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PubMed1998

[Treatment strategy in first traumatic anterior dislocation of the shoulder. Plea for a multi-stage concept of preventive initial management].

The purpose of this paper is to outline the treatment protocol for the first time traumatic anterior shoulder dislocator, with options including conservative, arthroscopic and open surgical treatment. Regarding the subclassification of the first time traumatic anterior dislocater, it is imparitive to differentiate between the unidirectional dislocator with and without hyperlaxity. This subclassification takes into account the structural quality of the stabilizing ligamentous structures of the glenohumeral capsule. The patient with hyperelastic ligaments exhibit elastic deformation of the glenohumeral ligaments at the time of dislocation and thus, sustain less interstitial structural damage to the ligament. Therefore, these patients benefit from non-operative treatment. There are extrinsic and intrinsic factors which determine the outcome of the primary traumatic anterior shoulder dislocation. Extrinsic factors are those that are not related to changes in the shoulder morphology. The most important extrinsic factor is the age of the patient at the time of injury. The younger the patient at the time of injury the greater the risk of recurrence. As a rule, those patients 25 years of age or less, at the time of initial injury are less likely to spontaneously stabilize without surgical intervention, than they are to develop recurrence. Secondly, the type and level of sport participation is related to recurrence. Although the severity of the trauma can not be quantified, it certainly has an influence on recurrence. Immobilization remains controversial. A rehabilitation program is more likely to be successful in atraumatic instability. Patient compliance is important regardless of the type of treatment selected. Intrinsic factors include injury to the various anatomic structures about the shoulder, occurring at the time of primary anterior shoulder dislocation. A deep Hill Sachs lesion is more likely to result in recurrence secondary to both the impaction of the bone, as well as, the reduction of the area of articular surface. A displaced bony Bankart is a highly unstable situation secondary to the loss of the butress to retain the humeral head. In contrast to a Hill Sachs lesion or a bony Bankart, a concomittent fracture of the greater tuberosity is unlikely to result in recurrent dislocation. Isolated laberal detachment is not related to recurrence, but a complete disruption of the laberal ligament complex is highly correlated with recurrence. A rare subluxation erecta, as a special form of traumatic inferior instability, has a high recurrence rate. With increasing age there is a higher risk of concomittent rotator cuff tear. In most situations surgical repair of the rotator cuff tear results in resolution of the instability. The essential issue in determining the treatment protocol is to define concomittent hyperlaxity in the injured shoulder. Concomittent hyperlaxity precludes initial surgical treatment. The orthopedic surgeon treating the patient at the time of injury needs to design a concise treatment protocol for the patient based on the assessment of the extrinsic and intrinsic factors. An unreducable shoulder dislocation or associated vascular injury requires emergent intervention. Absolute indications for surgical treatment include: persistent dislocation, bony Bankart, a grossly displaced greater tuberosity fracture, and rupture of the subscapularis tendon. Surgical stabilization of primary anterior traumatic dislocation is indicated if the following strict criteria are met: adequate trauma, no self reduction, unidirectional instability without hyperlaxity, Hill Sachs lesion, age below 26 years, high level of sport activity and the special situation of luxatio erecta. Post primary stabilization is indicated for persistent subluxation, subjective instability or demonstrated pathologic instability tests. Rotator cuff tears due to traumatic dislocation in the elderly population require surgical repair.

Arthroscopy↗
PubMed1999

Pigmented villonodular synovitis of the shoulder: review and case report.

Pigmented villonodular synovitis (PVNS) as reviewed in detail elsewhere most frequently involves the knee and finger synovial structures; shoulder involvement is rare: A search through the English literature yielded 18 publications describing 25 cases of PVNS affecting the shoulder joint. Analyzing these reports we found the clinical and radiological findings generally to be nonspecific, often mimicking a malignancy, as in the case presented here of a 16-year-old boy with painful swelling in the area of the left proximal humerus. Magnetic resonance imaging showed a suspected malignant soft tissue mass involving the shoulder capsule and measuring 7.5 x 6 x 4 cm. Preoperatively the patient could recall no trauma; however, postoperatively he did report a distortion trauma of the affected shoulder following a bicycle accident. Intraoperatively, two tumors were found infiltrating the axillary vessels and nerve and tendon structures originating in the capsule of the shoulder joint. Rapid sections of the tissue revealed no signs of malignancy; further pathohistological examination revealed localized PVNS. Preoperatively, the shoulder joint was not suspected as the primary site of origin of the tumor because the patient had no complaints or functional deficits of the shoulder. The clinical presentation of such a PVNS lesion over the proximal humerus is unusual and to date has only twice been described in the literature.

