Characterizing the comfort, function, and range of motion of the shoulder before and sequentially after treatment are the cornerstones clinical shoulder practice. As is the case for most types of measurement, greater accuracy, precision, and detail can be purchased with more money. The amount of accuracy, precision, and detail needed depends on questions that need to be answered.

For example, the authors of Test-retest reliability of isometric shoulder muscle strength during abduction and rotation tasks measured using the Biodex dynamometer found that shoulder muscle strength in abduction and rotation measured with the pricey Biodex dynamometer (see this link) are reproducible and correlate with the strength assessment of the Constant Score; under what circumstances is the increased cost worth it? Furthermore, the Constant Score itself requires the costs of travel and a clinic visit (see this Constant–Murley Score: systematic review and standardized evaluation in different shoulder pathologies).

By contrast, validated mail-in questionnaires assessing shoulder comfort and function avoid the costs of equipment, travel and an office visit and provide information on the patient's ability to perform individual shoulder functions before and sequentially after treatment (see Shoulder joint replacement arthroplasty - what outcomes do patients care about?).

As another example, the ranges of shoulder motion can be measured using an expensive artificial intelligence-based image recognition detectable sensor (see Comparative accuracy of a shoulder range motion measurement sensor and Vicon 3D motion capture for shoulder abduction in frozen shoulder); in what circumstances is the information gained worth the cost?

Even the use of a simple goniometer by clinical staff requires travel and an office visit.

Travel and visit costs for clinical followup can be avoided by the use of telehealth, as emphasized by the authors of Validation of an on-screen application-based measurement of shoulder range of motion (ROM) over telehealth medium who sought to investigate the accuracy and reliability shoulder range of motion measurement through telehealth in 24 healthy volunteers and 16 symptomatic patients with shoulder range of motion (ROM) deficits. The shoulder ROM was first examined physically using the goniometer in the clinic and then over Zoom. Comparison of the two methods showed only minor mean differences for the healthy volunteers and the patients. They concluded that the telehealth method of measuring shoulder ROM was accurate and reliable when compared to the clinical goniometer method.

Even simpler and more accessible than telemedicine is asking the patient, family, or friend to email photos of the arm in selected positions to follow ranges of motion in the treatment of conditions such as frozen shoulder and during joint replacement rehabilitation.

Patients can be sent the figures below, asking them to position the arm as far in the indicated direction as possible. By keeping the photos on file the surgeon can monitor patient progress. The advantage of this system is that the patient need not be connected in real-time via telehealth, but can send in the photos at whatever time works for them.

Here are a few examples:

This approach can demonstrate active range

assisted range

and the relative contributions of glenohumeral to scapulothoracic motion.

While this approach to following shoulder motion during treatment may not be as accurate as direct in-person measurements, it provides a cost effective method for monitoring the progress of shoulder range of motion achieved by physical therapy and surgery. Again, because photographs can be sent at a time convenient to the patient and viewed at a time convenient for the surgeon, this simple approach is easily accessible at both ends of the communication. If problems are identified, an in-person evaluation can be arranged.

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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).