about how the points are calculated. Bear in mind that 150 degrees of flexion give 8 points, while 151 degrees give 10 points.

STRENGTH

Strength is given a maximum of 25 points in the Constant Score. The significance and technique of strength measurement has been, and continues to be, the subject of much discussion.

The European Society for Shoulder and Elbow Surgery measures strength according to the following method:

• A spring balance is attached distal on the forearm.
• Strength is measured with the arm in 90 degrees of elevation in the plane of the scapula (30 degrees in front of the coronal plane) and elbow straight.
• Palm of the hand facing the floor ( pronation ).
• The patient is asked to maintain this resisted elevation for 5 seconds.
• It is repeated 3 times immediately after another.
• The average in pound ( lb ) is noted.
• The measurement should be painfree. If pain is involved the patient gets 0 points.
• If patient is unable to achieve 90 degrees of elevation in the scapula plane the patient gets 0 points.

Devices for Measuring Strength:

Strength can be measured with a standard Spring Balance (available from Fishing stores) or specific commercial devices.
An easy and small spring balance is the LAB Slim Penscale, which will fit in your pocket and is old fashioned good value at £8.99 from scales-r-us.com .
 LAB Slim Penscale

The Nottingham Mecmesin Myometer, from Atlantech, has been specifically designed for strength measurement of the Constant Score. The Myometer comprises a digital force reader that can either be used independently or linked to a PC in order to accurately measure and graph the function of muscle groups around the shoulder. The Windows Dataplot Software allows the Myometer to become a virtual chart reader where up to four tests can be plotted on one graph. Data can be exported in either tabular or graphical format into spreadsheets for later use. However, it is a bit bulky and requires recharging.
Nottingham Mecmesin Myometer

The EZForce Handheld myometer has also been designed specifically for strength testing of the shoulder. It is small, light and uses disposable batteries. This device is only in trial at the moment. For more information contact Mr Ofer Levy or tagltd@netvision.net.il
 

QUALITY ASSURANCE

It is essential that the measurement of all variables is standardised. When making any adjustments, such as using Age or Sex adjustments this should be mentioned. This also should apply when normalising the data.



REFERENCES

Also see:

• Constant Score Online Calculator (Calculate your Patient's Constant Score online)
• Constant Score Database