THE RELIABILITY,MINIMAL DETECTABLE CHANGE AND CONSTRUCT VALIDITY OF A CLINICAL MEASUREMENT FOR QUANTIFYING POSTERIOR SHOULDER TIGHTNESS IN THE POST‐OPERATIVE POPULATION

Background:

Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Although reliable and valid measures have been described for the non‐operative population one does not exist for the post‐operative population.

Study Design:

Blinded repeated measures design.

Purpose:

Investigate the intrarater reliability, minimal detectable change at the 90% confidence interval (MDC₉₀) and construct validity of an inclinometric measurement designed to quantify PST in the post‐operative population.

Methods:

One investigator performed PST measurements on the operative shoulder of 23 participants. Passive internal and external rotation measurements were performed for the validity component of the investigation.

Results:

Intrarater reliability using an intraclass correlation coefficient (ICC) model 3,k was good (ICC = 0.79). The MDC₉₀ indicated that a change of greater than or equal to 8 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter‐trial variability or measurement error. Construct validity was supported by a statistically significant relationship between PST and internal rotation r = 0.54 and by a relationship between PST and external rotation r = 0.30 which was not statistically significant.

Conclusion:

The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST in the post‐operative population. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values.

Level of Evidence:

Therapy, level 2b     

A COMPARISON OF RANGE OF MOTION CHANGE ACROSS FOUR POSTERIOR SHOULDER TIGHTNESS MEASUREMENTS AFTER EXTERNAL ROTATOR FATIGUE

Background:

Several glenohumeral joint (GHJ) positions have been recommended for assessing and correcting posterior shoulder tightness (PST) however, there is no agreement on which position is better for differentiating posterior muscle tightness from posterior capsular tightness. The purpose of this study was to compare the range of motion change before and after an external humeral rotator muscle fatigue protocol in order to identify a position that shows maximum range of motion change.

Methods:

ROM changes across four PST measurements were compared before, immediately after, at 24 hours after, and 48 hours after an external rotator fatigue protocol. Muscle stiffness of the infraspinatus and the teres minor (using a myotonometer) and external rotation force production (using hand‐held dynamometry) were measured to verify muscle fatigue.

Results:

There was a statistically significant interaction between measurement and condition (F = 2.47, p = 0.02). The planned one factor repeated measure ANOVA for each condition revealed that ROM change was statistically significant between PST measurements for all conditions. Post hoc comparisons indicated statistically significant greater overall ROM changes in a measurement combining GHJ extension and internal rotation compared to other tested measurements. There was also a main effect of time on infraspinatus muscle stiffness (F = 10.5, p < 0.0001). Post hoc comparison indicated a statistically significant increase in infraspinatus stiffness immediately after the fatigue protocol (p < 0.05).

Conclusion:

Immediate ROM reduction was observed across all the measurements except horizontal adduction (HAD). Maximum ROM reduction after an external rotation fatigue protocol was measured in a position of GHJ extension.

Clinical Relevance:

Posterior muscle tightness may influence the internal rotation range of motion to a greater extent when measured in glenohumeral joint extension.

Levels of Evidence:

II‐B     

TOTAL ARC OF MOTION IN THE SIDELYING POSITION: EVIDENCE FOR A NEW METHOD TO ASSESS GLENOHUMERAL INTERNAL ROTATION DEFICIT IN OVERHEAD ATHLETES

Background

Total arc of motion (TA) measured in a supine position has been utilized as a method to detect the presence of glenohumeral internal rotation deficit (GIRD) in overhead athletes. A component of supine TA is supine internal rotation (IR) range of motion (ROM), which has many variables including the amount and location of manual stabilization. A sidelying position for gathering IR ROM has recently been proposed and, when combined with supine external rotation (ER) ROM, constitutes a new method of quantifying TA. This new sidelying TA method, however, has no normative values for overhead athletes.

Purpose

The purposes of this study were to develop normative values for sidelying TA in overhead athletes, determine any ROM difference between supine and sidelying TA, and examine side‐to‐side differences within the two TA methods. A secondary purpose of the study was to examine for any effect of gender or level of competition on the two TA methods.

Study Design

Cross‐sectional study.

Methods

Passive supine IR ROM, supine ER ROM, and sidelying IR ROM were gathered on bilateral shoulders of 176 collegiate and recreational overhead athletes (122 male [21.4 ± 4.7 years, 71.7 ± 2.7 inches, 25.3 ± 2.7 BMI] and 54 female [21.4 ± 5.4 years, 67.6 ± 3.0 inches, 22.5 ± 2.37 BMI]).

