University of California Los Angeles Shoulder Score

Abstract

The University of California Los Angeles Shoulder Rating scale (UCLA score) is a widely utilized, combined outcome measure specifically designed for evaluating the functional status of the shoulder. Comprising 26 items that contribute to a total score of 35 points across five weighted categories, this system was initially developed to assess the results following shoulder arthroplasty procedures. The scale integrates two primary components: a self-evaluation questionnaire completed by the patient, and a physical examination and assessment performed by a clinician or researcher. A higher score on the UCLA scale is indicative of superior shoulder function, decreased pain, and improved range of motion.

Keywords

UCLA Shoulder Score, Shoulder Rating scale, Shoulder Arthroplasty, Functional outcome measure, Orthopedics, Physical therapy, Range of motion, Pain assessment.

Authors

Amstutz HC, Sew Hoy AL, Clarke IC, Williams PF, Coster I. (1981)

Purpose

The primary purpose of the UCLA Shoulder Rating scale is to provide a standardized, objective, and subjective evaluation tool for assessing the outcome of various shoulder treatments, particularly surgical interventions like total shoulder replacement. It aims to quantify changes in function, pain level, and range of motion over time, allowing clinicians to track patient recovery and compare the efficacy of different therapeutic approaches.

While originally focused on post-arthroplasty assessment, the scale has been successfully applied to evaluate outcomes for other shoulder pathologies, including rotator cuff repairs and instability procedures. Its combined structure ensures that both the patient’s perspective (self-report) and objective physical findings are considered in the final score, providing a comprehensive metric for the upper extremity function.

Construct

The UCLA Shoulder Rating scale measures the overall functional outcome of the shoulder joint, which is a multidimensional construct encompassing several key domains derived from the locomotor system and sensory functions. These domains include the assessment of pain severity and frequency, the capacity for activities of daily living (ADLs), active range of motion (ROM) in flexion and rotation, and overall patient satisfaction with the treatment outcome.

The construct is operationalized through five main components, each weighted to contribute to the maximum total score of 35 points. A high score reflects success across motor function, effective pain management, and a positive patient-reported quality of life related to the affected shoulder.

Validity

The validity of the UCLA Shoulder Rating scale has been extensively investigated in orthopedic literature. Early studies established strong content validity, ensuring that the 26 items adequately cover the critical aspects of shoulder function relevant to post-surgical recovery, including movement and daily tasks.

Furthermore, strong construct validity has been demonstrated through correlations with other established shoulder outcome measures, such as the Constant Score and the American Shoulder and Elbow Surgeons (ASES) score. The scale exhibits known-groups validity, successfully distinguishing between patients with excellent outcomes and those with poor outcomes following treatment. The responsiveness of the scale (longitudinal validity) is high, making it suitable for tracking clinically meaningful changes in patient status over time.

Reliability

The reliability of the UCLA score is generally considered robust, particularly concerning its inter-rater and intra-rater components. The physical examination portion requires standardized administration, but numerous studies have confirmed acceptable levels of inter-rater reliability among trained clinicians, especially concerning objective measurements of active range of motion.

The self-report questionnaire section demonstrates high internal consistency (often measured using Cronbach’s alpha) and test-retest reliability. This indicates that the patient’s subjective assessment of pain and function is stable over short periods when the clinical condition has not changed. This stability ensures the measure is a consistent tool for longitudinal clinical evaluation of musculoskeletal disorders.

Factor Analysis

While the UCLA score is traditionally treated as a composite, unidimensional measure of overall shoulder health (yielding a single total score out of 35), formal factor analysis has suggested that the underlying structure may be multidimensional. The five main scoring categories—Pain, Function, Active Forward Flexion, Active External Rotation, and Patient Satisfaction—often load onto distinct factors, reflecting the complexity of shoulder recovery.

Despite these findings, the common clinical practice remains the calculation of the total score, as a single summary metric is often preferred for tracking progress and comparing cohorts. Researchers continue to explore the utility of subscale scores derived from factor analysis to provide more nuanced insights into specific functional deficits.

Instrument

Test Type: Performance measure (Objective Clinical Assessment) and Patient-Reported Outcome Measure (PROM).

Format: Combined scoring system (26 items contributing to 5 weighted categories, totaling 35 points). The original PDF documentation outlining the scoring system can be downloaded here: UCLA Explanation Form PDF.

Language Available: English (Original), various official translations exist (e.g., Dutch, German, Spanish).

Population Group: Adults and Elderly patients (Volwassenen, Ouderen).

Age Group: Typically 18 years and older, focusing on those undergoing treatment for musculoskeletal disorders of the shoulder.

Population Details: Individuals suffering from shoulder pathology, especially those pre- and post-arthroplasty, rotator cuff tears, and instability procedures. The scale assesses functions related to general tasks and demands, the locomotor system, and sensory functions and pain.

Test Methodology: The scale requires a structured clinical interview and physical examination. The maximum score is 35 points, where 34–35 is considered excellent, 28–33 is good, 21–27 is fair, and 20 or less is poor. The measurement instrument PDF can be accessed here: UCLA Measurement Instrument PDF.

Keywords

Shoulder function, Locomotor system, Musculoskeletal disorders, Patient satisfaction, Range of motion, Physical examination, Outcome assessment, Upper extremity.

Authors

Author ORCID Identifier: Not publicly available for all original authors (1981).

Affiliation Email addresses: Information not provided in the source documentation.

Correspondence Address: Information not provided in the source documentation.

Permissions & Fee and Test Year

The UCLA Shoulder Rating scale was first published in 1981 by Amstutz et al. It is generally considered to be in the public domain for non-commercial clinical and academic research use, though specific institutions or translations may require permission from the copyright holder or subsequent validation authors. There is typically no fee associated with its standard clinical application, making it a highly accessible outcome measure.

Reference’s

Amstutz HC, Sew Hoy AL, Clarke IC. UCLA anatomical total shoulder arthroplasty. Clinical Orthopaedics and Related Research. 1981;155:7-20.

Ellman H, Kay SP, Wirth M. The development of a shoulder rating scale. Clinical Orthopaedics and Related Research. 1990;251:175-178.

Items of the University of California Los Angeles Shoulder score

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The source content provided did not include the individual 26 scale items. However, the score is calculated based on five weighted categories that assess the patient’s condition:

• Pain (Maximum 10 points)
• Function/Usage (Maximum 10 points)
• Active Forward Flexion (Maximum 5 points)
• Active External Rotation (Maximum 5 points)
• Patient Satisfaction (Maximum 5 points)