Reliability and minimal detectable change of inclinometric shoulder mobility measurements

Shoulder Proprioception: A Review

The purpose of this review is to provide a comprehensive resource for shoulder proprioception assessment and its integration into clinical decision making as well as targeted rehabilitation protocols. Data for this review were acquired from peer-reviewed articles from computerized online databases, namely PubMed and Medline, published between 1906 and 2021. The development of digital/smart phone goniometers can improve shoulder joint range of motion (ROM) measurements and demonstrate comparable measurement accuracy to the universal standard goniometer. The inclinometer offers a portable and cost-effective method for measuring shoulder joint angles and arcs of motion in the vertical plane. Two types of dynamometers, the computerized isokinetic machine and the handheld hydraulic dynamometer, are reliable tools for objective shoulder rotator cuff strength assessment. Motion analysis systems are highly advanced modalities that create three-dimensional models of motion arcs using a series of cameras and reflective beads, offering unparalleled precision in shoulder proprioception measurement; however, they require time-consuming calibration and skilled operators. Advancements in wearable devices and compact mobile technology such as iPhone applications may make three-dimensional motion analysis more affordable and practical for outpatient settings in the future. The complex interplay between proprioception and shoulder dysfunction is not fully understood; however, shoulder proprioception can likely both contribute to and be caused by shoulder pathology. In patients with rotator cuff tears, glenohumeral osteoarthritis, and shoulder instability, clinicians can track proprioception to understand a patient's disease progression or response to treatment. Finally, rehabilitation programs targeting shoulder proprioception have shown promising initial results in restoring function and returning athletes to play.

An evidence-informed rehabilitation management framework for posterior shoulder tightness: A scoping review

Objective

To systematically scope the literature on posterior shoulder tightness (PST) and define a therapist-instructed and therapist-administered management framework.

Design

Scoping review.

Literature search

We searched MEDLINE, EMBASE, CINAHL, Scopus and Google Scholar from inception to December 2021.

Study selection criteria

Peer-reviewed studies written in English, French, Greek, Japanese or Tamil, with extractable pre- and post-intervention data. Physiotherapy interventions amenable for posterior shoulder structural (muscle, capsule) causes of PST within an adult population.

Data synthesis

Arksey and O'Malley's framework was implemented and the PRISMA extension for scoping reviews directed our data synthesis. The data charted from each study included authors, title, study year, location, study design; participant number, age, sex; PST intervention and parameters; patient-reported outcomes; and results. Themes were organized into therapist-instructed and therapist-administered rehabilitation strategies, as well as combined treatment methods.

Results

Of 2777 articles identified from our search strategy, 21 articles were included. Therapist-instructed interventions included cross-body stretch (CBS), sleeper stretch (SS), a combination of the two and general stretching. Therapist-administered interventions included CBS, SS, instrument-assisted soft tissue mobilization (IASTM), muscle energy techniques, dry needling and Fauls protocol (12 therapist-assisted stretches). Combined interventions of tape with self-stretching and IASTM and stretching were also identified.

Conclusion

Based on the current evidence, CBS and SS are the most researched treatments for PST and seem to be effective at improving PST. Furthermore, stabilization of the scapula while performing these stretches optimized the stretch targeted to the PST and ROM benefits for horizontal adduction.

Effects of Different Frequencies of Physical Therapy Visits on Shoulder Function After Arthroscopic Rotator Cuff Repair

OBJECTIVE

There is no consensus about the optimal frequency of patient visits during the rehabilitation program after arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the short- and long-term effects of high-frequency (HF) and low-frequency (LF) visits of the patients in the first 12 weeks of rehabilitation after ARCR.

METHODS

This was a quasi-randomized study with 2 parallel groups. Forty-seven patients with ARCR were included in 2 different patient visit frequency protocols (HF = 23, LF = 24) in 12 weeks of postoperative rehabilitation. Patients in the HF group visited the clinic twice a week, whereas patients in the LF group visited once every 2 weeks for the first 6 weeks and once a week for the following 6 weeks. Both groups performed the same exercise protocol. Outcome measurements were pain and range of motion measured at baseline; at the 3rd, 5th, 8th, 12th, and 24th weeks; and at 1-year follow-up. Shoulder function was assessed at the 12th and 24th weeks and at 1-year follow-up with an American Shoulder and Elbow Surgeons score.

