Scores

Recommendations for using the Constant score

The examination technique for the Constant score was not exactly defined by the first author resulting in many problems. In particular, the way of force measurement affects the result to a considerable extent. According to Lillkrona (JSES 2008) this leads to an interobserver variability of 10 points at a maximum of 100 possible points representing an unsatisfactory condition.

Constant himself (1991) and Murray et al. (1985) favored a measurement at the Delta insertion, however, Constant (1987), Burkhead (Ciepela et al. 1996), Gerber (1996) and Moseley (1972) preferred to measure at the wrist. Thomas (2003) recommends a standardization of the torque taking into account the lever arm so that the force measurements result comparable at different points. There are also different specifications to the arm position. The majority of the authors use to measure in abduction, however, some authors also measure in inflection and others in elevation (abduction in the scapular plane). Habermeyer et al. (2006) show in their compilation of international used scores that the force measurement of the should be carried out at 90° abduction "or less if the patient is unable to abduction to that level?” (page 201). The authors furthermore cite Moseley (1972) "In patients whose active range of abduction is less than 90°, the power at whatever maximum abduction can be performed is taken using the spring balance ...".

Because of this contradictory information the publication of Constant CR et al. (2008) clarified the measurement methodology. The most important requirements are the force measurement at the wrist and at 90° of abduction. At lower values for the abduction force has to be set to 0. This measurement methodology inevitably leads to lower values than measurement at the Delta insertion or at a lower abduction, so that the results are not comparable to older studies. It is therefore advisable to use both methods. A subsequent conversion is possible using the method described by Thomas et al. (Z Orthop, 2003).

In 2004 Böhm et al. validated a questionnaire version of the Constant score for self-evaluation by the patient. This questionnaire allows raising the Constant score without examining the patient himself and can be downloaded here as a PDF document.

Literatur

  1. Ciepiela MD, Burkhead WZ (1996) The end result: Functional assessment of rotator cuff repair. In: Burkhead WZ (ed.) Rotator cuff disorders. Williams and Williams, Baltimore; p.p. 393-8.
  2. Constant CR, Gerber C, Emery RJH, Søjberg JO, Gohlke F, Boileau P (2008) A review of the Constant score: Modifications and guidelines for its use. J Shoulder Elbow Surg; 17(2): 355-61.
  3. Constant CR (1991) Schulterfunktionsbeurteilung. Orthopäde; 20:289-94.
  4. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Rel Res; 214:160-4.
  5. Gerber C, Hersche O, Farron a (1996) Isolated rupture of the subscapularis tendon. J Bone Joint Surg; 78-A:1015-23.
  6. Habermeyer P, Magosch P, Lichtenberg S (2006) Classifications and scores of the shoulder. Springer, Berlin, Heidelberg, pp. 199-204.
  7. Lillkrona U (2008) How should we use the Constant Score  - a commentary. J Shoulder Elbow Surg; 17(2):362-3.
  8. Moseley HF (1972) Examination of the shoulder. In: Moseley HF (ed.) Shoulder lesions. Paul B Hober, New York, p.p.22-30.
  9. Murray MP, Gore DR, Gardner GM, Mollinger LA (1985) Shoulder motion and muscle strength of normal men and woman in two groups. Clin Orthop; 192:268-73.
  10. Thomas M, Dieball O, Busse M (2003) Normalwerte der Schulterkraft in Abhängigkeit von Alter und Geschlecht .... Z. Orthop; 141:160-70.
    https://www.thieme-connect.com/DOI/DOI?10.1055/s-2003-38662
  11. Boehm TD, Wollmerstedt N, Doesch M, Handwerker M, Mehling E, Gohlke F. Entwicklung eines Fragebogens basierend auf dem Constant-Murely Score zur Selbst-evaluation der Schulterfunktion durch den Patienten. Unfallchiru 2004; 107: 397 - 402
    http://springerlink.metapress.com/content/w4l7n83u4ycrknub/

Empfehlungen zu Anwendung des Rowe-Score

Seit den Publikationen von Jensen et al. JSES 2009 ist bekannt, dass vom Rowe-Score mehrere Versionen benutzt werden, die auf Grund der Wichtung der einzelnen Parameter ein sehr unterschiedliches Ergebnis bedingen. Den Empfehlungen von Jensen folgend, ist die Verwendung des Scores von 1982 sinnvoll.
Der Rowe-Score ist zur Beurteilung von Patienten mit oder nach Schulterinstabilität besser geeignet als der Constant-Score.

Die deutschsprachige Publikation ist als pdf angehängt.

Patientenbogen für den Constant-Score

Constant Unfallchirurg (283.4 KiB)