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Constant-Murley Shoulder Score
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.
What the Constant Score means
Constant Score scores run from 0 to 100, where a higher score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.
- Poor0–69
These four grades are a widely used convention rather than part of the original description; compare against the age- and sex-matched relative score before acting on them.
- Fair70–79
- Good80–89
- Excellent90–100
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 | 10.4 points | — | Patients undergoing rotator cuff surgery | 12 months | Kukkonen J 2013 |
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 score totals 100 points from four domains. Pain contributes 15 points (none 15, mild 10, moderate 5, severe 0). Activities of daily living contribute 20 points: work 0–4, recreation or sport 0–4, sleep 0–2, and the highest painless working level of the hand 2–10 (waist 2, xiphoid 4, neck 6, top of head 8, above head 10). Range of motion contributes 40 points as four components of 10: forward flexion and lateral elevation each scored in 30° bands (0–30° = 0, 31–60° = 2, 61–90° = 4, 91–120° = 6, 121–150° = 8, 151–180° = 10), external rotation scored 2 points for each of five hand positions achieved, and internal rotation scored by the highest spinal level the dorsum of the hand reaches (lateral thigh 0 through interscapular 10). Strength contributes 25 points, one point per pound of isometric abduction force measured at 90° of abduction in the scapular plane, capped at 25 points. The four domain scores are added; a higher total is better, and 100 represents a normal pain-free shoulder. Because 65 of the 100 points are objective and both range and strength fall with age, the absolute total is commonly converted to a relative Constant score by dividing it by the published normal value for the patient’s age and sex.
Missing data
There is no imputation rule. Every component must be assessed for the total to be valid, and a total reported with a component missing is not comparable with a complete score or with published series. Where the strength test cannot be performed because of pain or because the arm will not reach 90° of abduction, the correct entry is 0 points rather than a blank.
Instrument profile
- Developer
- Christopher R. Constant and Alan H. G. Murley
- Institution
- Addenbrooke’s Hospital, Cambridge, United Kingdom
- First published
- 1987
- Custodian
- European Society for Shoulder and Elbow Surgery (SECEC/ESSSE), which adopted it as its standard score
- Items
- 10
- Response format
- Four clinician-rated categories plus a measured abduction force
- Score range
- 0 to 100
- Direction
- Higher score = better
- Recall period
- Current status at the time of examination
- Completion time
- About 10 minutes
- Age range
- Adults
- Regions
- Shoulder
- Conditions
- Rotator cuff tear, Subacromial pain syndrome, Adhesive capsulitis, Shoulder osteoarthritis, Proximal humerus fracture, Shoulder instability
- Procedures
- Rotator cuff repair, Subacromial decompression, Total shoulder arthroplasty, Reverse shoulder arthroplasty, Proximal humerus fracture fixation
- Languages
- English, German, French, Italian, Spanish, Dutch, Portuguese, Turkish, Chinese
- Observer agreement
- Total score 0.80–0.96; agreement is consistently lowest for the strength component
- Validity
- Correlates well with the ASES score, the SPADI and the DASH, and is the score most often reported in European shoulder arthroplasty and rotator cuff series, which is its main practical advantage.
- Reliability
- Responsive after rotator cuff repair and arthroplasty, but less responsive than patient-reported measures in conditions where pain changes more than movement.
- Ceiling effect
- Ceiling effects in young patients with good movement, particularly after instability surgery, where the score cannot distinguish a stable shoulder from an unstable one.
- Floor effect
- Uncommon; the positioning item and the elevation bands keep most impaired shoulders above zero.
Normative values
Reference values from published cohorts, for comparison against the score you calculated.
| Population | Age | Mean | SD |
|---|---|---|---|
| Healthy shoulders — the denominator used for the relative, age- and sex-adjusted Constant score | 21–40 | Approximately 95 points | — |
| Healthy shoulders — relative-score denominator | 61–80 | Approximately 75–83 points | — |
| Healthy shoulders — relative-score denominator | 21–40 | Approximately 90–97 points | — |
| Healthy shoulders — relative-score denominator | 61–80 | Approximately 70 points | — |
When to use the Constant Score
Well suited to
- Reporting outcomes after rotator cuff repair, shoulder arthroplasty or proximal humerus fracture, where comparison with the European literature matters.
- When objective movement and strength should carry most of the weight rather than patient report alone.
- Serial follow-up by the same examiner, where the strength measurement is performed the same way each time.
Limitations and poor fits
- Shoulder instability, where the score is insensitive to apprehension and recurrent dislocation — use the WOSI or the Rowe score.
- Postal or remote follow-up: 65 of the 100 points require a physical examination, so the score cannot be self-completed.
- Comparing series that measured strength differently — position, dynamometer and whether painful shoulders were scored zero all shift the total materially.
- Interpreting an absolute total in an older patient without converting it to the age- and sex-adjusted relative score.
Constant 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. |
| 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. |
| ASES Score | 11 | 0–100 | 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. |
| 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.
A clinician-administered assessment method rather than a proprietary questionnaire: the components and their point allocations were published in full in the 1987 paper and restated in the 2008 standardisation guidelines, and are reproduced throughout the literature without a licensing programme. We have found no active rights holder charging for the method itself, and have not sought written permission on that basis. Note that this is the method as published — any particular printed scoring sheet or data-collection form distributed by SECEC/ESSSE or a commercial vendor is a separate document with its own copyright, and is not reproduced here.
References
- Constant CR, Murley AHG. A clinical method of functional assessment of the shoulder. Clinical Orthopaedics and Related Research. 1987.
- Constant CR, Gerber C, Emery RJH, Søjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. Journal of Shoulder and Elbow Surgery. 2008.
- Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Äärimaa V. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. Journal of Shoulder and Elbow Surgery. 2013.
- Rocourt MHH, Radlinger L, Kalberer F, et al.. Evaluation of intratester and intertester reliability of the Constant-Murley shoulder assessment. Journal of Shoulder and Elbow Surgery. 2008.
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.