RESULTS

There was a significant group × time interaction in pain intensity during the activity between the groups. The activity pain intensity was higher in the LF group (4.2 points) at 8 weeks post surgery than in the HF group (2.7 points) (mean difference: 1.5 points, P < .05), whereas it was similar in both groups at other time periods. The interaction term was not significant between the groups for pain intensity during rest and night through the 1-year follow-up. No group × time interactions were observed in shoulder range of motion and American Shoulder and Elbow Surgeons score over the postoperative period.

CONCLUSION

Both rehabilitation programs at different visit frequencies after ARCR showed similar clinical results in the long term. A supervised, controlled rehabilitation program with LF visits in the first 12 weeks after surgery can be sufficient to achieve optimal clinical results and reduce rehabilitation-related costs after ARCR.

IMPACT

This study highlights that LF treatment protocols under the supervision of the therapist can be adopted after the arthroscopic rotator cuff repair to achieve successful results while decreasing the treatment costs. Physical therapists should plan the treatment sessions efficiently for the compliance of the patients to the exercise treatment.

LAY SUMMARY

If you are a patient with arthroscopic rotator cuff repair, a supervised, controlled rehabilitation program with low-frequency visits in the first 12 weeks after surgery could help you achieve the best outcome and help lower the costs of rehabilitation. A total of 3 visits in the first 6 weeks might be sufficient (once every 2 weeks). More frequent visits (1-2 visits a week) should happen 6 to 12 weeks after the surgery.

Effect of Hypertonic Dextrose Injection on Pain and Shoulder Disability in Patients with Chronic Supraspinatus Tendinosis: A Randomized Double-Blind Controlled Study

OBJECTIVES

To investigate the effect of hypertonic dextrose injection on pain and disability in patients with chronic supraspinatus tendinosis. The secondary aim was to evaluate its effect on the tendon range of motion (ROM) and morphology.

DESIGN

Randomized double-blind placebo-controlled trial.

SETTING

Outpatient clinic.

PARTICIPANTS

Individuals (N=57) with symptomatic chronic supraspinatus tendinosis.

INTERVENTIONS

Participants were randomly administered ultrasound-guided injections of 20% hypertonic dextrose (study group, n=29) or 5% normal saline (control group, n=28).

MAIN OUTCOME MEASURES

The primary outcome measure was visual analog scale (VAS) scores for pain and Shoulder Pain and Disability Index (SPADI) scores. Secondary outcomes included the ROM and ultrasound examination findings of the supraspinatus tendon at baseline and at 2, 6, and 12 weeks postintervention.

RESULTS

The study group exhibited significant improvements in the VAS (mean difference [MD], -2.1; 95% confidence interval [CI], -2.7 to -1.4; P<.001) and SPADI (MD, -11.6; 95% CI, -16.5 to -6.7; P<.001) scores compared with baseline scores at week 2. However, the effect was not sustained to week 6. Flexion ROM increased at weeks 2 (MD, 14.1; 95% CI, 5.7-22.5; P<.001) and 6 (MD, 8.9; 95% CI, 2.4-15.4; P=.003) compared with baseline. The thickness of the supraspinatus tendon improved at weeks 6 (MD, .50; 95% CI, .26-.74; P<.001) and 12 (MD, .61; 95% CI, .37-.84; P<.001) compared with baseline. The ratio of histograms also improved at weeks 6 (MD, .19; 95% CI, .06-.32; P=.002) and 12 (MD, .26; 95% CI, .10-.41; P<.001) compared with baseline.

CONCLUSION

Hypertonic dextrose injection could provide short-term pain and disability relief in patients with chronic supraspinatus tendinosis. Ultrasound imaging at week 6 revealed changed tendon morphology.

Inclinometer Reliability for Shoulder Ranges of Motion in Individuals With Subacromial Impingement Syndrome

OBJECTIVE

This study aimed to determine the intra- and interrater reliability of active and passive range of motion in the shoulders of individuals with subacromial impingement syndrome using a digital inclinometer.

METHODS

The raters evaluated active and passive range of motion in the shoulder of 50 individuals with unilateral subacromial impingement syndrome in movements including flexion, abduction, extension, external rotation in a neutral position, external rotation with the arm at 90° of abduction, and internal rotation with the arm at 90° of abduction. The tests were performed by 2 examiners on the same day, with a 10-minute interval, and were repeated by 1 examiner after a 2- to 4-day interval. Reliability was analyzed using the intraclass correlation coefficient (ICC_2,3).

