Clinical calculator
Rowe Score Calculator
Rowe Score for Shoulder Instability
The Rowe score is a 100-point clinician-administered rating for shoulder instability that awards 50 points for stability, 20 for range of motion and 30 for function, where 100 represents a stable, fully mobile and unrestricted shoulder.
What the Rowe Score means
Rowe Score scores run from 0 to 100, where a higher score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.
- Poor0–50
A recurrent dislocation scores zero for stability, which caps the total at 50 — so almost every failed stabilisation lands in this band by construction.
- Fair51–74
- Good75–89
- Excellent90–100
The large majority of shoulders after a successful stabilisation score here, which is the source of the score’s ceiling effect.
Published criteria and reliability
The published cut-offs that define this instrument, and the measured agreement between observers using it. Each is reported with the population it was derived in.
| Type | Value | Subscale | Population | Follow-up | Source |
|---|---|---|---|---|---|
| Criterion | Excellent 90–100, good 75–89, fair 51–74, poor 50 or below | — | Adults reviewed after Bankart repair for recurrent anterior instability | — | Rowe CR 1978 |
| Criterion | Stability 50 points, motion 20 points, function 30 points — a recurrent dislocation scores 0 for stability and therefore caps the total at 50 | — | Adults with anterior shoulder instability | — | Rowe CR 1978 |
| Criterion | Marked ceiling effect and limited published measurement-property evidence compared with instability-specific patient-reported instruments | — | Systematic review of shoulder instability outcome scores | — | Rouleau DM 2010 |
Criterion is a published cut-off, definition or performance figure belonging to a classification or decision rule — it is not a change score and should not be read as one.
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 three components. Stability contributes 50 points: no recurrence, subluxation or apprehension scores 50; apprehension when the arm is placed in certain positions scores 30; a subluxation that did not require reduction scores 10; a recurrent dislocation scores 0. Motion contributes 20 points, graded as a percentage of the opposite shoulder: full external rotation, internal rotation and elevation scores 20; 75% of normal external rotation with normal elevation and internal rotation scores 15; 50% of normal external rotation with 75% of normal elevation and internal rotation scores 10; 50% of normal elevation and internal rotation with no external rotation scores 5; less than 50% of normal elevation and internal rotation scores 0. Function contributes 30 points: no limitation in work or sport with little or no discomfort scores 30; mild limitation with minimum discomfort scores 25; moderate limitation and discomfort scores 10; marked limitation and pain scores 0. The three component scores are added and a higher total is better. The published grades are excellent 90–100, good 75–89, fair 51–74 and poor 50 or below. Because stability alone carries 50 points, a shoulder that has redislocated cannot reach the fair band.
Missing data
There is no imputation rule. All three components must be graded 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 movement cannot be examined — a postal or telephone follow-up, for instance — the Rowe score cannot be completed, and a patient-reported instability instrument such as the WOSI should be used instead.
Instrument profile
- Developer
- Carter R. Rowe, Dinesh Patel and William W. Southmayd
- Institution
- Massachusetts General Hospital, Boston
- First published
- 1978
- Items
- 3
- Response format
- Three clinician-graded components with fixed point values
- Score range
- 0 to 100
- Direction
- Higher score = better
- Recall period
- Status at the time of review. The stability component covers the whole period since the injury or the stabilisation procedure, not just the day of assessment.
- Completion time
- About 5 minutes
- Age range
- Adults and adolescents
- Regions
- Shoulder
- Conditions
- Shoulder instability, Recurrent anterior shoulder dislocation, Shoulder subluxation, Bankart lesion, Traumatic anterior shoulder dislocation
- Procedures
- Bankart repair, Arthroscopic shoulder stabilisation, Latarjet procedure, Open capsulolabral reconstruction, Remplissage
- Languages
- English, Brazilian Portuguese
- Validity
- Content validity for instability is high — it is the only common shoulder score that weights recurrence above everything else, which is why it remains the default in Bankart and Latarjet series. Construct validity against general shoulder scores is only moderate, precisely because those scores are not measuring instability.
- Reliability
- Responsive to a change in instability status, and largely unresponsive to anything else. Two shoulders that both remain stable can differ substantially in symptoms without differing in Rowe score.
- Ceiling effect
- Marked. Most stable shoulders score 90 or more, so the score cannot separate a good result from an excellent one and is a poor choice as the sole endpoint in a trial comparing two effective stabilisations.
- Floor effect
- Uncommon: a redislocating shoulder that still moves and functions reasonably well will score in the 30s or 40s rather than at zero.
Normative values
Reference values from published cohorts, for comparison against the score you calculated.
| Population | Age | Mean | SD |
|---|---|---|---|
| Shoulders reviewed after a successful stabilisation procedure, no recurrence | — | Typically 90–100, clustered at the top of the scale | — |
| Shoulders with recurrent dislocation after stabilisation | — | 50 or below, because the stability component scores zero | — |
When to use the Rowe Score
Well suited to
- Reporting the outcome of a stabilisation procedure — Bankart repair, arthroscopic stabilisation or Latarjet — where recurrence is the primary endpoint and comparison with the historical literature matters.
- Clinical follow-up of traumatic anterior instability, where apprehension and subluxation need to be recorded as distinct from frank dislocation.
- Alongside a patient-reported instability measure such as the WOSI, which supplies the discrimination the Rowe score lacks at the top of its range.
Limitations and poor fits
- Any shoulder condition other than instability: rotator cuff disease, arthritis and stiffness are barely represented, and 50 of the 100 points would be awarded automatically.
- Remote or postal follow-up — the motion and apprehension components require a physical examination, so the score cannot be self-completed.
- Trials comparing two effective stabilisation techniques, where the ceiling effect will conceal a real difference. Use the WOSI as the primary outcome.
- Multidirectional and atraumatic instability, for which the original sheet was not designed; Rowe later described a separate modified rating for that population, and the two versions are not interchangeable.
Rowe Score compared with other instruments
Instruments measuring a related construct, with the practical difference between them.
| Instrument | Items | Range | What it adds |
|---|---|---|---|
| WOSI | 21 | 0–100 | The Western Ontario Shoulder Instability Index is a 21-item patient-reported measure of the quality-of-life effects of shoulder instability, each item rated 0 to 100 across four domains — physical symptoms, sports and work, lifestyle and emotions — and usually reported as a percentage of normal in which 100% means no impairment. |
| 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. |
| 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. |
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 rating method rather than a proprietary questionnaire. The three components and their point allocations were published in full in the 1978 Bankart end-result study and have been reproduced throughout the instability literature ever since, with no rights holder operating a licensing programme. We have found no active claim over the method and have not sought written permission on that basis. Any particular printed rating sheet distributed by a society or a vendor is a separate document with its own copyright and is not reproduced here.
References
- Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. Journal of Bone and Joint Surgery (American). 1978.
- Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. Journal of Bone and Joint Surgery (American). 1981.
- Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair: apparent causes of failure and treatment. Journal of Bone and Joint Surgery (American). 1984.
- Rouleau DM, Faber K, MacDermid JC. Systematic review of patient-administered shoulder functional scores on instability. Journal of Shoulder and Elbow Surgery. 2010.
- Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability: the Western Ontario Shoulder Instability Index (WOSI). American Journal of Sports Medicine. 1998.
Editorial status
This page has not yet been signed off by a named clinical reviewer. The scoring logic is stated in full above so it can be independently verified, and every threshold is traceable to its source. See our editorial methodology.