Constant-Murley Score

Abstract

The Constant-Murley Score (CMS) is a standardized, combined scoring system utilized for the comprehensive evaluation of the functional status of the shoulder in patients presenting with various shoulder pathologies or complaints. Established in 1987, the CMS serves as a critical tool for assessing outcomes following interventions such as surgery or physical therapy.

The score is calculated based on two principal components: a subjective assessment derived from a patient-reported questionnaire (a form of Patient-Reported Outcome Measure) and an objective assessment completed by the examining clinician based on specific physical tests. The maximum achievable score is 100 points, with higher scores correlating directly with better shoulder function and reduced disability.

Keywords

Constant Score, Shoulder function, Patient-Reported Outcome Measure, Orthopedics, Upper extremity, Physical therapy, Musculoskeletal system, Range of Motion, Strength.

Authors

Constant CR, Murley AHG.

Purpose

The primary purpose of the Constant-Murley Score is to provide a reliable and validated method for grading the results of shoulder treatments and comparing functional outcomes across different patient populations and clinical trials. It is essential for standardizing the measurement of shoulder disability and recovery.

The scale integrates crucial functional aspects to give a holistic view of the patient’s condition, moving beyond simple pain assessment to include physical capacity and the impact on daily life. This allows clinicians to track progress accurately over time and determine the efficacy of interventions targeting the musculoskeletal system.

Construct

The CMS measures the construct of overall shoulder performance, which is operationalized through four distinct domains that contribute to the total 100-point score. These domains ensure a balanced assessment of both subjective experience and objective physical capacity of the upper extremity.

The four domains of the Constant-Murley Score are:

• Pain (15 Points): Assesses the severity and frequency of pain experienced by the patient.
• Activities of Daily Living (ADL) (20 Points): Measures the patient’s ability to perform routine tasks, focusing on functional capacity and mobility during everyday life.
• Range of Motion (ROM) (40 Points): Objectively measured by the examiner, encompassing forward elevation, lateral elevation, external rotation, and internal rotation.
• Strength (25 Points): Objectively measured by the examiner, typically assessing isometric strength during abduction.

Validity

The CMS is widely recognized in orthopedic literature for its strong psychometric properties. Studies have demonstrated good criterion validity, showing significant correlation with other established shoulder outcome measures, such as the American Shoulder and Elbow Surgeons (ASES) score and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Construct validity is supported by the scale’s ability to differentiate between patients with varying degrees of shoulder pathology and those who have undergone successful treatment versus those who have not.

Reliability

Research confirms that the Constant-Murley Score possesses acceptable levels of reliability, making it a dependable tool for repeated measurements. High inter-observer reliability has been reported, especially when the objective components (Range of Motion and Strength) are performed following strict standardization protocols. Intra-observer reliability is also generally high, indicating consistency when the same examiner administers the test over time.

Factor Analysis

While the CMS is often treated as a unidimensional scale yielding a single overall score for shoulder function, factor analyses frequently support the theoretical breakdown into four primary components: Pain, ADL, ROM, and Strength. These analyses confirm that the scale captures multiple, related aspects of shoulder health, with the objective components typically loading heavily on distinct factors related to biomechanical performance, separate from the subjective factors of pain and daily function.

Instrument

Test Type: Performance, Questionnaire

Format: Combined subjective (Patient-Reported Outcome Measure) and objective (Clinician-Observed Performance Test) assessment.

Language Available: Original English. A widely available Dutch version exists, derived from www.fysiovragenlijst.nl, alongside numerous other international translations.

Population Group: Clinical populations suffering from disorders of the musculoskeletal system.

Age Group: Adults, Elderly.

Population Details: Patients presenting with acute or chronic shoulder complaints, including those related to the rotator cuff, instability, arthritis, or trauma affecting the upper extremity.

Test Methodology: The assessment involves a structured interview or self-report form for subjective measures (Pain and ADL) and a physical examination using standardized techniques and equipment (e.g., goniometer, dynamometer) for objective measures (ROM and Strength).

The original reference documents for the Constant-Murley Score are available in PDF format. The manual or explanation form can be downloaded here: Constant-Murley Explanation Form PDF. The measurement instrument itself is available here: Constant-Murley Measurement Instrument PDF.

Keywords

Shoulder assessment, Orthopedic outcome measure, Constant-Murley, Functional evaluation, ADL, Range of Motion, Strength testing, Rehabilitation.

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: Not specified in source content.

Correspondence Address: Not specified in source content.

Permissions & Fee and Test Year

The Constant-Murley Score was originally published in 1987. Due to its status as a widely used, non-proprietary clinical measure, the core scale items are generally considered public domain for non-commercial clinical and academic research use. Users should, however, confirm licensing requirements for commercial applications or specific translated versions.

Reference’s

The primary reference for the scale’s introduction is:

1. Constant CR, Murley AHG. A clinical method of functional assessment of the shoulder. Clinical Orthopaedics and Related Research. 1987; (214): 160-164.

Items of the Constant-Murley Score

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

The specific item list for the Constant-Murley Score was not provided in the source content. The instrument is divided into four main sections (Pain, ADL, Range of Motion, and Strength). The full measurement instrument can be accessed via the provided PDF link.