RESULTS

There was moderate to excellent interrater (ICC_2,3 = 0.50-0.95) and intrarater (ICC_2,3 = 0.74-0.94) reliability. In the interrater analysis, the standard error of measurement (SEM) ranged from 4.1° to 10°, the percentage SEM (%SEM) ranged from 2% to 17%, and the minimum detectable change ranged from 9.5° to 23.4°. In the intrarater analysis, the SEM ranged from 4° to 9.2°, %SEM ranged from 3% to 14%, and the minimum detectable change ranged from 9.3° to 21.4°.

CONCLUSION

The digital inclinometer showed moderate to excellent reliability for measuring active and passive range of motion in shoulders with unilateral subacromial impingement syndrome.

The acute effect in performing common range of motion tests in healthy young adults: a prospective study

In the application of range of motion (ROM) tests there is little agreement on the number of repetitions to be measured and the number of preceding warm-up protocols. In stretch training a plateau in ROM gains can be seen after four to five repetitions. With increasing number of repetitions, the gain in ROM is reduced. This study examines the question of whether such an effect occurs in common ROM tests. Twenty-two healthy sport students (10 m/12 f.) with an average age of 25.3 ± 1.94 years (average height 174.1 ± 9.8 cm; weight 66.6 ± 11.3 kg and BMI 21.9 ± 2.0 kg/cm²) volunteered in this study. Each subject performed five ROM tests in a randomized order—measured either via a tape measure or a digital inclinometer: Tape measure was used to evaluate the Fingertip-to-Floor test (FtF) and the Lateral Inclination test (LI). Retroflexion of the trunk modified after Janda (RF), Thomas test (TT) and a Shoulder test modified after Janda (ST) were evaluated with a digital inclinometer. In order to show general acute effects within 20 repetitions we performed ANOVA/Friedman-test with multiple comparisons. A non-linear regression was then performed to identify a plateau formation. Significance level was set at 5%. In seven out of eight ROM tests (five tests in total with three tests measured both left and right sides) significant flexibility gains were observed (FtF: p < 0.001; LI-left/right: p < 0.001/0.001; RF: p = 0.009; ST-left/right: p < 0.001/p = 0.003; TT-left: p < 0.001). A non-linear regression with random effects was successfully applied on FtF, RF, LI-left/right, ST-left and TT-left and thus, indicate a gradual decline in the amount of gained ROM. An acute effect was observed in most ROM tests, which is characterized by a gradual decline of ROM gain. For those tests, we can state that the acute effect described in the stretching literature also applies to the performance of typical ROM tests. Since a non-linear behavior was shown, it is the decision of the practitioner to weigh up between measurement accuracy and expenditure. Researchers and practitioners should consider this when applying ROM assessments to healthy young adults.

Intra- and inter-rater reliability of joint range of motion tests using tape measure, digital inclinometer and inertial motion capturing

Background

In clinical practice range of motion (RoM) is usually assessed with low-cost devices such as a tape measure (TM) or a digital inclinometer (DI). However, the intra- and inter-rater reliability of typical RoM tests differ, which impairs the evaluation of therapy progress. More objective and reliable kinematic data can be obtained with the inertial motion capture system (IMC) by Xsens. The aim of this study was to obtain the intra- and inter-rater reliability of the TM, DI and IMC methods in five RoM tests: modified Thomas test (DI), shoulder test modified after Janda (DI), retroflexion of the trunk modified after Janda (DI), lateral inclination (TM) and fingertip-to-floor test (TM).

Methods

Two raters executed the RoM tests (TM or DI) in a randomized order on 22 healthy individuals while, simultaneously, the IMC data (Xsens MVN) was collected. After 15 warm-up repetitions, each rater recorded five measurements.

Findings

Intra-rater reliabilities were (almost) perfect for tests in all three devices (ICCs 0.886–0.996). Inter-rater reliability was substantial to (almost) perfect in the DI (ICCs 0.71–0.87) and the IMC methods (ICCs 0.61–0.993) and (almost) perfect in the TM methods (ICCs 0.923–0.961). The measurement error (ME) for the tests measured in degree (°) was 0.9–3.3° for the DI methods and 0.5–1.2° for the IMC approaches. In the tests measured in centimeters the ME was 0.5–1.3cm for the TM methods and 0.6–2.7cm for the IMC methods. Pearson correlations between the results of the DI or the TM respectively with the IMC results were significant in all tests except for the shoulder test on the right body side (r = 0.41–0.81).

Interpretation

Measurement repetitions of either one or multiple trained raters can be considered reliable in all three devices.

A device-based stretch training for office workers resulted in increased range of motion especially at limited baseline flexibility

BACKGROUND

It is unclear whether and under which conditions stretch training programs lead to gains in flexibility when applied in work health promotion for office workers in order to reduce musculoskeletal disorders (MSD).