Results

Sidelying TA mean for the dominant shoulder was 159.6 °±15.0 °; the non‐dominant shoulder was 163.3 °±15.3 °. Sidelying TA for both shoulders (p < 0.0001) was 14 ° less than supine TA. Both TA methods exhibited a 4 ° dominant‐shoulder deficit (p < 0.0001). For the dominant and non‐dominant shoulder, respectively, there was no gender (p = 0.38, 0.54) or level of competition (p = 0.23, 0.39) effect on sidelying TA.

Conclusion

In overhead athletes, sidelying TA is a viable alternative to supine TA when examining for the presence of GIRD. Gender and level of competition does not significantly affect sidelying TA, so the mean of 160 ° on the dominant shoulder and 163 ° on the non‐dominant shoulder can be used by clinicians.

Level of Evidence

Level 3     

THE RELIABILITY AND CONCURRENT VALIDITY OF SHOULDER MOBILITY MEASUREMENTS USING A DIGITAL INCLINOMETER AND GONIOMETER: A TECHNICAL REPORT

Purpose/Aim:

This study investigated the intrarater reliability and concurrent validity of active shoulder mobility measurements using a digital inclinometer and goniometer.

Materials/Methods:

Two investigators used a goniometer and digital inclinometer to measure shoulder flexion, abduction, internal and external rotation on 30 asymptomatic participants in a blinded repeated measures design.

Results:

Excellent intrarater reliability was present with Intraclass Correlation Coefficients (ICC- 3,k) for goniometry ≥ 0.94 and digital inclinometry ≥ 0.95. The concurrent validity between goniometry and digital inclinometry was good with ICC (3,k) values of ≥ 0.85. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to range from 2° to 20°.

Conclusions:

The results cautiously support the interchangeable use of goniometry and digital inclinometer for measuring shoulder mobility measurements. Although reliable, clinicians should consider the 95% limits of agreement when using these instruments interchangeably as clinically significant differences are likely to be present.

Level of evidence:

2b     

RELIABILITY OF TWO METHODS OF CLINICAL EXAMINATION OF THE FLEXIBILITY OF THE HIP ADDUCTOR MUSCLES

Background

An inadequate level of flexibility of the adductor muscles is one of the most critical risk factors for chronic groin pain and strains. However, measurement methods of adductor muscle flexibility are not well defined.

Purpose

To determine the inter‐session reliability of the biarticular and monoarticular adductor muscle flexibility measures obtained from passive hip abduction with the knee flexed over the edge of the plinth test (PHA) and the passive hip abduction test at 90° of hip flexion (PHA_90°).

Study design

Clinical Measurement Reliability study.

Methods

Fifty healthy recreational athletes participated in this study. All participants performed the PHA and PHA_90° on four different occasions, with a two‐week interval between testing sessions. Reliability was examined through the change in the mean between consecutive pairs of testing sessions (ChM), standard error of measurement expressed in absolute values (SEM) and as a percentage of the mean score (%SEM), minimal detectable change at 95% confidence interval (MDC₉₅), and intraclass correlation coefficients (ICC_2,k).

Results

The findings showed negligible or trivial ChM values for the two adductor flexibility measures analyzed (<2°). Furthermore, the SEM and MDC₉₅ were 2.1° and 5.9° and 2.2° and 6.2° for the measures obtained from the PHA and PHA_90°, respectively, with %SEM scores lower than 5% and ICC scores higher than 0.90.

Conclusion

The findings from this study suggest that the adductor muscle flexibility measures analyzed have good to excellent inter‐session reliability in recreational athletes. Thus, clinicians can be 95% confident that an observed change between two measures larger than 5.9° and 6.2° for the flexibility measures obtained from the PHA and PHA_90°, respectively, would indicate a real change in muscle flexibility.

Level of evidence

2     

SIDELYING GLENOHUMERAL PASSIVE INTERNAL ROTATION RANGE OF MOTION VALUES IN A HEALTHY COLLEGIATE POPULATION

Purpose/Background:

The sleeper stretch is a common intervention prescribed for individuals with decreased glenohumeral internal rotation. Passive glenohumeral internal rotation (GHIR) when quantified in sidelying has been suggested to be a more reliable measure as compared to measurments performed in supine with the humerus abducted to 908. Recently, the sidelying position has also been proposed as an evaluative measure to quantify GHIR. Minimal work however has described mean GHIR values in sidelying. Therefore, the objective of this study was to establish preliminary mean passive GHIR values in sidelying for a healthy, college‐age population. Secondary purposes were to ascertain if mean values were affected by upper extremity dominance or sex.

Methods:

Using a standardized protocol, passive GHIR was measured using a digital inclinometer on the dominant and non‐dominant shoulders of 60 healthy, college‐age participants (32 female [20.66±1.15 years, 170.70±14.38 cm, 63.34±7.51 kg] and 28 male [21.50±1.40 years, 183.81±13.17 cm, 90.04±17.91 kg]).