Adolescent↗
PubMed2005

Magnetic resonance imaging of shoulders with idiopathic adhesive capsulitis: reliability of measures.

The magnetic resonance imaging (MRI) findings in idiopathic adhesive capsulitis (AC) were compared with those of contralateral healthy shoulders and the reliability of measures assessed. Twenty-six consecutive patients (26 AC and 14 healthy shoulders) were prospectively assessed. The main measurements were thickness of the joint capsule and synovial membrane in the axillary recess and rotator interval in T1-weighted spin-echo sequence enhanced with intravenous (IV) gadolinium chelate (Gd-chelate). Reliability was studied by use of the intraclass correlation coefficient (ICC). The mean thickness of the axillary recess on the coronal plane was 9.0+/-2.2 mm in AC shoulders and 0.4+/-0.7 mm in healthy shoulders. The mean thickness of the rotator interval on the sagittal plane was 8.4+/-2.8 in AC shoulders and 0.6+/-0.8 mm in healthy shoulders. Interobserver reliability was good for the axillary recess, with ICC values of 0.84 for the coronal plane, and good for the rotator interval, with ICC values of 0.80 for the sagittal plane. MRI with IV Gd-chelate injection can show, with acceptable reliability, signal and thickness abnormalities of the shoulder joint capsule and synovial membrane in AC.

Adult↗
PubMed2002

The effects of neck-shoulder pain development on sensory-motor interactions among female workers in the poultry and fish industries. A prospective study.

OBJECTIVES: The purpose of this prospective laboratory study was to follow newly employed workers in the fish or poultry industry for 6 months and investigate possible changes in sensory manifestations and motor performance during low load, repetitive work simulation. It was investigated whether the changes were an effect of employment duration and of development of neck-shoulder complaints. METHODS: Twelve newly employed female filleting employees without any sign of neck-shoulder tenderness/pain at the time of employment of 0 months took part in two laboratory recording sessions planned within 1 month of employment and after 6 months of employment at the plant. After 6 months, six workers out of 12 had developed pain and/or tenderness in the neck-shoulder region. The recording sessions evaluated sensory-motor aspects by measuring pressure pain threshold, work-task timing, cutting forces, surface electromyographic activity of four shoulder muscles, displacement of the centre of pressure, and 3D movements of the arm and trunk during simulation of low load, repetitive filleting. RESULTS: Effects due to the duration of employment were observed in both groups, i.e. decreased sensibility to pressure, decrease in the duration of the work cycle, increased arm starting position with respect to the upright position, and decreased range of motion of the arm and trunk (P<0.05) after 6 months. Among the workers with neck-shoulder complaints, increased sensibility to pressure, lower force level, higher electromyographic activity, decreased amplitude of arm movement, and increased trunk posture and movement amplitude (P<0.05) were observed, compared with workers without complaints. CONCLUSIONS: Differences in terms of sensory manifestations and motor control strategy were seen after 6 months of employment with or without neck-shoulder complaints. In general, changes in sensory manifestations and motor control strategy after 6 months work were most likely of importance, as they underlined a learning process as employment duration increased. Moreover, the present sensory-motor changes observed among workers with neck-shoulder complaints highlighted the potential physical risk factors associated with low load, repetitive work.

Adult↗
PubMed2002

A method for estimating torque-vector directions of shoulder muscles using surface EMGs.

In this study, a new method is proposed to estimate the torque-vector directions of each shoulder muscle. The method is based on a multiple regression model that reconstructs shoulder torque, which is calculated from the hand force and posture, from the surface EMG of many muscles recorded simultaneously. The torque-vector directions of eleven shoulder muscles of four subjects were obtained at up to 30 different arm postures with this method. The mean confidence interval ( p< 0.05) of the estimated torque-vector direction of each subject was 7.7-10.6 degrees. The correlation coefficient between the measured shoulder torque and reconstructed shoulder torque was between 0.76-0.84. The results for majority of the muscles were in accordance with previous studies, and reasonable from the viewpoint of anatomy. The torque-vector directions of a muscle, which are estimated with this method, have more of a functional meaning than a pure anatomical or mechanical one. These indicate the direction of the shoulder torque accompanying the muscle activation for a normal shoulder action that involves the cooperative contraction of many muscles.