OBJECTIVE

The aim of this study was to analyze whether the stretch training "five-Business" leads to gains in range of motion (ROM). Furthermore, the influence of baseline flexibility and socio-demographic factors (sex, age, weight, height and body mass index (BMI)) on trainability was assessed.

METHODS

161 office workers (n = 45 female; n = 116 male) without major MSD were recruited. Over three months, a standardized static stretch training ("five-Business") was executed on a device, supervised twice per week for 10 min. ROM was assessed using a digital inclinometer (shoulder, hip and trunk extension) and a tape measure (fingertip-to-floor and lateral inclination).

RESULTS

ROM gains (p≤0.001) were present in all tests, except for the hip extension. ROM changes correlated moderately (0.24-0.62) with the baseline flexibility (p≤0.001). Subjects with limited flexibility reached the largest gains (1.41-25.33%). Regarding the socio-demographic factors only one low correlation occurred (weight - retroflexion; -0.177).

CONCLUSION

The "five-Business" stretch training effectively increases ROM in office workers, especially when baseline flexibility is limited.

Effects of Modified Posterior Shoulder Stretching Exercises on Shoulder Mobility, Pain, and Dysfunction in Patients With Subacromial Impingement Syndrome

BACKGROUND

Posterior shoulder stretching exercises (PSSEs) aim to reduce posterior shoulder tightness (PST). Position modification of traditional PSSEs has been suggested to minimize inadequate control of scapular and glenohumeral rotation, possibly leading to increased subacromial impingement.

HYPOTHESIS

Modified PSSEs will have positive effects on shoulder mobility, pain, and dysfunction.

STUDY DESIGN

Randomized controlled trial.

LEVEL OF EVIDENCE

Level 1.

METHODS

A total of 67 symptomatic patients with subacromial impingement syndrome (SIS) and shoulder internal rotation asymmetry were randomly assigned to 3 groups: modified cross-body stretch (MCS) (n = 22; treatment program + MCS), modified sleeper stretch (MSS) (n = 22; treatment program + MSS), and a control group (n = 23; treatment program consisting of only modalities, range of motion [ROM], and strength training but no PSSEs) for 4 weeks. Pain, PST, shoulder rotation ROM, and dysfunction were evaluated.

RESULTS

Pain, PST, shoulder rotation ROM, function, and disability improved in all groups (P < 0.05). The MCS and MSS groups had better results compared with the control group with regard to pain with activity, internal rotation ROM, function, and disability (P < 0.05). There was no significant difference between the stretching groups (P > 0.05).

CONCLUSION

All treatments improved pain, shoulder mobility, function, and disability in patients with SIS. However, modified PSSEs in addition to a treatment program was superior to the treatment program alone (without PSSEs) in improving pain with activity, internal rotation ROM, and dysfunction. Moreover, stretching provided clinically significant improvements.

CLINICAL RELEVANCE

Modified PSSEs, in addition to a treatment program, are beneficial for patients with SIS. Both modified cross-body and sleeper stretches are safe and efficacious for improving shoulder mobility, pain, and dysfunction.

Effects of Rigid and Kinesio Taping on Shoulder Rotation Motions, Posterior Shoulder Tightness, and Posture in Overhead Athletes: A Randomized Controlled Trial

Context:Alterations in posture and motion patterns are thought to play a role in developing shoulder injuries in overhead athletes. Taping is widely used in the sporting population, but there are limited empirical data regarding its effectiveness.Objectives:To determine and compare the effects of rigid and kinesio taping on shoulder rotation motions, posterior shoulder tightness (PST), and posture in overhead athletes.Design:Randomized controlled trial.Setting:Athletic training rooms.Participants:Eighty-six asymptomatic elite overhead athletes.Interventions:Participants were randomly divided into 4 groups: rigid taping group (RTG) that underwent therapeutic rigid taping, kinesio taping group (KTG) that underwent therapeutic kinesio taping, placebo group that underwent placebo kinesio taping (shoulder and scapular region taping for taping groups), and control group (no taping).Main Outcome Measures:Shoulder rotation motions, PST, and head and shoulder posture were evaluated at baseline, immediately after application and 60 to 72 hours after application for all groups.Results:Glenohumeral internal rotation increased immediately (P < .001) and at 60 to 72 hours after application in the KTG (P = .01), whereas it decreased immediately after application in the RTG (P < .001). Immediately after application, total rotation range of motion increased in the KTG (P =.02) and decreased in the RTG (P < .001), and there was a difference between groups (P = .02). Immediately after application, PST increased in the RTG (P < .001); after 60 to 72 hours, it decreased in the KTG (P = .04) and increased in the RTG (P = .01). Posture outcomes did not change significantly (P > .05).Conclusions:Kinesio taping may improve and rigid taping may worsen glenohumeral internal rotation and PST in overhead athletes. For increasing total rotation range of motion, kinesio taping is superior to rigid taping. Taping did not affect posture. Short-term kinesio taping in overhead athletes may be useful to improve glenohumeral internal rotation, total rotation range of motion, and PST.

