ASES Shoulder Score Explained

The American Shoulder and Elbow Surgeons Shoulder Score (ASES) is a mixed outcome reporting measure for use in a variety of shoulder pathology.

The ASES score can be viewed as a 100-point scale that evaluates two dimensions of shoulder function: pain and performance in activities of daily living. Each of the two domains make up for 50 of the 100 points.

The pain domain questions focus on the presence or absence of pain at night, use of OTC or prescription pain killers and a self-report of perceived intensity of pain.

The ADLs domain contains 10 functional items that are shoulder specific, as follows:

• Putting on a coat;
• Sleeping on the affected side;
• Washing your back/do up bra;
• Managing toileting;
• Combing hair;
• Reaching a high shelf;
• Lifting 10lbs. (4.5kg) above the shoulder;
• Throwing a ball overhand;
• Usual work;
• Usual sport/leisure activity.

Each of the above activities is scored on a scale from 0 to 3, depending on the difficulty encountered in performing the ADL:

• Unable to do (0);
• Very difficult to do (+1);
• Somewhat difficult (+2);
• Not difficult (+3).

Originally developed by Richards et al. in 1994, this composite instrument provides results in the 0 to 100 range, where 0 indicates a worse shoulder condition and 100 indicates best shoulder condition, so the greater the score, the lower the level of shoulder disability.

The score is easy to administer and the patient can complete it in up to 5 minutes.

Transforming the pain and the ADLs domains into the final score relies on the following formulas:

• Pain = 5 x (10 – Score from question 7)
• ADL = 5 x ADL Raw Score / 3
• ASES Score = Pain + ADL

Where ADL Raw score is sum of points from questions 8 to 17.

The ASES methodology has been found to be comparable in responsiveness with the Shoulder Pain and Disability Index (SPADI). The score has been validated and showed reliability and responsiveness in conditions such as rotator cuff disease, glenohumeral arthritis, shoulder instability, and shoulder arthroplasty.

References

Original reference

Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 1994; (November/December):347–52.

Other references

Wylie JD, Beckmann JT, Granger E, Tashjian RZ. Functional outcomes assessment in shoulder surgery. World J Orthop 2014; 5(5): 623-633.

Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J, Measures of adult shoulder function: disabilities of the arm, shoulder, and hand questionnaire (DASH) and its short version (QuickDASH), shoulder pain and disability index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) score (CS), simple shoulder test (SST), Oxford shoulder score (OSS), shoulder disability questionnaire (SDQ), and Western Ontario shoulder instability index (WOSI). Arthritis care & research, 2011; 63(S11), S174-S188.

Ellenbecker TS, Elmore E, Bailie DS. Descriptive report of shoulder range of motion and rotational strength 6 and 12 weeks following rotator cuff repair using a mini-open deltoid splitting technique. Journal of Orthopaedic & Sports Physical Therapy, 2006; 36(5), 326-335.