Adult↗
PubMed1979

The unstable shoulder: recurring subluxation.

A review of operative repairs for recurring dislocation of the shoulder revealed that a significant proportion of these operations was being done for what could best be described as recurring subluxation of the shoulder. The presenting complaint was of the shoulder 'going out of joint', but no significant trauma was recalled, dislocation was never shown on the radiograph and none required manual reduction. The only physical finding was apprehension on external rotation of the shoulder in abduction. Radiographs were frequently normal and arthrography and cineradiography were not helpful in confirming anterior displacement. The most useful preoperative information was obtained by manipulation of the shoulder under general anaesthesia just before the surgical repair. In all instances anterior instability could be demonstrated. Of 99 Magnuson-Stack repairs drawn from the records of the Vancouver General Hospital in a 3-year period, 34 proved to be examples of recurring subluxation. This high proportion of such patients contradicts the teaching in standard orthopaedic textbooks, but substantiates the warning of Rowe (1963) to beware of the patient whose shoulder 'dislocates' initially with little evidence of injury. It also substantiates Saha's concept (1971) of inherent shoulder instability as a contributor to the incidence of recurring dislocation.

Adolescent↗
PubMed1995

Load-sharing patterns in the shoulder during isometric flexion tasks.

Patterns of load-sharing between the shoulder muscles during isometric flexion tasks were studied by using both a biomechanical shoulder model and electromyographic (EMG) recordings of ten subjects. The effect of changes in several model parameters and shoulder stiffness constraints on the predicted load-sharing patterns were studied, while the arm position, hand load and precision requirements of the tasks were varied. The results calculated using the model were, when compared to the EMG recordings, plausible predicting a high level of synergistic contraction of muscles of the shoulder muscles during flexion tasks. The trends of the model-predicted muscle forces corresponded well to the EMG recordings. At low hand load levels the increasing of the shoulder stiffness strongly increased the muscle force levels, thus increasing also the level of synergistic contraction of muscles. At higher load levels the increase in the muscle forces was not so high, because the model predicted a high level of simultaneous contraction of muscles already at a low level of shoulder stiffness. Cluster analysis of the EMG recordings revealed large inter-individual differences in the load distribution patterns during flexion tasks. The constraint angle of the glenohumeral joint contact force direction was found to be an important model parameter affecting both the predicted forces and the maximum force production ability of the shoulder.

Adult↗
PubMed1996

Sonographic prediction of shoulder dystocia in infants of diabetic mothers.

OBJECTIVE: To determine if the difference between the abdominal diameter and biparietal diameter (AD-BPD difference), as measured by ultrasound examination, predicts shoulder dystocia in borderline macrosomic infants of diabetic mothers. METHODS: A retrospective study was performed of births occurring from January 1990 through June 1995. Eligibility requirements included diabetic pregnancy, ultrasound examination within 2 weeks of delivery, estimated fetal weight of 3800-4200 g, and vaginal delivery. The mean AD-BPD difference was compared in normal deliveries and those complicated by shoulder dystocia, using the Student t test and by multiple regression analysis. A receiver operating characteristic curve was generated to determine if an AD-BPD cutoff value could be used clinically to predict shoulder dystocia. RESULTS: Thirty-one patients, six with dystocia, were eligible for the study. The mean AD-BPD differences for those with and without shoulder dystocia were 3.1 and 2.6 cm, respectively, a statistically significant difference (P = .05). Comparing the groups with and without shoulder dystocia, no significant differences could be found in mean age, parity, weight, birth weight, or gestational age. Shoulder dystocia occurred in six of 20 patients (30%) in whom the AD-BPD difference was at least 2.6 cm but in none of 11 patients in whom it was less than 2.6 cm, also a statistically significant difference (P = .05). CONCLUSION: The AD-BPD difference was greater in borderline macrosomic fetuses of diabetic mothers who experienced shoulder dystocia than in those who had uncomplicated vaginal deliveries. Applying an AD-BPD cutoff value of 2.6 cm to this population prospectively would have provided excellent sensitivity, specificity, and predictive value in identifying those fetuses at high risk for birth injury.

Adult↗
PubMed2005

[Shoulder disability questionnaires: a systematic review].