Neck and Shoulder Motor Function following Neck Dissection: A Comparison with Healthy Control Subjects

Objective

To compare the neck and shoulder motor function of patients following neck dissection, including comparison with a group of healthy volunteers.

Study Design

Cross-sectional study.

Setting

Two tertiary hospitals in Brisbane, Australia.

Subjects and Methods

Participants included patients 0.5 to 5 years after unilateral nerve-sparing neck dissection and healthy control subjects. Demographic and clinical information was collected with cervical and shoulder motor function measures (scapular resting position, active range of motion, and isometric muscle strength). Differences between groups were examined via regression analyses that included statistical adjustment for the potential effect of age, sex, body mass index, and other disease-related variables.

Results

The 57 patients (68%, men; median age, 62 years) were typically older than the 34 healthy controls (47%, men; median age, 46 years). There were no differences between types of nerve-preserving neck dissection for any of the motor function measures. When adjusted for age, sex, and body mass index, healthy volunteers (vs patients) had significantly greater cervical range (eg, extension coefficient [95% CI]: 11.04° [4.41°-17.67°]), greater affected shoulder range (eg, abduction: 16.64° [1.19°-31.36°]), and greater isometric strength of the cervical flexors (eg, men: 4.24 kgf [1.56-6.93]) and shoulder flexors (eg, men: 8.00 kgf [1.62-14.38]).

Conclusions

Strength and flexibility of the neck and shoulder are impaired following neck dissection in comparison with healthy controls. Clinicians and researchers are encouraged to consider the neck—and the neck dissection as a whole—as a source of motor impairment for these patients and not just the status of the accessory nerve.

The reliability, validity, and methodologic quality of measurements used to quantify posterior shoulder tightness: a systematic review of the literature with meta-analysis

HYPOTHESIS AND BACKGROUND

Posterior shoulder tightness (PST) has been linked to numerous shoulder pathologies in both the general and athletic populations. Several methods for documenting PST have been described in the literature, which may lend to variability in clinical practice and research. The purpose of this study was to perform a systematic review with meta-analysis to investigate the reliability, validity, and methodologic quality of methods used to quantify PST.

METHODS

Relevant studies were assessed for inclusion, and selected studies were identified from the PubMed, Embase, Cochrane, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Data were extracted from the selected studies and underwent methodologic quality assessment and meta-analysis.

RESULTS

The search resulted in 1006 studies identified, with 18 ultimately retained. Intrarater reliability was reported in 12 studies with a summary intraclass correlation coefficient of 0.93 (95% confidence interval, 0.90-0.95), whereas inter-rater reliability was reported in 6 studies with a summary intraclass correlation coefficient of 0.89 (95% confidence interval, 0.80-0.94). Validity was reported in 10 studies, all using internal rotation as the convergent standard, and was found to be significant in all but 1 study.

CONCLUSION

Current methods used to quantify PST have good reliability but are primarily limited to measures of horizontal adduction of the glenohumeral joint with scapular stabilization. Limitations in using a single measurement technique exist particularly as there may be multiple contributing factors to PST. A more comprehensive approach for quantifying PST is necessary, and suggested components include a cluster of techniques composed of horizontal adduction, internal rotation, and total glenohumeral joint range of motion.

The office work and stretch training (OST) study: an individualized and standardized approach for reducing musculoskeletal disorders in office workers

Background

Musculoskeletal disorders (MSD) are a common health problem in office workers. In Germany, MSD (mainly back pain related) are the main cause of workdays lost to incapacity. This is not only bothersome for the employees, but also causes higher costs for the health system and employers. Workplace health promotion programmes (WHPP) can help to reduce this as they reach large target groups and are easily accessible. In this context, stretch training exercises have already proven to be effective. In the present study, a new approach focusing on trunk extension is to be investigated.

