Simple Shoulder Test

Abstract

The Simple Shoulder Test (SST) is a widely utilized, 12-item, Patient-Reported Outcome (PRO) measure designed to assess the functional status and limitations experienced by patients suffering from shoulder complaints. It specifically targets the functional limitations of the affected shoulder during common Activities of Daily Living (ADLs). Developed in 1993, the SST was derived from established scoring systems, including Neer’s Evaluation and the American Shoulder and Elbow Surgeons Shoulder Score (ASES), integrating clinical insights from the University of Washington.

Keywords

Simple Shoulder Test, SST, Shoulder pain, Functional limitation, Patient-Reported Outcome, Orthopedic assessment, Upper extremity, ASES, Neer score.

Authors

Lippitt SB, Harryman II DT, Matsen III FA (1993); van Kampen DA, et al. (Dutch Version, 2012).

Purpose

The primary purpose of the SST is to provide clinicians and researchers with a quick, reliable, and sensitive instrument for quantifying the subjective functional ability of a patient with a shoulder disorder. It is used both pre- and post-intervention to track recovery, measure treatment efficacy, and compare outcomes across different patient populations or surgical techniques.

The test specifically focuses on limitations related to basic shoulder functions, such as lifting, carrying, sleeping comfort, and the ability to perform tasks requiring overhead reach or rotation. Its simplicity makes it highly practical for routine clinical use, minimizing the burden on the patient while providing essential data on functional impairment.

Construct

The Simple Shoulder Test primarily measures the construct of Shoulder Function and Disability. This construct encompasses the patient’s perceived ability to use the affected shoulder during activities required for daily living, work, and recreation, as well as the related experience of pain.

The 12 dichotomous (Yes/No) questions cover essential domains of shoulder function, including range of motion, strength, and the presence of pain during specific activities. Although it is a concise measure, it captures the critical aspects of physical function and quality of life related to upper extremity pathology.

Validity

The SST demonstrates strong Construct Validity, showing significant correlation with other established shoulder outcome measures, such as the full ASES score and the physical functioning scales of the SF-36 Health Survey. This indicates that the SST accurately measures the intended domain of shoulder function and disability.

Furthermore, the SST exhibits high Responsiveness, meaning it is highly sensitive to clinically important changes following treatment, such as surgery or physical therapy. Studies have confirmed its ability to differentiate between patients with different levels of pathology and monitor progress effectively over time.

Reliability

The SST possesses good to excellent Test-Retest Reliability. This psychometric property ensures that if a patient’s clinical status remains unchanged, repeated administration of the scale yields consistent results. High reliability coefficients (often exceeding 0.80) have been reported across various studies, confirming its stability as a measurement tool.

While the SST is generally self-administered, demonstrating high inter-rater reliability is not strictly applicable. However, its straightforward, dichotomous scoring system ensures high internal consistency and minimizes interpretation variability, contributing to its overall robustness in clinical settings.

Factor Analysis

Early factor analysis of the Simple Shoulder Test typically supported a Unidimensional Structure, suggesting that all 12 items contribute to a single, overarching factor representing general shoulder function and disability. This simplicity aligns with its intended use as a straightforward clinical tool.

However, some advanced factor analysis studies have suggested the existence of two underlying factors: one related predominantly to Physical Function/Range of Motion, and a secondary factor related to Pain and Sleep. Despite these findings, the SST is generally scored as a single composite index, where each “Yes” answer contributes equally to the total score (maximum 12 points).

Instrument

Test Type: Patient-Reported Outcome (PRO) Questionnaire

Format: 12 dichotomous items (Yes/No response options)

Language Available: Original English; validated translations, including Dutch (Nederlandse versie: van Kampen DA, et al., 2012).

Population Group: Patients with musculoskeletal disorders affecting the upper extremity.

Age Group: Adults and Elderly (Volwassenen, Ouderen)

Population Details: Individuals presenting with various shoulder pathologies, including instability, rotator cuff tears, arthritis, and stiffness.

Test Methodology: Self-administered paper-based or electronic questionnaire. Each item is scored as 1 (Yes, function is possible) or 0 (No, function is limited or painful), resulting in a total score ranging from 0 to 12. Higher scores indicate better shoulder function.

The original PDF explanation form can be downloaded here: SST Explanation Form PDF.

The original PDF measurement instrument can be downloaded here: SST Instrument PDF.

Keywords

Shoulder function, Disability index, Orthopedics, Psychometrics, Activities of Daily Living (ADLs), Musculoskeletal, Construct Validity, Responsiveness.

Authors

Author ORCID Identifier: N/A (Not provided in source material)

Affiliation Email addresses: N/A (Not provided in source material)

Correspondence Address: Original correspondence likely related to the University of Washington Department of Orthopaedics (1993).

Permissions & Fee and Test Year

The Simple Shoulder Test (SST) was initially published in 1993. Given its widespread clinical adoption and frequent use in public domain research, the SST is often considered freely available for clinical and non-commercial academic use, though users should always verify specific licensing requirements with the original authoring institution or relevant licensing bodies.

Reference’s

• Lippitt SB, Harryman II DT, Matsen III FA. A practical guide to the management of shoulder problems. Part II. The Simple Shoulder Test. J Bone Joint Surg Am. 1993;75(11):1612-1617.
• van Kampen DA, van Beers LWAH, Scholtes VAB, et al. Translation and validation of the Dutch version of the Simple Shoulder Test. J Shoulder Elbow Surg. 2012;21(11):1456-1463.
• Harryman II DT, Matsen III FA, Sidles JA, et al. The relationship of the Simple Shoulder Test to the shoulder function score of the American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg. 1994;3:197-206.

Items of the Simple Shoulder Test

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

The specific 12 items of the Simple Shoulder Test were not provided in the original source content. Generally, these items cover abilities such as: placing the hand behind the head, touching the back of the neck, washing the opposite armpit, carrying a weight (8 lbs), sleeping comfortably, performing usual work, and throwing a ball.