Upper Extremity Examination

Introduction

As with the lower extremity, there are multiple patient-rated instruments for the upper extremity. The DASH and Quick- DASH are the most commonly used clinically. Functional tasks assessed are unique to the patient's activities. For example, a baseball pitcher may rate pain associated with throwing.

Disabilities of the Arm, Shoulder, and Hand (DASH)

This 30-item questionnaire is completed by the patient and results in a measurement of perceived physical function and symptoms associated with upper extremity pathology. The optional Work (four items) and Sport/Performing Arts (four items) modules have also been validated. Patients are asked to respond regarding their ability to perform certain activities on a 1 (No Difficulty) to 5 (Unable) scale over the previous week. The scoring algorithm is applied [(mean of all responses -1) ×25] to arrive at a percentage score from 0 to 100. Higher scores represent increased disability. The Work and Sport/Performing Arts modules are scored separately. In the U.S. population, the average score is 10.1 (±14.7).¹ The QuickDASH includes 11 items and can be used when a shorter version is preferred.

  Minimum Detectable Change: DASH 8–15; QuickDASH – 13 points²

  Minimal Clinically Important Difference: DASH = 13 (reported range 8–17); QuickDASH = 18 (reported range 16–20)³

Penn Shoulder Score (PSS)

Specific to the shoulder, the PSS contains three subscales. The Pain subscale requires the patient to report pain on a 0 to 10 scale during various conditions. The Satisfaction subscale uses the same 0 to 10 scale for the patient to describe the level of satisfaction with the current function. The Function subscale asks the patient to rate the extent of difficulty associated with different activities on a 4-point scale. The subscale scores are considered individually and in the aggregate from 0 to 100, with higher scores representing less disability. As with the DASH, the patient may achieve maximum scores on the PSS before achieving full participation status.⁴

  Minimum Detectable Change: 12 points (5 for pain section; 2 for satisfaction section; 9 for function section)5

  Minimal Clinically Important Difference: 11 points

Shoulder Pain and Disability Index (SPADI)

The SPADI can be used for patients with any shoulder pathology. To complete the SPADI, the patient responds to 13 statements on an 11-point numeric rating scale. Pain (five items) and function (eight items) subscores can also be calculated. Higher scores correlate with higher perceived pain and disability.

  Minimum Detectable Change: 13 points (reported values range from 13–22)²

  Minimal Clinically Important Difference: 13–23²

American Shoulder and Elbow Surgeons (ASES) Elbow Outcome Score

This region-specific instrument is designed to measure elbow function. The patient ...