title: The Constant score and the assessment of scapula dyskinesis: Proposal and assessment of an integrated outcome measure.
abstract: The Constant-Murley score (CMS) is a popular measure of shoulder function. However, its ability to monitor the evolution of patients during rehabilitation after rotator-cuff repair is controversial. Moreover, CMS does not account for possible alterations in the scapulo-humeral coordination (SHC, scapula dyskinesis), which are apparent in variety of shoulder pathologies. To address these issues, a new formulation of CMS was firstly proposed, which rates the "affected-to-controlateral side difference in SHC" of a patient with respect to reference values of asymptomatic controls (Scapula-Weighted CMS). Then, 32 patients (53±9year-old) were evaluated with CMS and SW-CMS at 45, 70, 90-day and >6-month after rotator-cuff repair, to test three hypotheses: (1) CMS and SW-CMS are largely responsive to change; (2) accounting (SW-CMS) or not (CMS) for scapula dyskinesis leads to statistically different scores and SW-CMS cannot be predicted from CMS without clinically relevant differences; (3) 90% of patients recover a side-to-side SHC similar to asymptomatic controls at 90days. Results supported hypotheses 1 and 2. On the contrary (hypothesis 3), only 10% of patients recovered for SHC alterations at 90days, and 50% at follow-up. These findings support the use of SW-CMS and the importance of treating scapula dyskinesis after rotator-cuff repair.
authors.affiliation: INAIL Centro Protesi - Vigorso di Budrio, Italy. Electronic address: ag.cutti@inail.it.
authors.forename: Andrea Giovanni
authors.initials: AG
authors.lastname: Cutti
authors.affiliation: "M. Simoncelli" Biomechanics Laboratory, "D. Cervesi" Hospital, Cattolica, Italy; Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Parel
authors.affiliation: Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, Italy; Orthopaedic and Trauma Department, University of Parma, Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pellegrini
authors.affiliation: Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Paladini
authors.affiliation: INAIL Centro Protesi - Vigorso di Budrio, Italy.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Sacchetti
authors.affiliation: Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Porcellini
authors.affiliation: Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Merolla
mesh_terms: D000328:Adult; D020820:Dyskinesias / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D017006:Rotator Cuff / Q000503:physiopathology; D012540:Scapula / Q000503:physiopathology*; D012720:Severity of Illness Index; D012782:Shoulder / Q000503:physiopathology; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Dyskinesis; Outcome measure; Rotator cuff; Scapula; Shoulder pain; Surgery