Methods

To evaluate the training device “five-Business”, 250 office workers will train two times a week for 3 months. The control group will consist of 100 office employees. The device “five-Business” enables five different full body exercises. The intervention will be evaluated before week one and after week twelve via three assessments: a) the Short Form-36 (SF-36) to record the general health status and health-related quality of life, taking into account physical, psychological and social factors, b) the Nordic Questionnaire to evaluate complaints of the musculoskeletal system, c) Range of Motion (ROM) measurements using a digital inclinometer and a measuring tape respectively.

Conclusion

The “five-Business” combines elements of yoga and the McKenzie fundamentals, taking into account the Myers myofascial pathways in a highly torso-oriented, standardized stretching program. Due to the given exercise execution on the device and the individual adjustment possibilities of the stretching position (body size and range of motion) by the abutment, all exercises are individualized and standardized at the same time. In comparison to existing stretching interventions, this is a new approach in the framework of reducing musculoskeletal disorders and improving the quality of life in workplace health promotion.

Intra-rater and inter-rater reliability of ultrasonographic measurements of acromion-greater tuberosity distance in patients with post-stroke hemiplegia

BACKGROUND

Glenohumeral subluxation (GHS) is reported in up to 81% of patients with stroke. Ultrasonographic measurements of GHS by measuring the acromion-greater tuberosity (AGT) have been found to be reliable for experienced raters.

OBJECTIVES

The primary aim was to assess the intra-rater reliability of measurements of AGT distance in people with stroke following a short course of rater training. A secondary aim was to compare the inter-rater reliability of these measurements between novice and experienced raters.

METHODS

Patients with stroke (n = 16; 5 men, 11 women; 74 ± 10 years) with 1-sided weakness who gave informed consent were recruited. Ultrasonographic measurements were recorded at the bedside by two physiotherapists with patients seated upright in a hospital chair. Reliability was assessed by intra-class correlation coefficients (ICCs) and the standard error of measurements (SEM). Minimum detectable change (MDC90) scores were used to estimate the magnitude of change that is likely to exceed measurement error.

RESULTS

Mean ± SD AGT distances on the affected and unaffected sides for rater 1 were 2.2 ± 0.7 and 1.7 ± 0.4 cm, respectively. Corresponding values for rater 2 were 2.5 ± 0.6 and 2.0 ± 0.4 cm. Intra-class correlation coefficient values for the affected and unaffected shoulders for rater 1 were 0.96 and 0.91, respectively. Corresponding values for rater 2 were 0.95 and 0.90.SEM and MDC90 for both affected and unaffected shoulders were ≤ 0.2 cm. Inter-rater reliability coefficients were 0.86 (affected) and 0.76 (unaffected) shoulders.

CONCLUSION

Ultrasonographic measurement of AGT distance demonstrates excellent intra-rater reliability for a novice rater. Inter-rater reliability of ultrasonographic measurement of AGT also demonstrates good reliability between novice and experienced raters.

Assessment of glenohumeral subluxation in poststroke hemiplegia: comparison between ultrasound and fingerbreadth palpation methods

BACKGROUND

Glenohumeral subluxation (GHS) is a common poststroke complication. Treatment of GHS is hampered by the lack of objective, real-time clinical measurements.

OBJECTIVE

The aims of this study were: (1) to compare an ultrasound method of GHS measurement with the fingerbreadth palpation method using a receiver operating characteristic curve (ROC) and (2) to report the sensitivity and specificity of this method.

DESIGN

A prospective study was conducted.

SETTING

The study was conducted in local hospitals and day centers in the southwest of England.

PATIENTS

One hundred five patients who had one-sided weakness following a first-time stroke (51 men, 54 women; mean age=71 years, SD=11) and who gave informed consent were enrolled in the study.

MEASUREMENTS

Ultrasound measurements of acromion-greater tuberosity (AGT) distance were used for the assessment of GHS. Measurements were undertaken on both shoulders by a research physical therapist trained in shoulder ultrasound with the patient seated in a standardized position. Fingerbreadth palpation assessment of GHS was undertaken by a clinical physical therapist based at the hospital, who also visited the day centers.

RESULTS

The area under the ROC curve was 0.73 (95% confidence interval [95% CI]=0.63, 0.83), suggesting that the ultrasound method has good agreement compared with the fingerbreadth palpation method. A cutoff point of ≥0.2 cm AGT measurement difference between affected and unaffected shoulders generated a sensitivity of 68% (95% CI=51%, 75%), a specificity of 62% (95% CI=47%, 80%), a positive likelihood ratio of 1.79 (95% CI=1.1, 2.9), and a negative likelihood ratio of 0.55 (95% CI=0.4, 0.8).

