Leanda McKenna

The validity and intra-tester reliability of a clinical measure of humeral head position

The purpose of this study was to determine the degree of criterion validity and intra-tester reliability of humeral head palpation in subjects with shoulder pathology. The study also sought to determine whether there was any effect of arm position on humeral head position in subjects with shoulder pathology. In a same day repeated measures design, 27 subjects had the distance between the most anterior portion of the humeral head and the anterior edge of the acromion measured by a radiologist using MRI (supine), and by a physiotherapist using palpation and photography (supine, sit with arm in neutral and in abduction). The Standard Error of Measurement (SEM) for the difference between MRI and palpation ranged from 3.4 to 4.4mm and correlated significantly with palpation measures in sit (r=0.57-0.64, p<or=0.002). The Intraclass Correlation Coefficients (ICCs) and SEMs for intra-tester reliability were 0.85 and 2.6mm for supine, 0.86 and 2.2mm for sit (glenohumeral neutral), and 0.91 and 3.0mm for sit (glenohumeral abduction). Significant differences between the positions of sit neutral and sit with abduction were found (p<0.001). Humeral head palpation in sit abduction demonstrates sufficient validity and reliability for clinical use.

Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis

Background It is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes. Objectives To determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis. Methods A systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis. Results Five studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24 months follow-up (RR=1.43, 95% CI 1.05 to 1.93). Conclusions Athletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.

The inter-tester reliability of humeral head position in junior swimmers

OBJECTIVES To determine the inter-tester reliability of a clinical measure of humeral head position. DESIGN Same day repeated measures inter-tester reliability study. SETTING 2 Western Australian Aquatic Centres. PARTICIPANTS 15 Junior elite swimmers were measured by 3 investigators. MAIN OUTCOME MEASURES The distance between the most anterior part of the humeral head and the anterior acromion was measured with shoulder in neutral position and hands on hips position. RESULTS The humeral head SEMs ranged from 2.4 to 3.2 mm. ICCs were 0.60-0.68 in the hands on hips position and 0.49 in the neutral position. Significant differences existed between testers for some humeral head measures. CONCLUSIONS Humeral head in the hands on hips position measure appears to be a clinically useful tool in assessment of the shoulder in young athletes.

Differences in scapular and humeral head position between swimmers and non-swimmers

The aims of this study were to determine differences between swimmers/non‐swimmers, males/females and dominant/non‐dominant sides for scapular and humeral head position, while accounting for size, and to determine the relationship between scapular and humeral head position. 46 teenage swimmers (30 females) and 43 non‐swimmers (28 females) were measured. The distances between (a) medial spine of the scapula and T3/4 (Superior Kibler), (b) inferior scapula and T7/8 (Inferior Kibler) and (c) anterior acromion and anterior humeral head were recorded while teenagers stood with their hands‐on hips. There was no main effect difference between swimmers and non‐swimmers for scapular or humeral head position. There were interactions for swim status/dominance (Superior Kibler; P=0.005, Inferior Kibler; P<0.001) and swim status/gender (Superior Kibler; P=0.027). The humeral head was significantly further from the acromion on the dominant side (adjusted mean difference=1.4 mm, P=0.004). Little relationship between scapular and humeral head position was evident. Clinicians should be aware that swim status, in combination with gender or dominance may affect scapular position but does not affect humeral head position. Where swimming had an effect, it minimized differences between genders and sides. The small dominance effect on the humeral head position is unlikely to be clinically detectable.

