Section 4: Upper Extremity Examination

PATIENT-REPORTED OUTCOME MEASURES

This section describes patient-rated functional outcomes for the upper extremity. Although the Disabilities of the Arm, Shoulder, and Hand (DASH) index is the most widely used instrument for upper-extremity conditions, it lacks the specificity found in other joint-specific instruments.

Disabilities of the Arm, Shoulder, and Hand

The DASH and QuickDASH are two of the most frequently used patient-rated instruments for evaluating the upper extremity. In these scales, the functional tasks assessed are unique to the patient’s activities.

The DASH is a 30-item questionnaire completed by the patient that results in a measurement of perceived physical function and symptoms associated with upper extremity pathology. Patients are asked to rate their ability to perform certain activities during the previous week on a 1 (No Difficulty) to 5 (Unable) scale. A scoring algorithm is then applied [(mean of all responses – 1) × 25] to calculate a percentage score from 0 to 100. Higher scores represent increased disability.

Within the DASH there are two optional sections for the work (four items) and sports/performing arts (four items) modules. These validated modules focus on the patient’s ability to perform specific tasks and are scored separately. In the U.S. population, the average DASH score is 10.1 (±14.7).¹

The QuickDASH includes 11 items and can be used when a shorter version is preferred and has demonstrated similar precision in upper extremity conditions.²

• Minimum Detectable Change: DASH 8–15; QuickDASH – 13 points³

• Minimal Clinically Important Difference: DASH = 13 (reported range 8–17); QuickDASH = 18 (reported range 16–20)⁴

Penn Shoulder Score (PSS)

Specific to the shoulder, the PSS contains three subscales (i.e., pain, satisfaction, and function). 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 lower scores representing increased disability. The patient may achieve maximum scores on the PSS before achieving full participation status.⁵

• Minimum Detectable Change: 12 points (5 for pain section; 2 for satisfaction section; 9 for function section)⁶

• 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.