Neer proposed criteria for evaluating functional ability in a patient with a proximal humeral fracture before and after surgery. The authors is from Columbia University in New York City.
Components:
(1) pain (maximum 35 points)
(2) function (maximum 30 points)
(3) range of motion (maximum 25 points)
(4) anatomy (maximum 10 points)
Subcomponents for function:
(1) strength
(2) reaching
(3) stability
Subcomponents for range of motion:
(1) flexion in sagittal plane
(2) extension
(3) abduction in coronal plane
(4) external rotation
(5) internal rotation
|
Parameter |
Finding |
Points |
|---|---|---|
|
pain |
none, can ignore |
35 |
|
|
slight, occasional, no compromise in activity |
30 |
|
|
mild, no effect on ordinary activity |
25 |
|
|
moderate, tolerable, makes concessions, uses aspirin |
15 |
|
|
marked, serious limitations |
5 |
|
|
totally disabled |
0 |
|
flexion in sagittal plane |
180 degrees |
6 |
|
|
170 degrees |
5 |
|
|
130 degrees |
4 |
|
|
100 degrees |
2 |
|
|
80 degrees |
1 |
|
|
less than 80 degrees |
0 |
|
extension |
45 degrees |
3 |
|
|
30 degrees |
2 |
|
|
15 degrees |
1 |
|
|
less than 15 degrees |
0 |
|
abduction in coronal plane |
180 degrees |
6 |
|
|
170 degrees |
5 |
|
|
140 degrees |
4 |
|
|
100 degrees |
2 |
|
|
80 degrees |
1 |
|
|
less than 80 degrees |
0 |
|
external rotation |
60 degrees |
5 |
|
|
30 degrees |
3 |
|
|
10 degrees |
1 |
|
|
less than 10 degrees |
0 |
|
internal rotation |
90 degrees (reach T-6) |
5 |
|
|
70 degrees (reach T-12) |
4 |
|
|
50 degrees (reach L-5) |
3 |
|
|
30 degrees (gluteal) |
2 |
|
|
less than 30 degrees |
0 |
|
anatomic changes |
none |
10 |
|
|
mild |
8 |
|
|
moderate |
4 |
|
|
marked |
2 |
|
|
extreme |
0 |
where:
• External rotation involves rotation from anatomic position with elbow bent.
• Internal rotation involves rotation from anatomic position with elbow bent (with elbow bent, what level can the fingers reach?).
• Anatomic changes include: rotation, angulation, joint incongruity, retracted tuberosities, failure metal, myositis, non-union, avascular necrosis or anything else that can go wrong.
|
Functional Abilities |
Finding |
Points |
|---|---|---|
|
strength |
normal |
10 |
|
|
good |
8 |
|
|
fair |
6 |
|
|
poor |
4 |
|
|
trace |
2 |
|
|
zero (none) |
0 |
|
reaching top of head |
able |
2 |
|
|
unable |
0 |
|
reaching mouth |
able |
2 |
|
|
unable |
0 |
|
reaching belt buckle |
able |
2 |
|
|
unable |
0 |
|
reaching opposite axilla |
able |
2 |
|
|
unable |
0 |
|
reaching a brassiere hook |
able |
2 |
|
|
unable |
0 |
|
stability on lifting |
able |
2 |
|
|
unable |
0 |
|
stability on throwing |
able |
2 |
|
|
unable |
0 |
|
stability on pounding |
able |
2 |
|
|
unable |
0 |
|
stability on pushing |
able |
2 |
|
|
unable |
0 |
|
stability on holding something overhead |
able |
2 |
|
|
unable |
0 |
where:
• Hopefully the "reaching a brassiere hook" could be interpreted in at least 2 ways for a man. I have entered it as "reaching behind the back" in the implementation.
total score =
= SUM(points for all parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• The score indicates the percent normal functional capacity.
Specialty: Surgery, orthopedic
ICD-10: ,
