Normalization of the Constant score

doi:10.1016/j.jse.2004.10.009

Journal of Shoulder and Elbow Surgery

Volume 14, Issue 3, May–June 2005, Pages 279-285

https://doi.org/10.1016/j.jse.2004.10.009 Get rights and content

The strength of the normal shoulder may differ by gender and deteriorate with age. Thus, the Constant score may also decrease in absolute value while still reflecting a normal score. To account for age- and gender-related differences, normal results for this scale must be determined across a population of patients without shoulder disease. Patients presenting for evaluation of nonshoulder conditions participated. A subjective questionnaire was completed. Range of motion and strength were measured. This analysis includes the data of 441 patients. The mean Constant score for men was significantly greater than that for women in each age group (P < .05). Significant age-related differences were noted in each group (P < .05). Normative values for the Constant score based on age and gender were determined. The adjusted score represents the gender- and age-matched function of the shoulder and is useful in the evaluation of shoulder outcomes.

Section snippets

Materials and methods

All patients underwent an informed consent process approved by the Institutional Review Board and Human Subjects Committee of Rush University Medical Center (Chicago, IL). Four hundred eighty patients presenting to a sports medicine clinic for evaluation of nonshoulder conditions participated in clinical testing that would allow the determination of the Constant score for the dominant shoulder. All participants were carefully screened by the examiner to determine the existence of current or

Results

Four hundred eighty patients were evaluated. Five were aged less than 18 years, and thirty-nine were not included in the analysis because of data that were either missing or not able to be read by the scanner. Our results are based on complete data from 441 patients (Table III). The mean Constant score for men was significantly greater than that for women in each age group (P < .05) (Figure 2). For men, patients aged older than 70 years had a significantly lower Constant score than those aged

Discussion

A shoulder scoring system serves as a simplified means for the evaluation of a variety of shoulder conditions. It is intended to represent the outcome of intervention without sensitivity to observer bias or bias based on the parameters measured. In addition, it should allow the effective communication of the results of medical and surgical intervention in a patient group. It would, therefore, allow comparison of different therapeutic modalities by defining functional improvement or