OBJECTIVES: To identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality. METHODS: We used the Medline database and the "Guide des outils de mesure de l'évaluation en médecine physique et de réadaptation" textbook to search for questionnaires. Analysis took into account the development methodology, clinimetric quality of the instruments and frequency of their utilization. We classified the instruments according to the International Classification of Functioning, Disability and Health. RESULTS: Thirty-eight instruments have been developed to measure disease-, shoulder- or upper extremity-specific outcome. Four scales assess upper-extremity disability and 3 others shoulder disability. We found 6 scales evaluating disability and shoulder pain, 7 scales measuring the quality of life in patients with various conditions of the shoulder, 14 scales combining objective and subjective measures, 2 pain scales and 2 unclassified scales. Older instruments developed before the advent of modern measurement development methodology usually combine objective and subjective measures. Recent instruments were designed with appropriate methodology. Most are self-administered questionnaires. CONCLUSION: Numerous shoulder outcome measure instruments are available. There is no "gold standard" for assessing shoulder function outcome in the general population.

Disability Evaluation↗
PubMed2006

Intraobserver reliability of 4 physiologic movements of the shoulder in subjects with and without symptoms.

OBJECTIVE: To assess intraobserver reliability of 4 physiologic movements of the shoulder. DESIGN: Test-retest analyses. Blinded data entry. SETTING: Outpatient department in National Health Service teaching hospital. PARTICIPANTS: Forty-five asymptomatic volunteers and 45 subjects with shoulder symptoms. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICC), 95% confidence intervals, and standard error (SE) of measurements for bilateral measurements of shoulder flexion and abduction (gravity dependent inclinometer), shoulder external rotation (tape measure), and shoulder internal rotation (visual estimation). RESULTS: For subjects without symptoms, single measure ICC results ranged from .85 to .96; SE of measurement results for the angular movements ranged from 2.1 degrees to 2.8 degrees and for the linear measurements 1.1 to 1.6 cm. For subjects with symptoms, single measure ICC results ranged from .82 to .98; SE of measurement results for the angular movements ranged from 1.5 degrees to 13.3 degrees and for the linear measurements 1.3 to 1.6 cm. CONCLUSIONS: With the exception of painful shoulder flexion in the group of subjects with symptoms, the single-measure ICC results were very good to excellent and the highest SE of measurement values were 5.3 degrees for the angular measurements and 1.6 cm for the linear measurements. For clinicians involved in the management of subjects with shoulder symptoms, the SE of measurement results provide guidance as to the error associated with the individual measurements. Using the SE of measurement results, a clinician may determine if a clinically important change, be it negative or positive, has occurred as a result of any intervention offered.

Adult↗
PubMed2004

The reliability between surgeons comparing arthroscopic and video evaluation of patients with shoulder impingement syndrome.

PURPOSE: To assess interobserver reliability between 2 surgeons, for real-time diagnostic arthroscopy and the corresponding videotape of shoulder pathology in patients with a clinical symptom complex consistent with shoulder impingement syndrome. TYPE OF STUDY: Prospective cohort. METHODS: Fifty-three patients with shoulder impingement syndrome underwent arthroscopic surgery by 1 of 2 experienced orthopaedic shoulder surgeons. All operations were videotaped. The surgeon who did not perform the surgery reviewed the videotaped procedure. The findings in the shoulder were independently documented by each surgeon on standardized shoulder information sheets. The video-review surgeon was blinded to the results of the arthroscopy and all preoperative workup information. The percentage agreement, kappa statistics, and correlations were calculated to assess the inter-rater reliability. RESULTS: The percentage agreement ranged from 100% for tendon ruptures to 39% when identifying acromion type. Interobserver kappa statistics were significant for all relevant structures with the exception of acromion type and coracoacromial ligament. CONCLUSIONS: There was satisfactory reliability between video and real-time arthroscopy. However, better objective definitions of pathology and standardization of arthroscopic techniques would improve these results. Videotaping of arthroscopy can be considered a useful educational tool, a way to improve communication between surgeons, and possibly a medicolegal tool when defining pathology in the shoulder. LEVEL OF EVIDENCE: Level II.

Adult↗
PubMed2006

Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique.

