Simple Shoulder Test

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Last updated: Thursday, May 26, 2011

About the simple shoulder test

The shoulder is essential for many activities of daily living. The ability of the shoulder to carry out these functions characterizes perhaps the most important aspect of its health. Conversely, the severity of shoulder conditions may be documented in terms of the compromise of these functions.

SST

Because of the critical importance of systematic documentation of shoulder function, we have developed the Simple Shoulder Test (SST): a series of 12 "yes" or "no" questions the patient answers about the function of the involved shoulder. The answers to these questions provides a standardized way of recording the function of a shoulder before and after treatment. Our practice is to obtain the Simple Shoulder Test on all patients presenting to the University of Washington Shoulder and Elbow Service so we will have a benchmark for comparison of their subsequent course.

The Simple Shoulder Test is standardized, simple, short, practical and free to all who would like to use it. Here is an Adobe Acrobat version of the Simple Shoulder Test.

More about the SST

Twelve questions

The questions of the SST are:

  1. Is your shoulder comfortable with your arm at rest by your side?
  2. Does your shoulder allow you to sleep comfortably?
  3. Can you reach the small of your back to tuck in your shirt with your hand?
  4. Can you place your hand behind your head with the elbow straight out to the side?
  5. Can you place a coin on a shelf at the level of your shoulder without bending your elbow?
  6. Can you lift one pound (a full pint container) to the level of your shoulder without bending your elbow?
  7. Can you lift eight pounds (a full gallon container) to the level of the top of your head without bending your elbow?
  8. Can you carry 20 pounds at your side with the affected extremity?
  9. Do you think you can toss a softball underhand 10 yards with the affected extremity?
  10. Do you think you can throw a softball overhand 20 yards with the affected extremity?
  11. Can you wash the back of your opposite shoulder with the affected extremity?
  12. Would your shoulder allow you to work full-time at your usual job?

Conditions

Each of the conditions potentially afflicting the shoulder may vary substantially in severity. The diagnoses of instability, cuff disease, arthritis, or frozen shoulder do not of themselves indicate the need for treatment. The need for treatment arises from the effect of the condition on the patient's function.

These data are easily presented in charts which show the percent of patients who cannot perform each of the 12 functions. Consult figures 1 and 2 to review SST data for patients presenting to the University of Washington Shoulder and Elbow Service with degenerative glenohumeral joint disease. The SST also facilitates comparisons, for example of the shoulder function of patients presenting with degenerative and rheumatoid glenohumeral joint disease (see figures 3 and 4).

The success of a treatment method is determined largely by its ability to restore function. The SST provides a practical method for evaluating results. We prefer to present the results in terms of the percent of patients gaining (and losing) each function after the treatment was instituted. Consult figures 5 and 6 for data about patients with degenerative glenohumeral joint disease treated with total shoulder arthroplasty. The standardized nature of the SST facilitates comparison of the effectiveness of different treatment methods, different diagnoses and different surgeons. For a comparison with the DJD results, see figures 7 and 8 with data about patients with rheumatoid glenohumeral joint disease treated with total shoulder arthroplasty.

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Figure 1
 
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Figure 2
 
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Figure 3
 
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Figure 4
 
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Figure 5
 
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Figure 6
 
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Figure 7
 
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Figure 8

 

Origins of the simple shoulder test

The Simple Shoulder Test questions were derived from the common complaints of patients presenting to the University of Washington Shoulder Service for evaluation.

Patient's own evaluation

It is important that the patient answer these questions without assistance: it is the patient's own evaluation of his or her shoulder function that is wanted. Because the patient is the consistent evaluator of the shoulder, concern about inter observer variability is eliminated. The SST reflects the status of the shoulder in functional terms, rather than in degrees of motion, appearance of radiographs or isokinetic torque measurements. If the situation requires, we can add questions to the original twelve, keeping the minimal data set intact. For example in studying high performance athletes, we add to the basic SST such questions as: "Does your shoulder allow you to pitch (or serve) with your usual speed and control?" "Does your shoulder allow you to swim your normal workout?" "Does your shoulder allow you to compete at the varsity level in your sport?"