Results:

The sidelying passive GHIR grand mean for all participants bilaterally was 50.4 ± 11.78. Mean passive GHIR values on the non‐dominant side (52.7 ± 10.28) were greater than those on the dominant side (48.0 ± 12.58) (p = 0.002). There was no difference when GHIR values were compared by sex (p = 0.327) and a significant interaction between UE dominance and sex was not apparent (p = 0.693).

Conclusions:

In a healthy college age population, these preliminary data suggest GHIR values are statistically greater on the non‐dominant side and that sex does not significantly affect GHIR measures in a sidelying position.

Level of Evidence:

Level 3c     

RELIABILITY OF THE MYOTONOMETER FOR ASSESSMENT OF POSTERIOR SHOULDER TIGHTNESS

Background/Purpose:

The Myotonometer® is an electronic tissue compliance meter that has been used to quantify the compliance of soft tissues. The Myotonometer® may be a valuable tool to measure the effectiveness of interventions commonly used to increase tissue compliance in individuals with posterior shoulder tightness (PST). Limited data exist on reliability and responsiveness of the Myotonometer® for assessment of soft tissues about the shoulder; therefore, the purpose of this study is to determine the intra‐ and inter‐session reliability and responsiveness of the Myotonometer® in measuring tissue compliance of the posterior shoulder musculature in asymptomatic subjects with PST.

Methods:

Fifteen asymptomatic subjects with unilateral shoulder range of motion deficits attended two measurement sessions to assess the compliance of the tissues overlying the posterior deltoid, infraspinatus, and teres musculature. Analyses of reliability and responsiveness were conducted using intra‐class correlation coefficients (ICCs) and the determination of minimal detectible change (MDC).

Results:

Intra‐session ICC values ranged from 0.69 to 0.91 for all muscles with MDC never exceeding 1.0 mm. Inter‐session ICC values were best for the posterior deltoid, which averaged 0.82, compared to the infraspinatus and the teres complex, which averaged 0.42 and 0.5 respectively. Inter‐session MDC ranged from 0.55 to 1.20 mm across all muscles.

Conclusions:

Clinicians can reliably detect relatively small changes in tissue compliance within a single treatment session utilizing the Myotonometer®. The Myotonometer® can reliably detect changes between sessions for tissues overlying the posterior deltoid; however, observed change in the infraspinatus and teres musculature must be above 1 mm to achieve meaningful change and account for decreased inter‐session reliability.

Level of Evidence:

3     

Reliability and minimal detectable change of inclinometric shoulder mobility measurements

The shoulder complex is one of the most commonly affected regions for which individuals present to physical therapy. Numerous shoulder disorders result in altered mobility with posterior shoulder tightness (PST), impaired internal rotation (IR), and either decreased or increased external rotation (ER) often reported in research investigations. The accurate assessment of shoulder mobility is an integral component of both the physical therapy examination and intervention. Therefore, the reliability and sensitivity to change of instruments used to measure mobility must be established. The purpose of this study was to investigate the intrarater reliability and minimal detectable change (MDC₉₀) of inclinometric measurements designed to quantify shoulder mobility. Active shoulder IR, ER, and passive PST were measured on the nondominant side of 30 asymptomatic volunteers in an intersession design. Intraclass correlation coefficients (ICCs) using model 3, k were excellent using the protocols described in this investigation with IR?=?0.987, ER?=?0.970, and PST?=?0.964. The MDC₉₀ indicates that a change of greater than or equal to 4° (IR), 5° (ER), and 8° (PST) would be required to be 90% certain that the change is not due to intertrial variability or measurement error.     

AN ELASTIC EXERCISE BAND MOUNTED WITH A BANDCIZER? CAN DIFFERENTIATE BETWEEN COMMONLY PRESCRIBED HOME EXERCISES FOR THE SHOULDER

Background

Home‐exercise is commonly prescribed for rehabilitation of the shoulder following injury. There is a lack of technology available to monitor if the patient performs the exercises as prescribed.

Purpose

The purpose of this study was to investigate the validity of using three dimensional (3D) gyroscope data recorded with the Bandcizer™ sensor to differentiate between three elastic band exercises performed in the shoulder joint: abduction, flexion, and external rotation.

Design

Concurrent validity study.

