Test validity and intra-rater reliability in the measurement of scapular position sense in asymptomatic young adults

Reduced shoulder proprioception due to fatigue after repeated handball throws and evaluation of test-retest reliability of a clinical shoulder joint position test

Background

Proprioception is vital for motor control and can be disturbed, for example, due to fatigue or injury. Clinical feasible, reliable and valid tests of shoulder proprioception are warranted. The aim was to investigate the effects of local fatigue on shoulder proprioception and the reliability of a feasible joint position sense test using an experimental repeated measures design.

Method

Forty participants repeated a shoulder joint position sense test to assess test-retest reliability. The test was then utilized on a subgroup of handball players who were subjected to five bouts of a repeated throwing task with the dominant hand. The effect of local fatigue was investigated by comparing the fatigued with the non-fatigued shoulder.

Results

There was a significant interaction for the arm × bout (p = 0.028, ηp2 = 0.20) and a significant effect for the arm (p = 0.034, ηp2 = 0.35) with a significant decrease in joint position sense for the throwing arm compared to the non-throwing arm. The intraclass correlation coefficient was 0.78 (95% CI = [0.57; 0.89]). The standard error of measurement between trials was 0.70° (range: 0.57°-0.90°).

Discussion

The results indicate that repeated throwing to fatigue disturbs shoulder joint position sense. Assessment with the modified test showed acceptable reliability and can be a valuable assessment tool in the clinic.

The effects of muscle fatigue on scapulothoracic joint position sense and neuromuscular performance

BACKGROUND

Fatigue of the scapular musculature might affect the sensorimotor system and neuromuscular control and therefore impair the dynamic alignment of the scapula. The purpose of this study was to investigate the effects of scapular muscle fatigue on joint position sense and the neuromuscular performance of the scapulothoracic joint.

METHODS

Thirty healthy subjects were recruited. The joint position sense (measured as reposition errors during the scapular elevation and protraction task) of the scapulothoracic joint and scapular kinematics and muscle activation (% of maximum voluntary isometric contraction) during scaption, shoulder elevation in the scapular plane, before and after the fatigue task (modified push-up) were measured. The repeated measures analysis of variance (ANOVA) was used to assess the effects of fatigue on scapular reposition error and neuromuscular control.

RESULTS

Although joint reposition sense did not change after fatigue, muscle activation of the serratus anterior increased significantly (18.5%-26.3%, p = 0.006, elevation task; 15.2%-27.4%, p = 0.037, protraction task). At 120° scaption, the scapula showed a decreased posterior tilt (13.8°-10.3°, p < 0.001), increased protraction (10.2°-13.3°, p = 0.004) and lateral rotation (52.8°-54.4°, p = 0.005). Muscle activation of the serratus anterior increased (65.9%-84.6%, p = 0.002) during 90°-120°scaption.

CONCLUSION

Scapular muscle fatigue did not alter the scapulothoracic joint position sense, but increased serratus anterior activation and resulted in a more anteriorly tilted, protracted, and laterally rotated scapula during scaption. Whether or not these fatigue-related changes are linked to the development of shoulder problems needs to be investigated further.

Shoulder and elbow joint position sense assessment using a mobile app in subjects with and without shoulder pain - between-days reliability

OBJECTIVES

To determine between-days reliability and the minimal detectable change for shoulder and elbow joint position sense assessment using a validated mobile app, in subjects with and without shoulder pain.

DESIGN

Reliability study.

SETTING

Clinical measurement.

PARTICIPANTS

Subjects with (n = 25) and without shoulder pain (n = 29).

MAIN OUTCOME MEASURES

Subjects were assessed by the same examiner in two sessions, with one-week interval. Active joint repositioning tests of shoulder flexion and scaption and elbow flexion were assessed at the target-angles of 50°, 70°, 90° and 110°. Intra-class correlation coefficient, standard error of measurement and minimal detectable change were calculated for constant, absolute, total and variable errors.

RESULTS

Good to excellent reliability was found for constant, absolute and total errors at the target-angle of 50° of scaption for healthy subjects; at 110° of shoulder flexion and all target-angles for elbow for both groups.

CONCLUSIONS

The mobile app is a reliable tool and may be useful for assessing shoulder joint position sense mainly at 110° of flexion and for elbow between 50° and 110° of flexion in subjects with and without shoulder pain. Minimal detectable changes were demonstrated and may help clinicians to follow-up rehabilitation and researchers to interpret findings of studies.

Effects of Kinesiology Taping on Scapular Reposition Accuracy, Kinematics, and Muscle Activity in Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Study

CONTEXT

Scapular proprioception is a key concern in managing shoulder impingement syndrome (SIS). However, no study has examined the effect of elastic taping on scapular proprioception performance.

