Constant Shoulder (Constant-Murley) Score
Evaluates overall shoulder function based on pain, performance in ADLs, upper extremity function or strength.
Refer to the text below the calculator for more information about the psychometric properties of this shoulder score.
The Constant Shoulder Score, also known as the Constant-Murley score (CMS) evaluates the level of pain and the patient’s ability to carry out normal daily activities.
Originally introduced to assess functionality after treatment of shoulder injury, the score is addressed to the patients suffering from osteoarthritis, joint pain and fractures, arthritis or following orthopedic surgery.
The assessment is divided into 4 subscales that total 100 points:
- Pain subscale – 15 points;
- ADLs subscale – 20 points;
- ROM subscale – 40 points;
- Strength subscale – 25 points.
The higher the score, the greater the level of function of that particular shoulder.
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The Constant-Murley Score for Shoulder Function
The Constant Shoulder Score, also known as the Constant-Murley score (CMS) evaluates the level of pain and the patient’s ability to carry out normal daily activities. Originally introduced to assess functionality after treatment of shoulder injury, the score is addressed to the patients suffering from osteoarthritis, joint pain and fractures, arthritis or following orthopedic surgery.
The assessment is divided into 4 subscales that total 100 points:
- Pain subscale – 15 points;
- ADLs subscale – 20 points;
- Movement subscale (shoulder flexion, internal rotation, external rotation and abduction) – 40 points;
- Strength subscale – 25 points.
The subjective part of the test can be completed by the patient alone, the objective section must be carried out by the administrator of the text.
| CMS subscale | CMS items | Interpretation |
| Pain | Visual analog scale | 0 = maximal pain, 15 = no pain |
| Activities of Daily Living | 3 items with Likert scales & 1 item with 6 answer choices | Up to a maximum of 20 points |
| Mobility/Movement | Forward flexion, lateral elevation, external rotation and internal rotation | 0 = worst, 10 = best for each, Up to a maximum 40 points |
| Strength | Measured at 90° lateral abduction | 1 point per 0.5 kg (1 lbs), up to a maximum of 25 points |
The higher the score, the greater the level of function of that particular shoulder. Please note that scores are age related and decrease in order patients. Similarly there are also gender-related differences.
Clinicians may wish to test both shoulders, the normal and the affected one to compare the function between the two. A possible interpretation is:
| Difference in Constant scores (R vs L shoulder) | Interpretation |
| > 30 points | Poor |
| 21 - 30 points | Fair |
| 11 - 20 points | Good |
| < 11 points | Excellent |
It was found that the Constant score may overestimate shoulder function in women older than 40 years and men older than 60 years. To combat this, relative Constant scores may be employed.
The instrument is recommended by the European Society of Shoulder and Elbow Surgery (ESSE) for a comprehensive and comparable assessment of shoulder function. The score has been praised for its applicability irrespective of diagnosis or radiological abnormalities and for the fact that it records individual parameters in a combination of subjective and objective measures.
About the Original Study
The CMS was originally published in 1987 in the Clinical Orthopaedics and Related Research and subsequently revised in 2008 in the Journal of Shoulder and Elbow Surgery. It has been used in the assessment of shoulder function in patients with rotator cuff disease and fractures, as well as in shoulder arthroplasty.
The score was found to have good reliability with an Intraclass Correlation Coefficient (ICC) between 0.80 – 0.96. The score also corelates with other measures of function, such as the Shoulder Pain and Disability Index (SPADI).
The intraobserver reliability of the Constant-Murley test was found to be higher than the intraobserver reliability for the total score and for the single items. The internal consistency of individual items ranges from 0.60 to 0.75.
However, the validity of the Constant shoulder score has been questioned since a single pain scale may be inadequate to claim a true picture of patient’s pain, the reporting of shoulder function is part of the subjective, patient-reported part of the test and is not specific enough to a particular activity. Additionally, it has been flagged that the method for measuring strength has not been standardized.
References
Original reference
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987; (214):160-4.
Other references
Fabre T, Piton C, Leclouerec G, Gervais-Delion F, Durandeau A. Entrapment of the suprascapular nerve. J Bone Joint Surg Br. 1999; 81(3):414-9.
Constant CR. et al. A review of the Constant score: modifications and guidelines for its use. Journal of Shoulder and Elbow Surgery 17.2; 2008; 355-361.
Vrotsou K, Ávila M, Machón M, Mateo-Abad M, Pardo Y, Garin O, Zaror C, González N, Escobar A, Cuéllar R. Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res. 2018; 27(9):2217-2226.
Bankes MJ, Crossman JE, Emery RJ. A standard method of shoulder strength measurement for the Constant score with a spring balance. J Shoulder Elbow Surg. 1998; 7(2):116-121.
Specialty: Pain Management
Year Of Study: 1987
Article By: Denise Nedea
Published On: October 9, 2020 · 12:00 AM
Last Checked: October 9, 2020
Next Review: October 9, 2025