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Although interest in studies evaluating the outcomes of rotator cuff repair is steadily increasing, the results and tendon integrity after arthroscopic rotator cuff repair in elderly patients have only been minimally investigated. The aim of this study was to evaluate clinical outcomes and repair integrity in patients over 65 years of age who underwent arthroscopic repair of full-thickness rotator cuff tears.
A retrospective study was conducted with the following inclusion criteria: (1) elective shoulder arthroscopy for rotator cuff repair for full-thickness posterosuperior tears; (2) age over 65 years at surgery; and (3) participation in 24 months of follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley Score (CMS) and at follow-up, the ROM, the 12-Item Short Form Survey, the American Shoulder and Elbow Surgeons, and the CMS were evaluated; an ultrasonographic assessment of tendon integrity was performed according to the adapted Sugaya classification.
The final sample consisted of 110 patients with an average age of 69.2 ± 3.5 years. The mean duration of nonoperative management before surgery was 2.6 ± 0.8 months. The mean period of preoperative physical therapy was 0.6 ± 0.9 months. ROM and CMS showed statistically significant improvement (all P < .001) after a mean follow-up time of 54.5 ± 22.3 months. The ultrasonographic assessment showed tendon integrity (types I and II) in 75% of cases; 21% were type III repair, and rotator cuff retear (types IV and V) was recorded in 4% of cases. All scores directly correlated with the integrity of the tendon. In the multivariate analysis, higher postoperative CMS was associated with male sex (P < .001, β = −6.085) and lower age (P = .004, β = −0.533). Higher postoperative American Shoulder and Elbow Surgeons were associated with lower age (P = .020, β = −0.414). Higher postoperative 12-Item Short Form Survey physical component score and mental component score were associated with lower age (P = .013, β = −0.550 and P < .001, β = −0.520, respectively) and shorter preoperative physical therapy period (P = .013, β = −2.075 and P = .006, β = −1.093, respectively).
A significant ROM and CMS recovery and a rotator cuff integrity rate of 75% can be expected in patients over 65 years of age who undergo arthroscopic repair for full-thickness rotator cuff tears. Better functional, physical, and mental health outcomes correlate with rotator cuff integrity and are predicted by male sex and a shorter period of preoperative physical therapy.
Pyrocarbon humeral heads for hemishoulder arthroplasty grant satisfactory clinical scores with minimal glenoid erosion at 5-9 years of follow-up
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Hemishoulder arthroplasty (HSA) is a more conservative alternative to total shoulder arthroplasty for young and active patients with minimal glenoid erosion or deformity. Pyrocarbon humeral heads were introduced as an alternative to metallic humeral heads, which were associated with glenoid erosion in 28%-43%. The purpose of this study was to evaluate the progression of glenoid erosion and clinical scores of HSA using pyrocarbon humeral heads from short- (2-4 years) to midterm (5-9 years).
We retrieved the records of 45 consecutive patients who underwent HSA with pyrocarbon humeral heads from 2013 to 2017. Patients were evaluated radiographically and clinically at a first follow-up (2-4 years) and a second follow-up (5-9 years). Preoperative glenoid morphology was assessed using computed tomography scans, and glenoid erosion was assessed using plain radiographs according to Sperling et al. The Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV) score were assessed by an independent observer.
From the initial cohort of 45 patients, 2 underwent revision surgery (4.4%) due to persistent pain (without signs of rotator cuff pathology or glenoid erosion) and 6 were lost to follow-up (13%), leaving 37 for outcome assessment (82%). At the first follow-up of 2.2 ± 0.4 years, all clinical scores improved substantially (CS from 29.3 ± 13.5 to 76.7 ± 14.4, ASES from 23.7 ± 15.6 to 87.0 ± 16.0, and SSV from 25.3 ± 12.2 to 84.1 ± 15.2), and at the second follow-up of 6.2 ± 1.2 years, good clinical scores were maintained (CS from 76.7 ± 14.4 to 80.8 ± 16.0, ASES from 87.0 ± 16.0 to 92.3 ± 15.0, and SSV from 84.1 ± 15.2 to 82.8 ± 18.3). At the second follow-up, glenoid erosion was moderate in 9 (24%) and severe in 3 (8.1%). When comparing with immediate postoperative radiographs, 10 shoulders exhibited progression of glenoid erosion by 1 grade (n = 9) or 2 grades (n = 1).
Pyrocarbon humeral heads for HSA grant satisfactory clinical scores with minimal glenoid erosion.
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Several techniques have been adopted during primary reverse shoulder arthroplasty (RSA) to manage glenoid bone defect. Among bone grafts, humeral head autograft is currently the mainstream option. However, autologous humeral heads may be unavailable or inadequate, and allografts may be a viable alternative. The aim of the present study was to evaluate the functional and radiologic outcomes of femoral head allografts for glenoid bone defects in primary RSA.
We conducted a retrospective study with prospective data collection enrolling 20 consecutive patients who underwent RSA with femoral head allografts for glenoid bone defects. Indications for surgery were eccentric cuff tear arthropathy in 10 cases (50%), concentric osteoarthritis in 9 cases (45%), and fracture sequelae in 1 case (5%). Each patient was evaluated preoperatively and at follow-up by radiologic and computed tomography (CT) and by assessing the range of motion (ROM) and the Constant-Murley score (CMS). A CT-based software, a patient-specific 3D model of the scapula, and patient-specific instrumentation were used to shape the graft and to assess the position of K-wire for the central peg. Postoperatively, CT scans were used to identify graft incorporation and resorption.
