This 2008 SECEC committee paper standardizes the methodology of the Constant-Murley shoulder score. It clarifies how each domain is measured, condemns manual muscle testing, and issues formal guidelines for consistent use across centers. It also introduces the relative Constant score as the recommended reporting standard.
A raw Constant score without age and sex context is nearly uninterpretable. A score of 75 is excellent for an 80-year-old woman (age-matched norm ~64) but represents significant dysfunction in a 30-year-old man (norm ~98).
When you use or report a Constant score, always calculate the relative Constant score by dividing the patient's result by the appropriate normative value from the 900-subject dataset.
For the strength component, use the Isobex or a fixed spring balance at 90° abduction in the scapular plane — never manual muscle testing. Record the best of 3 attempts, each separated by at least 1 minute; patients who cannot reach 90° abduction get a 0.
When interpreting serial Constant scores in a single patient, remember that measurement error alone can account for up to ±17.7 points. A change smaller than this threshold should be interpreted cautiously, particularly in arthritis or impingement populations where reliability is lower.
This 2008 SECEC committee paper standardizes the methodology of the Constant-Murley shoulder score. It clarifies how each domain is measured, condemns manual muscle testing, and issues formal guidelines for consistent use across centers. It also introduces the relative Constant score as the recommended reporting standard.
A raw Constant score without age and sex context is nearly uninterpretable. A score of 75 is excellent for an 80-year-old woman (age-matched norm ~64) but represents significant dysfunction in a 30-year-old man (norm ~98).
When you use or report a Constant score, always calculate the relative Constant score by dividing the patient's result by the appropriate normative value from the 900-subject dataset.
For the strength component, use the Isobex or a fixed spring balance at 90° abduction in the scapular plane — never manual muscle testing. Record the best of 3 attempts, each separated by at least 1 minute; patients who cannot reach 90° abduction get a 0.
When interpreting serial Constant scores in a single patient, remember that measurement error alone can account for up to ±17.7 points. A change smaller than this threshold should be interpreted cautiously, particularly in arthritis or impingement populations where reliability is lower.