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Computerized Branching Logic Systems Significantly Improve the Accuracy of ASES Scores for Patients with Bilateral Shoulder Pain Undergoing Shoulder Arthroplasty
Journal article   Peer reviewed

Computerized Branching Logic Systems Significantly Improve the Accuracy of ASES Scores for Patients with Bilateral Shoulder Pain Undergoing Shoulder Arthroplasty

Maria Bozoghlian, Joseph Galvin, Edward Rojas and Brendan M. Patterson
Journal of shoulder and elbow surgery
07/14/2026
DOI: 10.1016/j.jse.2026.06.029
PMID: 42448143

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Abstract

The American Shoulder and Elbow Surgeons (ASES) score is widely utilized to determine functional outcome following shoulder arthroplasty. There is, however, limited guidance on efficient and accurate collection methods of the ASES score for patients with bilateral shoulder pathology. We developed a branching logic system to improve ASES score collection accuracy. The purpose of this study was to analyze ASES scores for patients who had undergone shoulder arthroplasty and subsequently presented with contralateral shoulder pain within 1 year after surgery, before and after the implementation of a branching logic system. A retrospective review was performed of patients undergoing primary shoulder arthroplasty with a minimum 1-year postoperative follow-up. The cohort was divided into pre- and post-branching logic groups. Group A: patients in the pre-branching logic group who underwent unilateral shoulder arthroplasty and subsequently presented with contralateral shoulder pain. Group B: patients in the post-branching logic group who underwent unilateral shoulder arthroplasty and subsequently presented with contralateral shoulder pain. Group C: patients in the pre-branching logic group who underwent unilateral shoulder arthroplasty and did not present with contralateral shoulder pain at any time postoperatively. ASES scores, VAS pain and range of motion (ROM) were collected at 6 weeks, 3 and 6 months, and 1-year postoperatively. A total of 188 patients were included. There were 27 patients in group A, 29 in group B, and 132 in group C. In group A, without any known complications, the mean reported ASES score decreased significantly from 64 at 6 months to 37.2 at one-year (p=0.0007). Mean VAS pain score at 6 months was 3 and increased to 7 at one-year postoperatively (p<0.0001). Conversely, in group B, the mean postoperative ASES score improved during the entire postoperative course, reaching a maximum of 84 by one-year. Mean VAS pain scores decreased at each postoperative time point. Group A showed significantly lower ASES scores at 6 months (p=0.01) and 1 year (p<0.01) when compared to group B. Patients in group C demonstrated a similar trend in ASES and pain scores as compared to group B, with improvements in both scores at each postoperative time-point. Branching logic significantly improved the ability to obtain accurate ASES scores for shoulder arthroplasty patients, both from their operated shoulder and the newly symptomatic contralateral shoulder. Implementation of a branching logic system decreases question burden while allowing for accurate collection of ASES and pain scores for patients undergoing shoulder arthroplasty. Basic Science Study, Development/Validation of Outcome Measures
 ASES score bilateral surgery outcomes patient reported outcomes shoulder arthroplasty shoulder surgery

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