Shoulder Assessment

Constant-Murley Shoulder Score

International Knee Documentation Committee (IKDC)

Constant-Murley Shoulder Score

The Constant-Murley Score is a combined scoring system to evaluate the functional status of the shoulder in patients with shoulder pain. It consists of 2 parts: a questionnaire completed by the patient and a questionnaire completed by the examiner based on physical tests. A high score on the Constant Murley Score corresponds to a well-functioning shoulder.


Validity and Reliability

The Constant-Murley Score has gained acceptance and is frequently used despite never having been thoroughly validated. Responsiveness to change is the top characteristic in various shoulder pathologies but frozen shoulder. Better evidence was found for subacromial pathology among them. Cronbach alphas of up to >0.60 were obtained through reliability tests. For a variety of diseases and healthy patients, validity is acceptable (Vrotsu et al. 2018).


Scoring and Interpretation

The scoring system includes 35 points for the subjective measurement and 65 points for the objective measurement.


Subjective Assessment


The patient’s most severe pain experienced during daily activities over the course of a 24-hour period is taken into account when calculating the 15 points assigned to pain. A sliding cursor system with an ungraduated line and the words “no pain” and “intolerable pain,” respectively, marked at either end has been suggested. On the scale’s back, you can see the numerical score. It is crucial to emphasize that a functional assessment score is unrelated to episodic extreme pain (such as that experienced after a dislocation).


Activities of daily living (ADL)

A total of 20 points can be earned for ADL. Uninterrupted sleep receives 2 points, irregular interruption receives 1, and nightly interruption receives 0. Work and leisure activities each receive eight points. In response to the following questions: “How much of your typical work does your shoulder allow?” and “How much of your normal recreational activities does your shoulder allow?” this is graded on a fractional scale from 1 to 4. Similar evaluation would be done here using a sliding cursor and a visual analog scale. The terms ‘‘all’’ and ‘‘none’’ define the range. The functional use of the arm during daily activities is also included, and this aspect of the examination is given up to an additional 10 points. Patients are questioned about the level at which they can comfortably use their hand, ranging from below the waist (0 points) to above the head (10 points).


Objective Assessment


Forward elevation, lateral elevation, functional external rotation, and functional internal rotation can each receive 10 points out of the 40 points allotted to movement. Every movement must be dynamic and painless. To prevent spinal tilting, the patient should be sitting while measuring the patient’s pain-free forward elevation and lateral elevation with a goniometer. For abduction and forward flexion, the References points are the axis of the arm and the spinous processes of the thoracic spine. These motions are simultaneously captured on both arms. As soon as the subject reaches 31°, 61°, 91°, 121°, and 151°, points are awarded in increasing amounts. It is crucial to note that 150° is equivalent to 8 points, not 10.

Allocate 2 points for each of the 5 distinct active motions that make up functional external rotation. The following positions are given points: hand to the back of the head with the elbow forward, 2 points; hand to the back of the head with the elbow back, 2 points; hand to the top of the head with the elbow forward, 2 points; and full elevation, 2 points. These must be performed unassisted. The hand should be placed behind and above the head without touching the head.

Utilizing the thumb as a pointer against the anatomical markers behind the buttock (2 points), the sacroiliac joint (4 points), the level of the waist (6 points), the twelfth thoracic vertebra (8 points), and the interscapular level, internal rotation is also quantified as an unsupported movement (10 points). Patients who can only reach the lateral thigh receive 0 points.



This measurement is done in the scapular plane at a 90° abduction. The hand is facing downward because the wrist is in pronation. The patient performs three maximal abductions against resistance on a handheld dynamometer, with the highest score being recorded. Scores vary from 0 to 25, with each point representing 1 pound of force. Patients who are unable to hold their shoulders abducted at 90° during the test should receive a strength score of 0.


The formula for the total score is:

  • pain (0-15) + ADL (4 x (0-5) = 0-20) + mobility (4 x (0-10) = 0-40) + strength (0-25)


The Constant-Murley score is interpreted as follows:

  • 0-55 points = poor
  • 56-70 points = mediocre
  • 71-85 points = good
  • 86-100 points = excellent

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