OBJECTIVE

To investigate the immediate effect of kinesiology taping (KT) on scapular reposition accuracy, kinematics, and muscle activation in individuals with SIS.

DESIGN

Randomized controlled study.

SETTING

Musculoskeletal laboratory, National Yang-Ming University, Taiwan.

PARTICIPANTS

Thirty overhead athletes with SIS.

INTERVENTIONS

KT or placebo taping over the upper and lower trapezius muscles.

MAIN OUTCOME MEASURES

The primary outcome measures were scapular joint position sense, measured as the reposition errors, in the direction of scapular elevation and protraction. The secondary outcomes were scapular kinematics and muscle activity of the upper trapezius, lower trapezius, and serratus anterior during arm elevation in the scapular plane (scaption).

RESULTS

Compared with placebo taping, KT significantly decreased the reposition errors of upward/downward rotation (P = .04) and anterior/posterior tilt (P = .04) during scapular protraction. KT also improved scapular kinematics (significant group by taping effect for posterior tilt, P = .03) during scaption. Kinesiology and placebo tapings had a similar effect on upper trapezius muscle activation (significant taping effect, P = .003) during scaption.

CONCLUSIONS

Our study identified the positive effects of KT on scapular joint position sense and movement control. Future studies with a longer period of follow-up and clinical measurement might help to clarify the clinical effect and mechanisms of elastic taping in individuals with SIS.

Shoulder proprioception: How is it measured and is it reliable? A systematic review

STUDY DESIGN

Systematic review.

INTRODUCTION

Constituents of proprioception include our awareness of the position (joint position sense [JPS]) and motion (kinesthesia) of our limbs in space. Proprioceptive deficits are associated with musculoskeletal disorders but remain a challenge to quantify, particularly at the shoulder.

PURPOSE OF THE STUDY

To report the psychometric values of validity, reliability, and responsiveness for shoulder JPS and/or kinesthesia protocols.

METHODS

A review of 5 databases was conducted from inception to July 2016 for studies reporting a psychometric property of a shoulder proprioception protocol. The included studies were evaluated using the QualSyst checklist and COSMIN 4-point scale.

RESULTS

Twenty-one studies were included, yielding 407 participants and 553 evaluated shoulders (n). The included studies support excellent methodological scores using the QualSyst checklist (88.1 ± 9.9%) and good psychometric scores with the COSMIN for reliability (71.1%) and moderate-to-low quality score (50%) for criterion validity. Weighted average intraclass correlation coefficients (ICCs) for intrarater reliability were highest for passive JPS and kinesthesia, ICC = 0.92 ± 0.07 (n = 214) and ICC = 0.92 ± 0.04 (n = 74), respectively. The most reliable movement and tool are internal rotation at 90° of abduction, ICC = 0.88 ± 0.01 (n = 53), and the dynamometer, ICC = 0.92 ± 0.88 (n = 225). Only 2 studies quantify an aspect of validity and no responsiveness indices were reported among the included studies.

CONCLUSION

Based on the results of the included studies, the evaluation of shoulder proprioception is most reliable when using a passive protocol with an isokinetic dynamometer for internal rotation at 90° of shoulder abduction. Standardized protocols addressing the psychometric properties of shoulder proprioception measures are needed.

LEVEL OF EVIDENCE

Level 1a: systematic review.

Errors in Shoulder Joint Position Sense Mainly Come from the Glenohumeral Joint

While synchronous movement of the glenohumeral and scapulothoracic joints has been emphasized in previous kinematics studies, most investigations of shoulder joint position sense have treated the shoulder complex as a single joint. The purposes of this study were to investigate the joint position sense errors of the humerothoracic, glenohumeral, and scapulothoracic joints at different elevation angles and to examine whether the errors of the glenohumeral and scapulothoracic joints contribute to the errors of the humerothoracic joint. Fifty-one subjects with healthy shoulders were recruited. Active joint position sense of the humerothoracic, glenohumeral, and scapulothoracic joints was measured at 50°, 70°, and 90° of humerothoracic elevation in the scapular plane. The results showed that while scapulothoracic joint position sense errors were not affected by target angles, there was an angle effect on humerothoracic and glenohumeral errors, with errors decreasing as the target angles approached 90° of elevation. The results of a multiple regression analysis revealed that glenohumeral errors explained most of the variance of the humerothoracic errors and that scapulothoracic errors had a weaker predictive relationship with humerothoracic errors. Therefore, it may be necessary to test scapular joint position sense separately in addition to the assessment of the overall shoulder joint position sense.