A review of the Constant score: modifications and guidelines for its use.

The requirement to assess surgical results and the means of quantifying them have always provoked intense debate. Since Codman’s introduction of ‘‘the end result idea,’’ the main aim in assessment has not changed, but our requirements are now more sophisticated and include observation of natural history, follow-up, and disability quantification. The Constant score was devised by Christopher Constant with the assistance of the late Alan Murley during the years 1981-1986. The score was first presented in a university thesis in 1986 and the methodology published in 1987. This functional assessment score was conceived as a system of assessing the overall value, or functional state, of a normal, a diseased, or a treated shoulder. If universally accepted, it would further progress in clinical research in shoulder surgery and enhance the value of multicenter trials. In this score, 35 points are allocated for subjective assessments of pain and activities of daily living and 65 points are available for objective measures of range of movement and shoulder strength. A young healthy patient can therefore have a maximum score of 100 points.