Original articles
The constant score in normal shoulders

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Relative Constant-Murley shoulder scores are based on an age- and sex-matched normal population from Constant’s original research. The purpose of this study was to determine normal Constant scores in a contemporary population and compare these values with those originally established by Constant. Two subject groups were analyzed. The first group comprised 1620 clinic patients whose normal shoulders were scored by resident physicians instructed on the Constant scoring technique. The second group comprised 115 healthy volunteers whose normal shoulders were scored by 1 experienced physician-researcher. There were no significant score differences between the two groups, indicating that, after instruction, scoring did not depend on tester experience. In both groups, there were significant score differences between sex and age groups. Similar to Constant’s study, age-related declines in scores and strength existed for both sexes but were less pronounced. Using Constant’s original values to calculate relative scores can overestimate shoulder function in women aged over 40 years and men aged over 60 years. If relative Constant scores are used, absolute scores should be concurrently reported to allow comparisons with different populations.

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Materials and methods

This study was approved by the institutional review board at our institution. The study consisted of two subject groups.

Results

Group 1 consisted of 1046 male subjects and 573 female subjects. Age ranged from 11 to 87 years. The mean range of motion was as follows: forward flexion, 162° in male subjects and 161° in female subjects; abduction, 166° in male subjects and 166° in female subjects; external rotation, 63° in male subjects and 66° in female subjects; and internal rotation, 79° in male subjects and 82° in female subjects. The mean abduction strength was 8.6 ± 2.8 kg in male subjects and 4.6 ± 1.7 kg in female

Discussion

Outcomes scoring is valuable for assessing patients after surgical treatment. It must be clinically reliable and reproducible by different observers of varying experience levels. In our study, with the use of modern strength measurement techniques, there were no significant differences in examination results between an experienced tester in a research setting and trained residents in a clinical setting. This is consistent with the small interobserver differences (mean, 3%) reported by Constant5

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This study was supported by the ResOrtho Foundation, Zürich, Switzerland

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