The inter-tester reliability of anthropometric measurement with portable tools

Abstract Aim: To determine whether height, weight, body mass index (BMI) and chest width, as measured using portable tools, have adequate inter-tester reliability for use in field-based research. Methodology: Same-day repeated-measures inter-tester reliability study in 15 adolescent swimmers and three testers. Height was taken with a portable stadiometer and weight with a digital floor scale. BMI was calculated using weight in kilograms/height in metres squared. Chest width was measured at the level of the inferior border of the spinous process of T7 at the end of expiration, with an anthropometer. Major findings: The SEMs were 3.8 mm for height, 0.48 kg for weight, 0.22 kg/m2 for BMI and 12.8 mm for chest width. Intra-class coefficients (ICCs) for the anthropometric variables were all above 0.98, except for chest width (0.80). Significant differences between testers for height and chest width existed, but not for weight and BMI. Conclusions: Anthropometric measures that are measured using field-based tools have acceptable inter-tester reliability for use in field-based assessment.

Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: A systematic review and meta-analysis

ABSTRACT The relationship between subacromial pain syndrome (SAPS) and altered scapular movement has been previously reported. The purpose of this review was to determine the effect of interventions that focus on addressing scapular components to improve shoulder pain, function, shoulder range of motion (ROM), and muscle strength in adults with SAPS. Databases searched in September 2016 were: PubMed, the Cochrane Central Register of Controlled Trials [Central], EMBASE [via Ovid] and PEDro. All studies selected for this review were randomized controlled trials. In total, six studies met the inclusion criteria and were included in the meta-analyses. In adults with SAPS, scapular focused interventions significantly improved pain with activities (MD [95% CI] = −0.88 [−1.19 to −0.58], I2 43%) and shoulder function (−11.31 [−17.20 to −5.41] I2 65%) in the short term. No between-group difference in shoulder pain and function were found at follow up (4 weeks). A between-group difference in shoulder abduction ROM in the short term only was found (12.71 [7.15 to 18.26]°, I2 36%). No between-group difference in flexion ROM, supraspinatus muscle strength, pectoralis minor length or forward shoulder posture were found. In conclusion, in adults with SAPS, scapular focused interventions can improve short-term shoulder pain and function.

Measurement of muscle thickness of the serratus anterior and lower trapezius using ultrasound imaging in competitive recreational adult swimmers, with and without current shoulder pain

OBJECTIVES To compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging. DESIGN A single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers. METHODS Muscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm. RESULTS There was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group. CONCLUSIONS There appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain.

Differences in Scapular Orientation Between Standing and Sitting Postures at Rest and in 120° Scaption: A Cross-Sectional Study

Scapular orientation may be influenced by static body posture (sitting and standing) and contribute to the development of shoulder pain. Therefore, a consistent body posture should be considered when assessing scapular orientation as well as enhancing optimal scapular positioning.

Reliability and Validity of the Measurement of Scapular Position Using the Protractor Method

Background The protractor method is a proposed clinical assessment tool, the first to measure vertical scapular position, that directly compares scapular and spinal landmarks. This tool has the potential to reliably and accurately measure excessive scapular elevation or depression. Objective The purpose of this study was to determine reliability and validity of the protractor method to measure resting scapular position. Design An interrater and intratester reliability and validity study was conducted. Methods Testing was conducted on the same day by 2 physical therapists who were blinded to each others results. The vertical distances between the spinous process of C7 and the superior margin of the medial aspect of the spine of the scapula (C7 method) and the spinous process of T8 and the inferior angle of the scapula (T8 method) were palpated and measured on the symptomatic shoulder in 34 people with current shoulder pain using the protractor method. Measurements were compared with 2-dimensional camera analysis to assess validity. Results For intertester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were 6.3 mm, 17.3 mm, and .78, respectively, for the C7 method and 5.7 mm, 15.7 mm, and .82, respectively, for the T8 method. For intratester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were <0.9 mm, <2.5 mm, and .99, respectively. For validity, significant correlations (r) and mean differences were .83 and 10.1 mm, respectively, for the C7 method and .92 and 2.2 mm, respectively, for the T8 method. Limitation The results of this study are limited to static measurement of the scapula in one plane. Conclusion Both protractor methods were shown to have good reliability and acceptable validity, with the T8 method demonstrating superior clinical utility. The clinical use of the T8 method is recommended for measurement of excessive resting scapular elevation or depression.