Patient-reported outcome measure

ASES Score

American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form — patient self-report section

The ASES score is a patient-reported shoulder index running from 0 to 100 in which a single 0–10 pain rating supplies 50 points and ten activities of daily living rated 0–3 supply the other 50, so that 100 represents a pain-free shoulder with no functional difficulty.

Free to use11 items~5 min0–100, higher is better

What the ASES Score means

ASES Score scores run from 0 to 100, where a higher score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.

Severe impairment0–29.9
Descriptive groupings only. The ASES research committee defined no severity categories for this index — interpret the total against the published change thresholds and the patient’s own baseline, not against these labels.
Marked impairment30–49.9
Moderate impairment50–69.9
Mild impairment70–89.9
Minimal impairment90–100

Clinically important thresholds

A change in score only matters if it exceeds the smallest difference patients actually notice. Every threshold below is reported with the population it was derived in — a threshold quoted without its population is not usable.

Type	Value	Subscale	Population	Follow-up	Source
MCID	6.4 points	—	Patients with shoulder pain of mixed cause receiving outpatient physical therapy	—	Michener LA 2002
MCID	12.0 to 17.0 points	—	Rotator cuff disease treated nonoperatively	—	Tashjian RZ 2010

MCID is the smallest change a patient perceives as meaningful. PASS is the score above which patients consider their state acceptable. SCB is a substantial rather than minimal benefit. MDC is the smallest change exceeding measurement error.

How the score is calculated

Stated in full so the calculation can be independently checked, and reproduced by hand if needed.

The index uses only the patient self-report section of the form and is scored out of 100, split evenly between pain and function. The pain component is (10 − the pain visual analogue rating) × 5, giving 0 to 50 points, so a rating of 0 scores the full 50. The function component is the sum of the ten activity items, each rated 0 to 3, multiplied by 5/3; the maximum activity sum of 30 therefore also gives 50 points. The two components are added for a total of 0 to 100, in which a higher score is better. The physician assessment section of the same form — range of motion, strength, stability and physical signs — is recorded separately and must never be added to this index; a "100-point ASES score" that includes examination findings is a different measurement and is not comparable with the published literature.

Missing data

The developers published no imputation rule. The pain rating supplies half the index and no total is reported without it. Where activity items are missing, the calculator above prorates the function half across the items that were answered, so the result stays on the 0–100 scale — this is an explicit convenience, not a published rule, and a prorated total should not be reported as an ASES score in research. The usual-sport item is the one most often left blank by patients who play no sport; the intended answer is a rating of the difficulty they would have, not a blank.

Instrument profile

Developer: Research Committee of the American Shoulder and Elbow Surgeons (Robert R. Richards and colleagues)
Institution: American Shoulder and Elbow Surgeons, United States
First published: 1994
Custodian: American Shoulder and Elbow Surgeons (ASES)
Items: 11
Response format: One 0–10 pain rating plus ten activities of daily living rated 0–3
Score range: 0 to 100
Direction: Higher score = better
Recall period: Current status, including the pain experienced today
Completion time: About 5 minutes
Age range: Adults
Regions: Shoulder
Conditions: Rotator cuff tear, Subacromial pain syndrome, Shoulder osteoarthritis, Adhesive capsulitis, Shoulder instability, Cuff tear arthropathy
Procedures: Rotator cuff repair, Subacromial decompression, Total shoulder arthroplasty, Reverse shoulder arthroplasty, Shoulder stabilisation
Languages: English, Brazilian Portuguese, Spanish, German, Dutch, Turkish, Italian, Chinese, Japanese, Korean, Persian
Test–retest (ICC): 0.84–0.96 over intervals of a few days to three weeks in stable patients
Internal consistency: Cronbach’s alpha around 0.86 for the combined index
Validity: Correlates strongly with the SPADI, the Constant score and the simple shoulder test across rotator cuff disease, arthritis and instability, and is the shoulder measure most often reported in the North American literature.
Responsiveness: Responsive after rotator cuff repair and shoulder arthroplasty, with effect sizes comparable to the SPADI; the even 50/50 split means a patient whose pain resolves but whose function does not can still gain 40 or more points.
Ceiling effect: Marked in recovered patients and in young active patients after stabilisation, who cluster in the 90s and cannot be distinguished from each other.
Floor effect: Uncommon; few patients score below 20.

