Mayo Performance Elbow Score (MEPS): Understanding Its Components, Interpretation, and Importance

What is Mayo Performance Elbow score?

The Mayo Performance Elbow Score (MEPS) is a widely utilized, clinician-administered outcome measure designed to objectively assess the functional status and pain levels of a patient's elbow following injury, surgery, or during the course of a condition.

Understanding the Mayo Performance Elbow Score (MEPS)

The Mayo Performance Elbow Score (MEPS), sometimes referred to as the Mayo Elbow Performance Score, is a crucial tool in orthopedic and rehabilitation medicine. Developed by Morrey et al. at the Mayo Clinic, its primary purpose is to provide a standardized, quantitative method for evaluating the overall function of the elbow joint. This score helps healthcare professionals, including orthopedic surgeons, physical therapists, and kinesiologists, to:

• Assess Baseline Function: Establish a starting point for a patient's elbow health before intervention.
• Monitor Progress: Track improvements or declines in elbow function over time, especially during rehabilitation.
• Evaluate Treatment Efficacy: Determine the success of surgical procedures, physical therapy, or other interventions.
• Facilitate Research: Provide a consistent measure for comparing outcomes across different studies and patient cohorts.

The MEPS moves beyond simple range of motion measurements by incorporating subjective patient experience (pain) with objective physical findings and functional capabilities, offering a more holistic view of elbow health.

Components of the MEPS

The MEPS is a 100-point scale comprising four distinct categories, each weighted differently to reflect its importance in overall elbow function. A higher score indicates better elbow performance. The categories are:

• Pain (45 points): This is the most heavily weighted component, reflecting the significant impact pain has on a patient's quality of life and functional capacity.
  • No pain: 45 points
  • Mild pain: 30 points
  • Moderate pain: 15 points
  • Severe pain: 0 points
• Arc of Motion (20 points): This objective measure assesses the range of movement at the elbow joint, specifically flexion-extension and pronation-supination.
  • >100 degrees (flexion-extension arc): 20 points
  • 75-100 degrees: 15 points
  • 50-74 degrees: 10 points
  • <50 degrees: 5 points
  • Note: Some versions of the MEPS also factor in pronation/supination, but the primary focus is often on the flexion-extension arc.
• Stability (10 points): This component evaluates the integrity of the elbow joint's ligaments and structures, assessing for any abnormal laxity or instability.
  • Stable: 10 points
  • Mild instability: 5 points
  • Gross instability: 0 points
• Function (25 points): This section assesses the patient's ability to perform everyday activities involving the elbow. It's often evaluated through a series of questions or observations.
  • Ability to perform activities of daily living (ADLs) without difficulty: Points are awarded based on the level of independence and ease in performing specific tasks like eating, hygiene, dressing, and carrying objects. A common breakdown awards points for the ability to:
    • Eat: 5 points
    • Hygiene: 5 points
    • Dress: 5 points
    • Perform personal activities: 5 points
    • Carry 5kg: 5 points

The maximum possible score is 100 points, indicating excellent elbow function and no pain.

Interpreting MEPS Scores

The total MEPS score is categorized into performance levels, providing a quick interpretation of the patient's elbow status:

• 90-100 points: Excellent
  • Indicates near-normal or full elbow function with minimal to no pain.
• 80-89 points: Good
  • Suggests satisfactory function with some minor limitations or occasional mild pain.
• 60-79 points: Fair
  • Implies moderate functional limitations and/or moderate pain, potentially impacting daily activities.
• <60 points: Poor
  • Indicates severe functional limitations, significant pain, and often a need for further intervention or extensive rehabilitation.

These categories guide clinicians in assessing treatment effectiveness and planning future care.

Why the MEPS Matters in Rehabilitation and Training

For fitness professionals, trainers, and kinesiologists, understanding the MEPS provides valuable context when working with clients recovering from elbow injuries or conditions. While direct administration is typically reserved for medical professionals, the underlying principles are highly relevant:

• Objective Assessment: The MEPS provides a structured way to quantify the impact of an elbow condition, moving beyond subjective complaints. This helps in setting realistic goals for rehabilitation and training.
• Guiding Exercise Progression: Knowledge of the MEPS components (pain, range of motion, stability, function) directly informs exercise selection and progression. For instance, a low MEPS due to poor range of motion would prioritize mobility drills, while a low score due to instability would emphasize stabilization exercises.
• Identifying Deficits: A breakdown of the MEPS components helps pinpoint specific areas of deficit (e.g., persistent pain despite good range of motion, or excellent range of motion but poor functional ability), allowing for targeted intervention strategies.
• Facilitating Communication: Understanding the language of MEPS allows for more effective communication with physical therapists, orthopedic surgeons, and other healthcare providers involved in a client's care, ensuring a cohesive approach to recovery.
• Monitoring Progress: Although not directly administering the score, fitness professionals can track improvements in their clients' pain levels, range of motion, stability during exercise, and ability to perform functional movements, aligning with the MEPS criteria.

Limitations and Considerations

While the MEPS is a valuable tool, it's essential to acknowledge its limitations:

• Subjectivity: The "Pain" and "Function" components rely on patient self-reporting, which can be subjective and influenced by individual pain tolerance or perception.
• Lack of Specificity: While comprehensive, it doesn't diagnose specific pathologies. A low score indicates a problem but doesn't pinpoint the exact cause (e.g., tendonitis vs. arthritis).
• Clinical Context Required: The score should always be interpreted within the broader clinical context, considering the patient's medical history, physical examination findings, and imaging results. It is not a standalone diagnostic tool.
• Ceiling Effect: For patients with excellent recovery, the score may not capture subtle improvements beyond the "Excellent" category.

Conclusion

The Mayo Performance Elbow Score is an indispensable, evidence-based instrument for evaluating elbow function and pain. Its structured approach provides clinicians with a standardized method to assess the severity of elbow conditions, monitor recovery progress, and evaluate the effectiveness of various treatments. For fitness and exercise science professionals, understanding the MEPS components enhances their ability to design effective, targeted programs for clients with elbow issues, fostering a more informed and integrated approach to rehabilitation and performance.