Prior to the clinical introduction of the Simple Shoulder Test we verified that almost all normal patients aged 60 to 70 years were able to perform the twelve basic functions. Subsequently, we have used the Simple Shoulder Test on thousands of clinical occasions.

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Figure 9 -
Twelve basic functions

 


Attributes of the simple shoulder test

Reproducibility, practicality, and more

The SST has demonstrated a high degree of reproducibility. In normal subjects, the reproducibility is essentially 100%, with almost all subjects answering "yes" to all twelve questions. As a more stringent test, we tested seventy patients with abnormal SST's and then retested them 5 to 30 days later (average 14 days). Sixty-three percent of the patients had identical responses on retesting. Ninety percent of the patients answered no more than one question differently on retest. Over 96 percent made no more than two different responses on retest. This lack of absolute reproducibility is not a deficiency of the SST; instead it reflects an actual day-to-day variation in some patients' view of their shoulder function.

The Simple Shoulder Test provides a practical method for determining the pretreatment shoulder function as well as the shoulder function at various intervals after the treatment. Sequential SST's indicate the length of time required to achieve maximum functional benefit after treatment. The difference between the shoulder function before treatment and after the recovery period is the effectiveness of the treatment.

The simplicity of the SST facilitates the communication of results to patients. Prospective surgical candidates are able to compare their own pretreatment status with the typical pretreatment status of others having the same diagnosis. This information enables them to answer questions such as, "How bad is my arthritis in comparison with other individuals who have had a total shoulder replacement?" Similarly, by reviewing the functional results of a given treatment for their diagnosis, patients can answer the questions, "What are the chances that I will be able to do these activities after the treatment?" and "How long will it take before I see improvement?"

The SST facilitates comparisons because

  1. the questions are standardized,
  2. the SST is a patient self-assessment (eliminating concerns about inter-observer variations),
  3. the SST is simple and free (so it can be repeated often and used by anyone).