PURPOSE: The purpose of this study was to prospectively evaluate the surgical outcome of arthroscopic Bankart repair via suture anchors in patients with recurrent traumatic anterior shoulder instability with a minimum follow-up of 2 years. METHODS: We included 54 consecutive patients without an osseous Bankart lesion of greater than 25% of the glenoid circumference with a mean age of 25.3 years (range, 16 to 58 years) undergoing arthroscopic Bankart repair via suture anchors for traumatic anterior shoulder instability. The mean follow-up was 3.7 years (range, 2.3 to 5.2 years) at the final follow-up examination. Patients were evaluated prospectively according to the rating scales of Rowe, the American Shoulder and Elbow Surgeons, and Constant and Murley. One patient was lost to follow-up. RESULTS: After 3.7 years, 4 patients had recurrent instability: 3 had redislocated and 1 had recurrent subluxations. Thus the overall redislocation rate was 7.5%. Of the 4 redislocators, 3 had a traumatic onset of the redislocation. All shoulder scores (Rowe, American Shoulder and Elbow Surgeons, and Constant and Murley) revealed highly significant improvements postoperatively. At final follow-up, 85.7% of patients had returned to their preoperative sports level. CONCLUSIONS: Our results in this series demonstrate the efficacy of arthroscopic Bankart repair with suture anchors for the treatment of recurrent traumatic anterior shoulder instability with respect to recurrence rate, range of motion, and shoulder function during a mean follow-up of 3.7 years. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Adolescent↗
PubMed2005

High incidence and recurrence of shoulder and neck pain in nursing home employees was demonstrated during a 2-year follow-up.

OBJECTIVE: This study describes the course of shoulder and neck complaints in a working population over time. STUDY DESIGN AND SETTING: Questionnaires were administered on neck and shoulder complaints over 3 consecutive years. RESULTS: We observed 12-month incidence rates for neck and shoulder complaints of 16% to 18%, 12-month prevalence rates roughly twice as high, and 12-month recurrence rates approximately twice the prevalence rates. Each year, medical care was sought by 21% to 38% of the subjects with neck or shoulder pain, and 13% to 21% were absent from work. Although at the population level the occurrence of neck and shoulder complaints remained constant, the course of complaints within individuals demonstrated a strong episodic nature of neck and shoulder pain. Results from this study suggest that neck and shoulder complaints for most subjects run a recurrent course characterized by a strong variation in occurrence and a self-limiting course. CONCLUSION: These findings suggest that clinical trials should have a sufficiently long follow-up period to demonstrate sustainability of the therapeutic results.

Absenteeism↗
PubMedDate not supplied

Radiographic analysis of the acromion in the loose shoulder.

To investigate the contribution of bony stability to the pathogenesis of the loose shoulder, geometric parameters of the acromion by use of cineradiography were evaluated in patients with a loose shoulder and compared with those in the normal shoulder. One hundred twenty healthy individuals and eighty-two patients were enrolled. To evaluate the size of the acromion and the coverage of the humeral head by the acromion, the anterior width of the acromion and three angle parameters were measured. The findings demonstrated that the loose shoulder had a relatively smaller and more upwardly inclined acromion that was against the glenoid and provided less coverage of the humeral head. These characteristics of the acromion may contribute to the hypermobility and functional instability of the shoulder joint observed in patients with a loose shoulder. Therefore, a radiographic evaluation of the geometry of the acromion is important to determine the pathogenesis of the loose shoulder.

Acromion↗
PubMedDate not supplied

Replacement arthroplasty in the weight-bearing shoulder of paraplegic patients.

We review the early results of shoulder arthroplasty in the weight-bearing shoulder of long-term paraplegic patients. We have been unable to find previously published results of this subgroup of shoulder arthroplasty patients in the literature. Five paraplegic, female patients who had undergone shoulder arthroplasty were analyzed. All patients had been prospectively assessed with the American Shoulder and Elbow Surgeons (ASES) function score and the Constant score. The mean age at the time of surgery was 70 years. Three shoulders had full-thickness rotator cuff tears, and two were repaired at the time of shoulder arthroplasty. The mean preoperative Constant score was 30 out of 100, improving to 52 out of 100 at a mean follow-up of 30 months (range, 24-36 months). The mean preoperative ASES function score was 28 out of 55, improving to 37 out of 55. One patient was pain-free after surgery, and the mean postoperative pain score was 10 out of 15. There were no features of progressive radiolucency around the glenoid or the humeral components at last review apart from one case in which glenoid implant migration occurred. In view of the satisfactory improvement in terms of pain, mobility, and independence, we believe that it is reasonable to continue to offer this procedure to this subgroup of patients. We will, however, remain vigilant with regard to any further complications arising in these prostheses in the medium to long term as a result of increased loading.