LIMITATIONS

Clinical therapists involved in the routine care of patients conducted the fingerbreadth palpation method. It is likely that they were aware of the patients' subluxation status.

CONCLUSION

The ultrasound method can detect minor asymmetry (≤0.5 cm) and has the potential advantage over the fingerbreadth palpation method of identifying patients with minor subluxation.

Effect of scapular stabilization during horizontal adduction stretching on passive internal rotation and posterior shoulder tightness in young women volleyball athletes: a randomized controlled trial

OBJECTIVE

To evaluate the effect of scapular stabilization during horizontal adduction stretching (cross-body) on posterior shoulder tightness (PST) and passive internal rotation (IR).

DESIGN

Randomized controlled trial with single blinding.

SETTING

Athletic club.

PARTICIPANTS

Asymptomatic volleyball players who are women with glenohumeral internal rotation deficit (N=60).

INTERVENTIONS

Subjects were randomly assigned to either horizontal adduction stretching with manual scapular stabilization (n=30) or horizontal adduction stretching without stabilization (n=30). Passive stretching was performed for 3- to 30-second holds in both groups.

MAIN OUTCOME MEASURES

Range of motion measurements of PST and IR were performed on the athlete's dominant shoulder prior to and immediately after the intervention.

RESULTS

Baseline mean angular measurements of PST and IR for all athletes involved in the study were 62°±14° and 40°±10°, respectively, with no significant difference between groups (P=.598 and P=.734, respectively). Mean PST measurements were significantly different between groups after the horizontal adduction stretch, with a mean angle of 83°±17° among the scapular stabilization group and 65°±13° among the nonstabilization group (P<.001). Measurements of IR were also significantly different between groups, with a mean angle of 51°±14° among the scapular stabilization group and 43°±9° among the nonstabilization group (P=.006).

CONCLUSIONS

Horizontal adduction stretches performed with scapular stabilization produced significantly greater improvements in IR and PST than horizontal adduction stretching without scapular stabilization.

Motion patterns in activities of daily living: 3- year longitudinal follow-up after total shoulder arthroplasty using an optical 3D motion analysis system

Background

Total shoulder arthroplasty (TSA) can improve function in osteoarthritic shoulders, but the ability to perform activities of daily living (ADLs) can still remain impaired. Routinely, shoulder surgeons measure range of motion (ROM) using a goniometer. Objective data are limited, however, concerning functional three-dimensional changes in ROM in ADLs after TSA in patients with degenerative glenohumeral osteoarthritis.

Methods

This study included ten consecutive patients, who received TSA for primary glenohumeral osteoarthritis. The patients were examined the day before, 6 months, and 3 years after shoulder replacement as well. We compared them with a control group (n = 10) without any shoulder pathology and measured shoulder movement by 3D motion analysis using a novel 3 D model. The measurement included static maximum values, the ability to perform and the ROM of the ADLs “combing the hair”, “washing the opposite armpit”, “tying an apron”, and “taking a book from a shelf”.

Results

Six months after surgery, almost all TSA patients were able to perform the four ADLs (3 out of 40 tasks could not be performed by the 10 patients); 3 years postoperatively all patients were able to carry out all ADLs (40 out of 40 tasks possible). In performing the ADLs, comparison of the pre- with the 6-month and 3-year postoperative status of the TSA group showed that the subjects did not fully use the available maximum flexion/extension ROM in performing the four ADLs. The ROM used for flexion/extension did not change significantly (preoperatively 135°-0° -34° vs. 3 years postoperatively 131° -0° -53°). For abduction/adduction, ROM improved significantly from 33°-0° -27° preoperatively to 76° -0° -35° postoperatively. Compared to the controls (118°) the TSA group used less ROM for abduction to perform the four ADLs 3 years postoperatively.

Conclusion

TSA improves the ability to perform ADL and the individual ROM in ADLs in patients with degenerative glenohumeral osteoarthritis over the course of 3 years. However, TSA patients do not use their maximum available abduction ROM in performing ADLs. This is not related to limitations in active ROM, but rather may be caused by pathologic motion patterns, impaired proprioception or both.