Shoulder & Elbow Articles

  1. About the Mechanics of Shoulder Stability.
  2. Anterior glenoid reconstruction for unstable dislocating shoulders. Surgery to restore lost anterior glenoid bone and deep the socket with a bone graft can restore shoulder anatomy and lessen pain and improve function.
  3. Arthroplasty in Cuff Tear Arthropathy: Surgery for shoulders with a rotator cuff tear and arthritis can lessen shoulder pain and improve function with joint replacement.
  4. Atraumatic Shoulder Instability.
  5. Bankart repair for unstable dislocating shoulders: Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals.
  6. Basics of failed shoulder surgery, complications of shoulder surgery and revision shoulder surgery
  7. Chondrolysis
  8. Clinical Presentation and Evaluation of Glenohumeral Arthritis.
  9. Clinical Presentation of Glenohumeral Instability.
  10. Compartmental Syndromes.
  11. Diagnosis of Capsulorraphy Arthropathy.
  12. Diagnosis of the Frozen Shoulder.
  13. Evaluation of Recurrent Instability.
  14. Evaluation of the Rough Shoulder.
  15. Evaluation of the Stiff Shoulder.
  16. Evaluation of the Weak Shoulder.
  17. Examination Under Anesthesia.
  18. Failed Shoulder Replacement and Revision.
  19. Glenohumeral Arthritis References.
  20. Home Exercises for the Rough Shoulder.
  21. Home Exercises for Stiff Shoulder
  22. Home Exercises for the Unstable Shoulder.
  23. Home Exercises for the Weak Shoulder.
  24. Humeroscapular Positions and Motion.
  25. Humerothoracic Positions and Motion.
  26. Injuries Associated with Anterior Dislocations.
  27. Intermediate Shoulder Instability.
  28. Management of Glenohumeral Arthritis.
  29. Mechanics of Glenohumeral Arthritis.
  30. Mechanics of Glenohumeral Arthroplasty.
  31. Mechanics of Glenohumeral Instability.
  32. Mechanics of Shoulder Strength.
  33. More Information on Rotator Cuff Surgery.
  34. Posterior glenoid osteoplasty for unstable dislocating shoulders. Surgery to build up the back of the glenoid socket using an osteotomy and graft can restore shoulder anatomy and lessen pain and improve function.
  35. Ream and Run for Shoulder Arthritis: Conservative Reconstructive Surgery for Selected Individuals Desiring Higher Levels of Activity than Recommended for Traditional Total Shoulder Joint Replacement
  36. Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.
  37. Rehabilitation after Shoulder Arthroplasty.
  38. Rehabilitation following shoulder joint replacement arthroplasty
  39. Relevant Anatomy of Glenohumeral Instability.
  40. Repair of Rotator Cuff Tears: Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty.
  41. Reverse Shoulder Replacement (Delta joint replacement) for arthritis: Surgery with a reverse prosthesis can lessen shoulder pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability.
  42. Reverse Total Shoulder or Delta Shoulder for Shoulder Arthritis Combined with Massive Rotator Cuff Tear and for Failed Conventional Total Shoulder Replacement
  43. Rotator Cuff Clinical Presentation.
  44. Rotator Cuff Differential Diagnosis.
  45. Rotator Cuff Failure.
  46. Rotator Cuff Historical Review.
  47. Rotator Cuff Imaging Techniques.
  48. Rotator Cuff Relevant Anatomy and Mechanics.
  49. Rotator Cuff Tear: When to Repair and When to Smooth and Move the Shoulder
  50. Rotator Cuff Treatment.
  51. SF 36 and Health Status.
  52. Scapulothoracic Positions and Motion.
  53. Shoulder Arthritis
  54. Shoulder Arthritis Book
  55. Shoulder and Elbow Cases to Consider.
  56. Shoulder arthritis and rotator cuff tears: The combination of arthritis and rotator cuff tears is called rotator cuff tear arthropathy. The management of this condition requires thought and experience.
  57. Shoulder arthritis: Osteoarthritis, Chondrolysis, Rheumatoid Arthritis, Degenerative joint disease, and arthritis after shoulder surgery.
  58. Shoulder joint replacement arthroplasty for shoulder arthritis pain and stiffness: two options: total shoulder and ream and run
  59. Shoulder osteoarthritis, chondrolysis, rheumatoid arthritis, degenerative joint disease, and arthritis after shoulder arthroscopy and open surgery
  60. Simple Shoulder Test.
  61. Subacromial Smoothing.
  62. Surface replacement for shoulder arthritis: Surgery with a CAP, a special type of conservative resurfacing joint replacement that resurfaces the ball of the ball and socket joint, can lessen pain and improve function.
  63. Surgery for Atraumatic Instability of the Shoulder.
  64. Surgical release for stiff frozen shoulders: Surgery to remove scar tissue and release contractures can lessen pain and improve function for stiff shoulders that have not responded to rehabilitation or physical therapy.
  65. Total Shoulder Replacement Arthroplasty for Shoulder Arthritis
  66. Total elbow joint replacement for elbow arthritis: Surgery with a dependable, time-tested prosthesis can lessen pain and improve function in elbows, especially in rheumatoid arthritis of the elbow
  67. Total shoulder joint replacement for shoulder arthritis: Surgery with a dependable, time-tested conservative prosthesis and accelerated rehabilitation can lessen pain and improve function in shoulders with arthritis.
  68. Traumatic Shoulder Instability.
  69. Treating Shoulder Dislocation / Subluxation (Instability) and Associated Pain with Minimally Invasive Arthroscopy
  70. Treatment of Recurrent Instability.
  71. Types of Glenohumeral Instability.