The Single Assessment Numeric Evaluation (SANE) Score in the Evaluation of Elbow Conditions: A Systematic Review
Teonna Sharpe, Mary Grannary DO, Aaron Skeene, Shantanu Amin, Alexander Featherstone, Lucia Guo, Raven Hollis, Rolanda Willacy MD* and Marvin Dingle MD
ABSTRACT
Introduction: The Single Assessment Numeric Evaluation (SANE) score is a patient reported outcome measure (PROM) increasingly used across orthopedics, with studies showing moderate to a very strong correlation with established tools such as ASES, WORC, and Quick Dash. However, reported MCID values vary widely, and most validations evidence forces on other joints, leaving elbow specific performance less understood. Given the limited research in elbow conditions and the growing need for efficient outcome measure by consolidating available evidence we aim to clarify the SANE scores utility in both clinical practice and research addressing elbow pathology.
Method: A PRISMA-guided systematic review of PubMed, Embase, and Scopus (2015–2025) identified studies evaluating the SANE score in patients with elbow pathology and comparing it with at least one validated elbow PROM (OES, ASES-Elbow, Quick DASH, or WORC). Cohort, case-control, and cross-sectional designs were eligible. Conference abstracts, non-English studies, and studies lacking comparison data were excluded. Six reviewers independently screened titles, abstracts, and full texts.
Results: Of 28 screened studies, 4 met criteria, representing 844 patients with diverse elbow conditions. Across studies, SANE demonstrated moderate to strong correlations with established PROMs. SANE correlated strongly with the Oxford Elbow Score (r = 0.903), including psychosocial (r = 0.885), function (r = 0.847), and pain (r = 0.804) domains, and inversely with VAS pain (r = –0.631). Correlation with the ASES-Elbow was moderate (r = 0.623), as was correlation with Quick DASH (r = –0.537). One study reported a minimal important difference (MID) of 0.8 and smallest detectable change (SDC) of 1.94 for SANE, values lower than those of OES and Quick DASH, suggesting high sensitivity to change.
Conclusion: The SANE score shows moderate to strong validity compared with established elbow-specific PROMs and offers a quick, patient-centered measure of elbow function. However, variation in correlation strength and a limited number of elbow-specific studies suggest that SANE should complement rather than replace comprehensive PROMs. Additional research is needed to refine elbow-specific MCID values and evaluate responsiveness across broader patient populations
