American Shoulder and Elbow Surgeons Score
American Shoulder and Elbow Surgeons Standardized Assessment Form · Also known as: ASES, ASES Shoulder Score
The American Shoulder and Elbow Surgeons (ASES) Standardized Assessment Form is a hybrid outcome instrument combining patient self-report and clinician assessment to evaluate shoulder function and pain. Developed by the ASES Committee in 1994 and published in the Journal of Shoulder and Elbow Surgery, the ASES Score has become the standard shoulder outcome measure in orthopedic and sports medicine settings, widely used in clinical trials, surgical registries, and longitudinal outcomes tracking.
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When to use it
The ASES Score is indicated for any patient with shoulder pathology, including rotator cuff disease (tears, tendinopathy), shoulder instability, osteoarthritis, fractures, post-surgical rehabilitation, and acromioclavicular joint injury. It is the gold-standard outcome measure in shoulder surgery trials and is essential for comparative effectiveness research (e.g., comparing rotator cuff repair techniques, arthroscopic vs. open approaches). The ASES Score is preferred in settings where both subjective patient report and objective clinician assessment are feasible; it is less suitable for telehealth or self-report-only research (use patient self-report component alone in those settings). Use ASES when comprehensive shoulder evaluation—pain, activity, strength, and ROM—is central to the clinical question.
Strengths & limitations
- Excellent test–retest reliability (ICC 0.89–0.97) and internal consistency (Cronbach α 0.83–0.92); robust across age groups, pathologies, and surgical vs. non-surgical populations.
- Hybrid design captures both patient perspective (pain, activity limitations) and clinician objective assessment (strength, ROM), providing multidimensional shoulder health profile.
- Highly responsive to change; sensitive to improvements from rotator cuff repair, physical therapy, and other interventions; widely used in shoulder surgery trials, enabling meta-analysis across studies.
- 0–100 intuitive scale; components can be interpreted separately (patient pain/activity vs. clinician strength/ROM) or as combined total; extensive validation data available across shoulder pathologies.
- Clinician assessment component requires examiner training and standardization; inter-rater variability can occur without consistent ROM and strength testing protocols. Standardized testing equipment (e.g., dynamometers) improves reliability but adds time/cost.
- Hybrid design limits use in settings without clinician availability (pure telehealth, self-report-only registries); patient self-report component alone (0–50) has fewer validation data.
- Activity items are weighted equally; some activities (e.g., putting on a bra) may not apply to all patients (e.g., male patients), potentially affecting score interpretation in specific populations.
- Does not capture higher-level shoulder function (throwing velocity, sport-specific demands); for overhead athletes, ASES should be supplemented with sport-specific outcome measures.
Frequently asked
What is the difference between ASES and other shoulder scales like SANE (Single Assessment Numeric Evaluation)?
ASES is comprehensive (10-item patient form + clinician assessment, 0–100 scale) with strong psychometric validation. SANE is a single item ('How satisfied are you with your shoulder function?' 0–100) and is quicker but less detailed. Use ASES for thorough outcomes tracking in clinical trials and surgery; SANE is acceptable for rapid screening or longitudinal monitoring in high-volume clinics.
Can I use ASES in a patient who cannot attend a clinic visit for clinician assessment?
The patient self-report component (50 points) can be administered independently via phone, mail, or online survey. However, the clinician assessment component (strength, ROM testing) is lost, and your score range becomes 0–50 instead of 0–100. For research, either require clinician assessment as part of the protocol, or pre-specify that you will report patient self-report component only (0–50), with clear labeling.
How soon after shoulder surgery can I administer ASES?
Wait 2–4 weeks post-op until basic wound healing is stable and acute post-op pain begins to resolve. Baseline ASES at 2–4 weeks is standard in shoulder surgery trials. Administering ASES at 1 week post-op typically yields severe scores (5–20) that don't reflect long-term prognosis, and ROM testing may be premature and uncomfortable.
What if a patient is unable to complete some activity items due to disease in the contralateral shoulder or other comorbidities?
The nine activities should reflect shoulder-specific limitations, not general disability. If a patient cannot put on a shirt due to hip osteoarthritis (not shoulder), consider assigning that item a score of 0 (unable) to be conservative, or note the reason for non-response. Missing data in 1–2 items are acceptable; if >2 items are missing, consider mean imputation or exclusion of that assessment from analysis.
Sources
- Richards RR, An KN, Bigliani LU, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3(6):347-352. DOI: 10.1016/S1058-2746(09)80019-0 ↗
How to cite this page
ScholarGate. (2026, June 3). American Shoulder and Elbow Surgeons Standardized Assessment Form. ScholarGate. https://scholargate.app/en/sports-medicine/ases-shoulder
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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