A comparison of quantitative and qualitative shoulder range of motion with patient-reported outcomes

Brian M Johnson; Zachary Crawford; Johnathan Harley; John P Bonamer; Brian M Grawe

doi:10.1016/j.jse.2023.02.133

A comparison of quantitative and qualitative shoulder range of motion with patient-reported outcomes

J Shoulder Elbow Surg. 2023 Jul;32(7):1364-1369. doi: 10.1016/j.jse.2023.02.133. Epub 2023 Mar 29.

Authors

Brian M Johnson¹, Zachary Crawford², Johnathan Harley², John P Bonamer², Brian M Grawe²

Affiliations

¹ Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: johns4bi@ucmail.uc.edu.
² Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

PMID: 36997153
DOI: 10.1016/j.jse.2023.02.133

Abstract

Background: The evaluation of shoulder function requires a combination of physical examination of shoulder range of motion and measures of functional outcome measures. Although efforts have been made to define range of motion for clinical evaluation with respect to functional outcomes, a disconnect still exists when defining a successful outcome. We aim to compare quantitative and qualitative measures of shoulder range of motion with patient-reported outcome measures.

Methods: Data from 100 patients who presented to the office of a single surgeon with a chief complaint of shoulder pain were evaluated for this study. Evaluation included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation relative to the shoulder of interest, demographic information, and range of motion in the shoulder of interest.

Results: Internal rotation angle did not correlate with patient-reported outcomes, whereas external rotation and forward flexion angles did. Qualitative internal rotation as measured by hand-behind-back reach demonstrated a weak to moderate correlation with patient-reported outcomes, and a significant difference in global range of motion and functional outcome measures were identified in patients who can or cannot reach above the belt line or to the thoracic spine. Qualitative assessment of forward flexion demonstrated that patients who can reach specific anatomic landmarks have significantly improved functional outcome measures, and the same is true when comparing patients who can externally rotate past neutral.

Conclusions: Hand-behind-back reach can be used as a clinical marker of global range of motion and functional outcome measures for patients with shoulder pain. Goniometer measurement of internal rotation has no relationship with patient-reported outcomes. Forward flexion and external rotation assessment with qualitative cutoffs can additionally be used clinically to determine functional outcome for patients with shoulder pain.

Keywords: Shoulder; goniometry; hand-behind-back; internal rotation; outcomes; range of motion; shoulder examination.

MeSH terms

Arthroplasty, Replacement, Shoulder* / adverse effects
Humans
Patient Reported Outcome Measures
Range of Motion, Articular
Shoulder Joint* / surgery
Shoulder Pain / etiology
Treatment Outcome