After a median follow-up of 26.5 months (24-38), ROM and CMS showed a statistically significant improvement (all P = .001). The median measures of the graft were as follows: 28 mm (28-29) for diameter, 22° (10°-31°) for angle, 4 mm (2-8 mm) for minimum thickness, and 15 mm (11-21 mm) for maximum thickness. Before the surgery, the median glenoid version was 21.8° (16.5°-33.5°) for the retroverted glenoids and −13.5° (−23° to −12°) for the anteverted glenoids. At the follow-up, the median postoperative baseplate retroversion was 5.7° (2.2°-1.5°) (P = .001), and this value was close to the 4° retroversion planned on the preoperative CT-based software. Postoperative major complications were noted in 4 patients: 2 dislocations, 1 baseplate failure following a high-energy trauma, and 1 septic baseplate failure. Partial graft resorption without glenoid component failure was observed in 3 cases that did not require revision surgery.
The femoral head allograft for glenoid bone loss in primary RSA restores shoulder function, with CMS values comparable to those of sex- and age-matched healthy individuals. A high rate of incorporation of the graft and satisfactory correction of the glenoid version can be expected after surgery. The management of glenoid bone defects remains a challenging procedure, and a 15% risk of major complication must be considered.
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Addressing irreparable subscapularis in conjunction with reverse total shoulder arthroplasty (RTSA) presents challenges. RTSA without subscapularis repair leads to similar clinical results compared to those with a subscapularis repair but with less range of motion in internal rotation (IR). Optimization of IR and anterior stability after RTSA, in the setting of an irreparable subscapularis may be achieved with a pectoralis major (PM) tendon transfer. This study aims to describe a novel surgical technique involving PM transfer in RTSA for irreparable subscapularis and report the initial clinical and radiological outcomes.
This study included 13 patients with an average of 65.5 years (range, 52-82 years). All patients underwent a lateralized RTSA with concurrent PM transfer, associated to an irreparable subscapularis, performed by a single surgeon (PV). Preoperative and postoperative range of motion, including internal rotation 1, internal rotation 2, external rotation 1 (ER1) and forward elevation, were measured. The absolute Constant score, the age and sex-adjusted Constant Murley score, Visual Analog Scale and subjective shoulder value were evaluated by the same surgeon. Standard X-rays, preoperative magnetic resonance imaging, and computed tomography scan were performed for all patients.
With an average follow-up of 37 months, the mean Constant score improved from 17.7 preoperatively to 61 postoperative (P < .05). Postoperative clinical outcomes significantly improved across the study group. Mean internal rotation 2 increased from 44.6° to 61.5° (P < .05), while internal rotation 1 improved from 2.6 to 5 (P < .05). The Gerber test yielded positive results for all patients, while the belly press test was negative for eleven patients. Postoperative imaging assessment of the transferred PM tendon transfer showed intact repair, a good cicatrization on the lesser tuberosity with excellent trophicity of the muscle without any fatty infiltration in all patients.
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Literature describing outcomes and integrity after isolated subscapularis (SSC) tendon repair is emerging but remains limited to a few small case series with short-term follow-up. The aim of this study was to evaluate the long-term clinical outcomes and repair integrity in patients who underwent arthroscopic repair of isolated SSC tears.
A retrospective study was conducted with the following inclusion criteria: (1) primary and elective shoulder arthroscopy for isolated SSC repair, (2) type III (a full-thickness tear in the upper two-thirds of the tendon) or IV (a complete tear without tendon retraction) SSC tear according to the Lafosse classification, and (3) a minimum 24-month follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley score (CMS) and at follow-up, the ROM, the University of California-Los Angeles (UCLA) Shoulder Rating Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the CMS were evaluated; an ultrasonographic assessment of tendon healing was performed according to the Sugaya classification.
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The medium-term results of reverse shoulder arthroplasty (RSA) that has been performed by a single surgeon have been previously reported. The purpose of this study was to investigate the minimum 10-year clinical and radiographic outcomes of these patients.
In this prospective cohort study, 27 patients were evaluated after RSA for massive rotator cuff tear with or without eccentric osteoarthritis (OA) or concentric OA with the Constant-Murley Score (CMS), range of motion (ROM), and a radiologic assessment.
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RSA led to excellent clinical and functional outcomes for patients up to 17 years postoperatively, and there was no decrease in the CMS over time. No loosening of implants was noted, and the rate of scapular notching was 66%, mostly grade 1 or 2.

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Original articleNormalization of the Constant score

Section snippets

Materials and methods

Results

Discussion

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Sci Med Sport

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Clin Biomech (Bristol, Avon)

Isometric muscle strength and muscular endurance in normal persons aged between 17 and 70 years

Scand J Rehabil Med

Shoulder strength analysis using the Cybex II isokinetic dynamometer

Clin Orthop

Influence of sports discipline on shoulder rotator cuff balance

Med Sci Sports Exerc

An evaluation of the Constant-Murley shoulder assessment

J Bone Joint Surg Br

Original article
Normalization of the Constant score