Normative values

Reference values from published cohorts, for comparison against the score you calculated.

Population	Age	Mean	SD
Asymptomatic shoulders	—	Close to 100, with a marked ceiling effect	—
Symptomatic rotator cuff disease before treatment	—	Typically 40 to 60	—

When to use the ASES Score

Well suited to

Reporting outcomes after rotator cuff repair or shoulder arthroplasty, where the ASES is the expected measure in the North American literature and published change thresholds exist.
Following an individual patient through nonoperative treatment, where separating the pain half from the function half shows which one is actually changing.
Postal, telephone or electronic follow-up — the index is entirely patient-reported and needs no examination.

Limitations and poor fits

Assessing shoulder instability in athletes, where the items do not capture apprehension, recurrence or sport-specific demand — use the WOSI instead.
Detecting further improvement in patients already scoring in the 90s, because of the ceiling effect.
As a measure of impairment: it records what the patient reports, not measured movement or strength, and does not replace the examination section of the same form.
Reporting a total that mixes the patient self-report and physician assessment sections, or one prorated over missing activity items, as though it were a standard ASES score.

ASES Score compared with other instruments

Instruments measuring a related construct, with the practical difference between them.

Instrument	Items	Range	What it adds
SPADI	13	0–100	The SPADI is a 13-item patient-reported questionnaire that measures shoulder pain and disability over the past week on two subscales — 5 pain items and 8 disability items — each rated 0–10 and transformed to a 0–100% score in which a higher score means more pain and greater disability.
Constant Score	10	0–100	The Constant-Murley score is a 100-point clinician-administered shoulder assessment combining 35 subjective points for pain and daily activities with 65 objective points for measured range of motion and abduction strength, where 100 represents a normal, pain-free shoulder.
UCLA Shoulder Score	5	2–35	The UCLA Shoulder Rating Scale is a 35-point shoulder assessment scoring pain and function out of 10 each, active forward flexion and forward-flexion strength out of 5 each, and patient satisfaction as either 0 or 5, where a higher total is better and 34–35 is graded excellent.
SST	12	0–12	The Simple Shoulder Test asks twelve yes-or-no questions about everyday shoulder functions and scores the number answered yes, giving a total from 0 to 12 where 12 means all twelve functions are retained.
QuickDASH	11	0–100	The QuickDASH is an 11-item shortened form of the DASH that measures physical function and symptoms across the whole upper limb on a single 0 to 100 scale, where a higher score means greater disability.
Oxford Shoulder Score	12	0–48	The Oxford Shoulder Score is a 12-item patient-reported questionnaire about shoulder pain and everyday function over the past four weeks, each item scored 0 to 4 and summed to a total of 0 to 48 in which 48 represents the best possible shoulder — it is licensed by Oxford University Innovation, so the item wording is not reproduced here.

Copyright and permitted use

Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.

Free to use

The assessment form was published in full in the peer-reviewed literature in 1994 by the ASES research committee as a deliberate standardisation effort, with the express aim of common adoption. It is reproduced freely in clinical practice and research and is not subject to a commercial licensing programme. Attribution to the ASES research committee is expected.

References

Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD. A standardized method for the assessment of shoulder function. Journal of Shoulder and Elbow Surgery. 1994.
Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. Journal of Shoulder and Elbow Surgery. 2002.
Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP. Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. Journal of Bone and Joint Surgery (American Volume). 2010.
Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis and Rheumatism (Arthritis Care and Research). 2009.

Editorial status

Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.