The ASES score is a widely used shoulder-specific patient-reported outcome measure. This page explains what the ASES is, what it measures, the questions it contains, how it is scored, and how it is applied in shoulder care.
What is the ASES score?
The ASES (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form) is a shoulder outcome instrument developed by the American Shoulder and Elbow Surgeons and described by Richards and colleagues in 1994. The patient self-report section is a validated, widely cited tool used to evaluate pain and function across a variety of shoulder conditions, including rotator cuff disease, glenohumeral arthritis, instability, and shoulder arthroplasty.
What does the ASES measure?
The patient-reported ASES score evaluates two dimensions of shoulder health that are weighted equally: pain and function in activities of daily living. Each dimension contributes 50 points to a 100-point total, so a patient's subjective discomfort is weighted the same as their functional ability. The self-report form can typically be completed in under five minutes.
What questions are included in the ASES?
The scored portion of the patient self-assessment uses one pain item and ten activities-of-daily-living (ADL) items. Pain is captured on a visual analog scale from 0 (no pain) to 10 (worst pain). The ten ADL items ask about shoulder-specific tasks such as putting on a coat, sleeping on the affected side, washing the back or fastening a bra, managing toileting, combing hair, reaching a high shelf, lifting a weight above shoulder height, throwing a ball, and performing usual work and sport or leisure activities. Each ADL item is rated on a 4-point ordinal scale.
How is the ASES scored?
The pain visual analog score is converted to a 50-point pain subscore using the formula (10 − pain VAS) × 5. The ten ADL items are each scored from 0 (unable to do) to 3 (not difficult), summed to a maximum raw score of 30, and then converted to a 50-point function subscore (raw ADL score multiplied by 5/3). The pain and function subscores are added to give a total from 0 to 100, where higher scores indicate less pain and better function. A commonly cited combined formula is ASES score = 5 × ([10 − pain VAS] + cumulative ADL score ÷ 3).
How is the ASES used in clinical practice?
Surgeons and therapists use the ASES to establish a baseline before treatment and to measure change after interventions such as rotator cuff repair, arthroplasty, or non-operative rehabilitation. Because it has demonstrated reliability, validity, and responsiveness across multiple shoulder pathologies, it is frequently reported in clinical trials and registries, allowing outcomes to be compared across studies and over time.
Strengths and limitations
The ASES is quick, shoulder-specific, and balances pain and function equally, which supports its broad adoption. Its limitations include potential ceiling effects in high-functioning patients and reliance on a single pain item; it is best interpreted alongside physical examination findings and imaging rather than as a stand-alone determinant of treatment success.
Frequently asked questions
What is a good ASES score? Scores range from 0 to 100, and higher is better; 100 indicates no pain and full function.
How many items are scored on the ASES? Eleven items are scored: one pain item and ten activities-of-daily-living items.
Is the ASES patient-reported? The scored self-assessment section is completed by the patient, which makes it a patient-reported outcome measure.
References
- Richards RR, An KN, Bigliani LU, et al. A standardized method for the assessment of shoulder function. Journal of Shoulder and Elbow Surgery. 1994;3(6):347-352.
- Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. Journal of Shoulder and Elbow Surgery. 2002;11(6):587-594.
- Shirley Ryan AbilityLab, Rehabilitation Measures Database. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form.