Aged↗
PubMedDate not supplied

Stability and instability of the glenohumeral joint: the role of shoulder muscles.

Shoulder muscles contribute to both mobility and stability of the glenohumeral joint. To improve treatments for shoulder instability, we focused on the contribution of the shoulder muscles to glenohumeral joint stability in clinically relevant positions. Both computational and experimental models were used. A computational model of the glenohumeral joint quantified stability provided by active muscle forces in both mid-range and end-range glenohumeral joint positions. Compared with mid-range positions, the resultant joint force at end-range positions was more anteriorly directed, indicating that its contribution to glenohumeral joint stability was diminished. In end-range positions, simulated increases in rotator cuff muscle forces tended to improve stability whereas increases in deltoid or pectoralis major muscle forces tended to further decrease stability. To validate these results, a cadaveric model, simulating relevant shoulder muscles, was used to quantify glenohumeral joint stability. When infraspinatus muscle activity was decreased, compressive forces decreased. When pectoralis major muscle activity was increased, anteriorly directed forces increased. If anteriorly directed forces increase or compressive forces decrease, stability of the glenohumeral joint decreases. This cadaveric model was then used to evaluate the effect of placing the joint in the apprehension position of abduction, external rotation, and horizontal abduction. Consistent with the results of our computational model, apprehension positioning increased anteriorly directed forces. Knowledge gained from these models was then used to develop a cadaveric model of glenohumeral joint dislocation. Dislocation resulted from the mechanism of forcible apprehension positioning when the appropriate shoulder muscles were simulated and a passive pectoralis major muscle was included. Capsulolabral lesions resulted that were similar to those observed in vivo. Shoulder muscle forces are usually powerful stabilizers of the glenohumeral joint, especially in mid-range positions when the passive stabilizers are lax. However, muscle forces can contribute to instability as well. Certain muscle forces decrease glenohumeral joint stability in end-range positions. We found this to be the case with both active and passive pectoralis major forces. Improved understanding of the contribution of muscle forces not only toward stability but also toward instability will improve rehabilitation protocols for the shoulder and prove useful in the treatment of joint instability throughout the body.

Biomechanical Phenomena↗
PubMedDate not supplied

Augmented subscapularis muscle transposition for rotator cuff repair during shoulder arthroplasty in patients with rheumatoid arthritis.

The effectiveness of rotator cuff repair by augmented subscapularis transposition via the Leeds-Keio artificial ligament was evaluated in patients with rheumatoid arthritis undergoing total shoulder arthroplasty. The minimum follow-up period was 2 years. Final clinical scores (Hospital for Special Surgery scoring system) and the incidence of radiolucency and upward migration of shoulder components in 20 shoulders with rotator cuff repair by augmented subscapularis transposition were superior to those of 19 shoulders with cuff repair by subscapularis transposition alone and similar to those of 22 shoulders with intact rotator cuffs. In shoulders with augmented subscapularis transposition and intact cuffs, clinical scores continued to improve even after the first postoperative year. Our augmented subscapularis transposition did not increase postoperative complications. We conclude that cuff repair by augmented subscapularis transposition is an acceptable alternative for repairing a supraspinatus or supraspinatus and infraspinatus rotator cuff defect in rheumatoid arthritis patients undergoing total shoulder arthroplasty.

Aged↗
PubMedDate not supplied

Does hand-behind-back range of motion accurately reflect shoulder internal rotation?

Shoulder internal rotation (IR) is commonly assessed by an indirect method where the hand is placed behind the back and the distance reached by the tip of the extended thumb is recorded. The aim of this study was to assess the validity of measuring active IR range of motion (ROM) by use of the indirect hand-behind-back (HBB) ROM method in subjects with shoulder pain of mechanical origin. We recruited 137 subjects with unilateral shoulder pain. HBB ROM was determined by measuring the distance between the T1 spinous process and the radial styloid process. Active shoulder IR was measured in the supine position in 45 degrees or 90 degrees abduction. Correlation coefficients adjusted for measurement error were calculated. HBB ROM demonstrated only a low to moderate correlation with active shoulder IR. Active HBB ROM is not an accurate method of measuring active shoulder IR in patients with shoulder pain.

Biomechanical Phenomena↗