El Test de Constant-Murley como método de valoración clínica para el seguimiento de las fracturas de extremidad proximal del húmerorevisión y controversias

Resumen

Introduction. The Constant scale, also known as the Constant- Murley test, is one of the most widely used tools to evaluate the functional capacity of the shoulder, which has been shown to be specifically useful for evaluating clinical results in shoulder arthroplasty, rotator cuff reparations, adhesive capsulitis and proximal humerus fractures. Previ-ous clinical trials have shown the different use of this test depending on the population groups (age and sex), the type of the rotator cuff pathology, and the poor results of the reliability and the test reproduction. The aim of this article is to show our experience with the test application in 36 patients with proximal humerus fractures, and the review of the present literature about the use of the scale based on the psycomethric evidence, on the validity, and on the try to decrease the bias relating to the population groups, the previous shoulder pathology and the differences asses in the observer variation. Material and Methods: We have reviewed the actual literature and included 30 published articles between 1969 and 2018. We have applied the test for the clinical and functional follow-up of 3 different treatments in patients with proximal humerus fracture. Results. The lack of the standardization of the parameters measurement makes it difficult to execute and interpret the results. The quantification of the internal and external rotation through functional movement, doesn’t allow to specify the articular range, and the strength has wide measurement and interpretation variability depending on the explorers, withouth specific judgments. Discussion. This review supports the use of the Constant test for the clinical follow up of the shoulder pa-thology, and the specific investigation protocols, but shows the necessity of better standardization for the joint ranges measurement and strength; making important the precaution in the score interpretation. Conclusion. The Constant-Murley test is easy to apply and offers advantages in the follow-up of different shoulder pathologies, but the lack of the standard-ization in the items measurement makes that difficult to reproduce, specially at the strength. There is no evidence about the most important psychometric properties, such as validity, the detectable minimal change, and the minimal clinical differ-ence.It would be necessary to constitute tables adjusted to the age and sex of each population, for the results would be optimal; and improve the agreement between observers for the better comparison of the results, as the same patient as the population which it belongs to.