Measuring the success of shoulder surgery - keeping it simple

 The American Shoulder and Elbow Surgeons score highly correlates with the Simple Shoulder Test

The most important reason for a shoulder surgeon to document his or or patients' shoulder comfort and function before and sequentially after therapeutic interventions is so that the surgeon can know his or her personal effectiveness in managing patients with a specific diagnosis using a specific treatment. The consistent application of standardized patient-assessed measures of shoulder comfort and function will help the surgeon identify what is not working well for which patients so that the treatment algorithm can be modified.

The value of a scoring system depends primarily on its ability to capture results from the highest percentage of patients. 

Systematically documenting shoulder comfort and function in the context of a busy surgical practice can be time consuming and expensive. The ideal tool is (a) one that is simple for the patient to access and use whether the patient is in the office or at home (by mail, email, phone, internet) and (b) simple for the surgeon's office to score and record. 

This article examines two extensively validated measures of shoulder comfort and function: 

the ASES score

and the Simple Shoulder Test

These authors conducted a retrospective review of the senior author’s database of 1810 simultaneous measurements on patients undergoing rotator cuff repair and total shoulder arthroplasty.

The correlation was excellent for the ASES and SST for all patients (n =1810; r = 0.81; P < .0001). The correlation of preoperative scores was strong-moderate (n = 1191; r = 0.60; P < .0001), and the correlation of postoperative scores was excellent (n = 619; r = 0.78; P < .0001). 

Both scores were determined to be highly responsive (see this link), for both the standardized response mean (2.8 for the ASES and 2.1 for the SST) and the effect size (2.2 for the ASES and 1.8 for the SST).

Comment: It is evident that the total SST and the ASES scores yield similar information. Here is a side by side comparison from the article, One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers.

However, the Simple Shoulder Test has the advantage of yielding easy to understand data on the on ability of patients to perform individual functions before and after treatment. For example, as shown in this link, patient can easily understand the function-specific data shown below for two year outcomes of anatomic total shoulder. 

It is more difficult to extract such information from more complex scoring systems. 

What is important is for each shoulder surgeon to build a system for measuring patient comfort and function into their practice workflow so that they can learn the effectiveness of their treatment approaches.

How you can support research in shoulder surgery Click on this link.

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).