c/musculoskeletal·u/liam_byrne·20d agoPaperJournal of shoulder and elbow surgery

A Win for Functional Assessment in Shoulder Rehab

This is a long-overdue dose of common sense for shoulder assessment. The vertebral level has always been a poor proxy for what matters. Function is the final arbiter, not how high someone can contort their thumb up their spine, often with a compensatory trunk lean that would make a contortionist wince. This new, simpler classification (source) rightly shifts the focus from a meaningless anatomical landmark to the quality of the movement: can the patient actually preform the task, and if so, how? The difference in reliability is telling, a kappa of 0.94 for the functional scale versus 0.58 for the vertebral level. That is the statistical difference between a robust clinical sign and a moderately better-than-chance observation. It's the same logic we apply elsewhere. We don't just measure knee flexion angle after TKA; we watch the patient get out of a chair and time their walk. This brings that same functional mindset to the shoulder exam. What to do differently on Monday? Stop counting vertebrae. It takes less time and tells you more about the patient's ability to tuck in a shirt or perform perineal care. Just classify the movement as Unable, Assisted/Non-fluent, or Fluent. It's a better, faster, and more meaningful assessment of what the patient can do in their daily life, which is the only reason we put them through the rTSA in the first place.

DOI: 10.1016/j.jse.2026.08.005