Carter-Rowe Score: what it is, and how to use it in Ninsaúde Apolo

Defined by the sum of the scores achieved in an evaluation, the Score helps health professionals to obtain a more accurate diagnosis in their care.

When it comes to the area of orthopedics, there are several specific questionnaires for assessing shoulder instability, including the WOSI (The Western Ontario Shoulder Instability Index) questionnaire, the Oxford Shoulder Instability Questionnaire, the Melbourne Instability Shoulder Scale, and what we will cover today, the Rowe questionnaire.

The Carter-Rowe Score has become a necessary assessment questionnaire for anamnesis, even done over the phone, when follow-up examinations are required after Bankart arthroscopic surgery. Research on PubMed.gov and MedPilot.de showed, however, that there were four different versions of Rowe's Score.

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The first three versions date from 1978, 1981, and 1982, published in The Journal of Bone & Joint Surgery. The fourth and last revised version was published by Carter R. Rowe in 1988 in his book "The Shoulder".

The original Rowe score is an instrument completed by the doctor in 3 steps. His questions address the categories of stability, movement, and function of the shoulder. Scores range from 0 to 100, where:

• 90 to 100 points: indicates an excellent rating;
• 75 to 89 points: indicates a good rating;
• 51 to 74 points: indicates a moderate assessment;
• 0 to 50 points: indicates a bad rating.

After some studies, some translations were defined for Rowe's questionnaire into Portuguese. Check below the translation used by health professionals in Brazil, and the score for each item:

Section 1 - Stability:

• No recurrence, subluxation or seizure = 50
• Apprehension when placing the arm in certain positions = 30
• Subluxation (not requiring reduction) = 10
• Recurring dislocation = 0

Section 2 - Movement

• 100% of normal internal rotation, external rotation and elevation = 20
• 75% of normal internal rotation, external rotation and elevation = 15
• 50% of normal internal rotation, external rotation and elevation = 5
• 50% of normal elevation and internal rotation, without external rotation = 0

Section 3 - Function

• No work or sports limitations, little or no discomfort = 30
• Discreet limitation and minimal discomfort = 25
• Moderate limitation and discomfort = 10
• Marked limitation and pain = 0

How to use the Carter-Rowe Score in Ninsaúde Apolo?

The medical software Ninsaúde Apolo has the functionality of form templates, where the health professional can include questionnaires that will be used in the care. These questionnaires are for the professional to perform a better investigation and documentation of the patient's symptoms and problems, in a practical and agile way. With the form ready, just add the answers. You can learn more about this feature in our article "Ninsaúde Apolo forms: a tool for all specialties".

The healthcare professional can create their forms by accessing the Form Templates menu and then pressing the New button, which is on the upper right side of the screen. If you prefer, you can import our model which is available on the Import button, just search for your specialty and select the desired form.

The forms of Ninsaúde Apolo also have the calculated field, for this reason, when selecting the answers given by the patient, the health professional obtains the score result automatically, without the need to perform calculations manually. Observe in the example below how it works:

As new appointments are made for the same patient, using the same form, the health professional can use the Graphics tab to make a comparison between the results obtained. The graph can be viewed in a row, column, or even table formats:

Who was Carter R. Rowe?

Carter Redd Rowe (1906 - 2001), was born in Fredericksburg, Virginia, where he also passed away, at the age of 94. Rowe was a prominent Boston Shoulder Surgeon who also served as an important sports medicine physician during his career.

Carter R. Rowe was Boston's first true shoulder specialist, and during his career developed advanced concepts for surgical treatment of shoulder injuries, including Bankart's Instability Repair. His publications on the management of shoulder instability formed the “gold standard” for dealing with these problems.

His name has become synonymous with the Boston shoulder tradition, and his clinical experience formed the basis for the development of many arthroscopic methods to treat shoulder instability.

Not only was he a founding member of the American Shoulder and Elbow Surgeons (ASES) Society and the American Orthopedic Society for Sports Medicine (AOSSM), but he was also president of the American Orthopedic Association (AOA), one of the most prestigious organizations in Orthopedics.

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Source: Boston Shoulder Institute | Journal of Shoulder and Elbow Surgery | SciELO