Saturday, March 19, 2011

The Simple Shoulder Test

The goal of treating a person with a shoulder problem is to improve his or her  comfort and function. With this purpose in mind, we developed the Simple Shoulder Test (SST) to enable each individual to evaluate each of their shoulders in their own terms before and sequentially after treatment. The SST, as it has come to be known, is convenient for both the patient and the doctor - it can be completed at home and emailed in to the doctor's office - so that the course of the shoulder can be followed for long periods of time. The SST is now used in many languages the word over as a 'universal currency' by which patients, shoulder conditions, and results of different treatments can be compared.  This simple tool enables orthopaedic surgeons to achieve long term follow-up on the course of recovery and the durability of different approaches to reconstruction of the arthritic shoulder. The abstract of one of our early publications using the SST is shown below.

The Simple Shoulder Test

Name _________________                       


Date this form is completed: ________

Please answer YES or NO for BOTH of your shoulders
RIGHT
LEFT


YES
NO
YES
NO
1
Is your shoulder comfortable with your arm at rest by your side?
£
£
£
£
2
Does your shoulder allow you to sleep comfortably?
£
£
£
£
3
Can you reach the small of your back to tuck in your shirt with your hand?

£
£
£
£
4
Can you place your hand behind your head with the elbow straight out to the side?
£
£
£
£
5
Can you place a coin on a shelf at the level of your shoulder without bending your elbow?
£
£
£
£
6
Can you lift one pound (a full pint container) to the level of your shoulder without bending your elbow?
£
£
£
£
7
Can you lift eight pounds (a full gallon container) to the level of your shoulder without bending your elbow?
£
£
£
£
8
Can you carry twenty pounds at your side with this extremity?
£
£
£
£
9
Do you think you can toss a softball under-hand twenty yards with this extremity?
£
£
£
£
10
Do you think you can toss a softball over-hand twenty yards with this extremity?
£
£
£
£
11
Can you wash the back of your opposite shoulder with this extremity?
£
£
£
£
12
Would your shoulder allow you to work full-time at your regular job?
£
£
£
£
 F. A. Matsen

Matsen, F. A., 3rd, D. W. Ziegler, et al. (1995). "Patient self-assessment of health status and function in glenohumeral degenerative joint disease." J Shoulder Elbow Surg 4(5): 345-51.
One hundred three consecutive patients with primary glenohumeral degenerative joint disease completed standard questionnaires regarding their general health status (Short Form-36) and the function of their shoulder (Simple Shoulder Test). These patients' self-assessed health status indicated overall bodily pain, physical functioning, and physical role fulfillment scores that were significantly below those of population-based control groups. Self-assessed shoulder functions were likewise consistently below those of patients with normal shoulders. These deficits clearly indicated the problems that the patients desired to have resolved by treatment. The use of self-assessment questionnaires to routinely characterize patients with shoulder conditions is practical in the context of a busy practice. These data enable surgeons to understand the condition from the patient's perspective. This understanding should be central to the planning of treatment and to the evaluation of treatment effectiveness.




The simple shoulder test is responsive in assessing change following shoulder arthroplasty.


Responsiveness statistics are a useful means to compare different outcomes in terms of their ability to detect clinical change. While the responsiveness of the SST has been established for rotator cuff repair, it has not been determined for patients undergoing arthroplasty.


Patients undergoing shoulder arthroplasty (n=120) were evaluated prior to surgery and 6 months after. The evaluation included the SST, Disabilities of the Arm, Shoulder and Hand questionnaire, range of motion, and isometric strength. Responsiveness to change was assessed using standardized response mean (SRM), while longitudinal construct validity was evaluated using Pearson correlation. Receiver operating characteristics curves were plotted to determine clinically important difference of SST.

The SST and Disabilities of the Arm, Shoulder and Hand questionnaire were highly responsive (SRM, >1.70) for this population. For the assessment of impairment, range of motion (SRM, 0.64-1.03) was moderately to highly responsive, while isometric strength was minimally to moderately responsive (SRM, 0.32-0.69). The clinically important difference of the SST was established at 3.0 SST points. Pearson correlations indicated moderate associations between the change scores of the SST and the Disabilities of the Arm, Shoulder and Hand questionnaire (r=0.49).

The SST has been previously shown to be valid and highly reliable. The present results show that the SST is also responsive following shoulder arthroplasty and that it has a clinically important difference of 3.0 SST points. This should provide confidence to clinicians who wish to use a brief shoulder-specific measure in their practice.

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