The effect of arm position on the ultrasonographic measurements of the acromion-greater tuberosity distance

Ultrasonographic measurements of acromion-greater tuberosity (AGT) distance have shown to be reliable and valid in the assessment of glenohumeral subluxation (GHS) in patients with stroke. The primary aim of this study was to investigate the effect of arm positions on ultrasonographic measurements of AGT distance. The secondary aim was to assess the intra-rater reliability of AGT distance in different arm positions. Sixteen healthy individuals with a mean age 28 standard deviation 11 years who gave informed written consent were recruited. Four clinically relevant arm positions for patients with stroke were selected: (1) arm hanging freely by the side; (2) forearm on a pillow placed on participants lap with the elbows at 90° flexion and the forearms in pronation; (3) as in position 2, but with the elbow supported and (4) shoulder in 10° of abduction and 60° of flexion with the arm resting on a pillow placed on a table. Repeated measures analysis of variance showed a statistically significant effect of arm positions on mean AGT measurements for the right (F (3, 45) = 51.2666, p < 0.001, effect size = 0.774) and left (F (3, 45) = 51.883, p < 0.001, effect size = 0.776) shoulders. AGT distance was significantly reduced in positions 3 and 4. Within-session intra-class correlation coefficients and the minimum detectable change values ranged from 0.94 to 0.97 and 0.1 to 0.2 cm, respectively, for all four positions. This preliminary study corroborates that supported arm position does reduce the AGT distance in healthy people suggesting ultrasonographic technique has potential to provide objective measurements in clinical management of patients with GHS.

Can glenohumeral joint isokinetic strength and range of movement predict injury in professional rugby league

OBJECTIVE

To isokinetically record shoulder strength scores and range of motion in a professional rugby league squad. To prospectively monitor injuries over a season looking for associations between measured variables and injury.

DESIGN

A cohort study design involving prospective screening of risk factors with subsequent injury surveillance.

SETTING

University Sports Science Laboratory and Professional Rugby League Club.

PARTICIPANTS

All players participating in the clubs reserve team squad for the 2011 season (n = 20).

MAIN OUTCOME MEASURES

Concentric (Con) and eccentric (Ecc) peak torque values; ratio of Ecc internal rotation IR to Con external rotation ER, also known as the dynamic control ratio (DCR), shoulder range of IR and ER.

RESULTS

Eight players (36%) received a total of eleven injuries over the season. There were no statistically significant differences between injured and non-injured shoulders. IR range of movement was significantly lower in injured versus non-injured groups with left (p = 0.022) and right (p = 0.024). Left IR range of movement was predictive of injury using binary logistic regression (p = 0.046). No isokinetic strength parameters reached statistical significance (p > 0.05) for prediction of injury; however size effects were apparent for reduced con IR of the left shoulder and Ecc IR of both shoulders.

CONCLUSION

Reduced shoulder IR range appears predictive of future shoulder injury although caution is drawn due to small participant numbers. Injury prevention strategies for rugby league players should include exercises to improve shoulder IR and possibly Ecc IR strength.

Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness

Background

Clinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness.

Methods

A randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive.

Results

Fifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage.

Conclusions

Massage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness.

Trial registration

This clinical trial is registered at Trial Registration "Trial registration: Clinicaltrials.gov NCT01022827".

Shoulder joint and muscle characteristics among healthy female recreational weight training participants

Shoulder disorders attributed to weight training are well documented in the literature, with prevalence rates exceeding that of the general population. Although researchers have identified both intrinsic and extrinsic risk factors among men who participate in weight training, a paucity of evidence-based research exists to describe risk factors inherent to participation among women. The purpose of this study was to investigate shoulder joint and muscle characteristics among healthy female recreational weight training (RWT) participants to determine specific risk-related adaptations that may occur from training. Eighty-eight women aged 18-55 (mean 26.8), including 57 who participated in upper extremity RWT and 31 controls with no record of RWT participation were recruited. Active range of motion (AROM), posterior shoulder tightness (PST), glenohumeral (GH) joint laxity, body weight-adjusted strength and strength ratios of force couples were compared between the RWT and control groups. Statistical analysis identified significant differences (p ≤ 0.004) between groups when analyzing shoulder internal rotation AROM, PST, and joint laxity. The RWT participants had decreased internal rotation AROM, greater PST, and anterior GH joint hyperlaxity when compared to the control group. No differences in strength ratios between groups were identified (p ≥ 0.109) implying the absence of weight training-induced muscle imbalances. The findings of this investigation suggest that female RWT participants are predisposed to mobility imbalances as a result of training. The imbalances identified in this investigation have been associated with shoulder disorders in both the general and athletic population thus may place weight training participants at risk for injury. Clinicians and strength and conditioning professionals should consider the biomechanical stresses and adaptations associated with RWT when prescribing exercises. Exercise prescription that mitigates mobility imbalances may serve to prevent injury in this population.