Abstract
Introduction: The Constant Score Functional Assessment (CS) is now the standard method of assessing shoulder disability in Europe. It has been observed that CS values decrease with age and attempts have been made in Canada (Constant, 1986), Germany (Tempelhof, 1999), Switzerland (Gerber, 1992) and US (Romeo, 2002) to produce national norms. Unfortunately the methods used for measuring the “Strength” category of the CS have varied. This study aimed to establish UK norms.
Methods: 200 patients stratified for age over 50 were invited to take part in this study for which Local Ethics Committee approval had been obtained. Of these 200, 46 patients (21 males) attended and all attendees had a CS carried out with the “Strength” measurement made in 3 ways – 1) maximum force using a fixed spring balance – FSB(max); 2) maximum force using a Nottingham myometer – M(max); 3) mean force from 2 to 4 seconds using a Nottingham myometer – M(mean). Results: The results for the 25 females and 21 males using M(mean) show a general trend of decreasing Constant Score with increasing age for the left and right shoulders of both the male and female subjects. There were some outliers, particularly in the female results, which were reflected in widened 95% confidence intervals. Paired student t-tests found statistically significant differences between M(mean) and FSB (max) results (left, p< 0.01; right, p=0.013) and M(mean) and M(max) (left, p< 0.01; right, p< 0.01).
Discussion: The results confirm deterioration in the CS with age in both men and women. Constant Score values from our study differ from previous studies, with up to 15 points difference between our results and those from Romeo 2002.
Significant differences were identified between the 3 methods of “Strength” measurement, highlighting the need for a uniform method of carrying out the CS. Conclusion: The UK pattern of deteriorating CS with age mirrors that seen in other countries but the values are different. These differences are significant and make it necessary to reconsider the use of the corrected CS. It is probably wiser to use the uncorrected CS but refer to normal values as a guide for the expected CS at different ages.
These abstracts were prepared by Mr Cormac Kelly. Correspondence should be addressed to him c/o British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