Methods

This study was performed over two phases. In the first phase, 20 subjects performed three sets of 10 of shoulder abduction, external rotation and flexion exercises with a Thera‐Band mounted with a Bandcizer, while supervised by a physical therapist. The Bandcizer has an inbuilt three‐dimensional gyroscope, capable of measuring angular rotation. Gyroscope data were analyzed in Matlab, and a one‐way ANOVA was used to test for significant differences between each of the three exercises. An algorithm was then created in Matlab based on the exercise‐data from the gyroscope, to enable differentiation between the three shoulder exercises. Twenty new subjects were then recruited to cross‐validate the algorithm and investigate if the algorithm could differentiate between the three different shoulder exercises.

Results

A blinded assessor using the Matlab algorithm could correctly identify 56 out of 60 exercise sets. The kappa agreement for the three exercises ranged between 0.86‐0.91.

Conclusion

The ability to differentiate between the home exercises performed by patients after shoulder injury has great implications for future clinical practice and research. When home exercises are the treatments‐of‐choice, clinicians will be able to quantify if the patient performed the exercise as intended. Further research should be aimed at investigating the feasibility of using the Bandcizer™ in a home‐based environment.

Word count

2429

Level of Evidence

2     

EFFECTS OF A DRY‐LAND STRENGTHENING PROGRAM IN COMPETITIVE ADOLESCENT SWIMMERS

Background

Shoulder pain is common in competitive young swimmers. A relationship between shoulder strength and shoulder soreness in competitive young swimmers may indicate need for strengthening.

Purpose

To determine if a shoulder exercise program will improve shoulder strength and decrease pain in competitive young swimmers.

Study Design

Randomized control

Methods

Participants (10 control, 11 experimental), randomly assigned to a control or experiment group, completed the 12 week program. Strength was measured prior to the study for shoulder flexion, abduction, external rotation, internal rotation, and extension on the dominant arm using handheld dynamometry. The experimental group was then assigned exercises to be performed three times per week. The control group was instructed not to perform the exercises. All participants were re‐tested at six and twelve weeks following initiation of the study.

Results

The changes in strength for each muscle group and pain were compared between groups using a mixed design two‐way ANOVA. The experimental group significantly increased external rotation strength compared to the control group. Shoulder soreness was not significantly different between groups.

Conclusion

Adolescents who perform shoulder strengthening significantly increased their external rotation strength compared to adolescents who only participated in a regular swimming regimen.     

THE EFFECTS OF A DAILY STRETCHING PROTOCOL ON PASSIVE GLENOHUMERAL INTERNAL ROTATION IN OVERHEAD THROWING COLLEGIATE ATHLETES

Introduction/Purpose:

Shoulder dysfunction and injury are common in throwing athletes. Loss of internal rotation has been correlated to shoulder pathologies. The purpose of this study was to assess the effects of a stretching protocol on passive internal rotation. The purpose of this study was assess the effects of a stretching protocol on passive internal rotation motion in the throwing shoulders of collegiate baseball players.

Study Design:

Pre-Post, intervention, using a within subjects comparison of a convenience sample.

Methods:

Glenohumeral internal rotation and external rotation of the throwing and non-throwing shoulders of NCAA Division I baseball players were measured using a universal goniometer. Determinations were made as to the degree of Glenohumeral Internal Rotation Deficit (GIRD) in the throwing shoulder. A daily (5 days per week), 12-week posterior capsule stretching program was administered. Post-stretching internal rotation and external rotation measures were again obtained. The coaches and athletic trainers of the included team monitored the players for shoulder injuries and innings of training/competition lost due to shoulder injuries during the 12 week intervention.

Results:

A significant increase in range of motion was found for dominant arm internal rotation (IR) and total range of motion (TOT) following the stretching program. No statistically significant improvement in range of motion was found for external rotation (ER), non-throwing arm internal rotation (NDIR), non-throwing arm external rotation (NDER), and non-throwing arm total motion (NDTOT).

Conclusions:

Implementation of a posterior capsule stretching program may be helpful to facilitate increased passive internal rotation range of motion at the glenohumeral joint. Further research should be performed using a control group not receiving the stretching program in order to more completely establish the impact of stretching on measures of passive glenohumeral range of motion.

Level of Evidence:

1b     

Passive Rotation Range of Motion and Shoulder Subluxation: A Comparative Study

Background

Conflicting reports of range of motion (ROM) findings exist related to shoulder instability. Knowledge of range of motion findings among individuals with shoulder subluxation may aid in diagnosis and facilitate appropriate management.

Purpose

The purpose of this study was to compare passive rotation ROM and determine if a symptom-provoking activity alters ROM between patients with shoulder subluxations and healthy controls.

Methods

Seventeen symptomatic patients with shoulder subluxations and 14 healthy controls between the ages of 18 and 35 years were recruited. Lateral and medial rotation ROM measures were taken using a universal goniometer. Symptoms were assessed using a 10cm visual analog scale (VAS). Each group performed a symptom-provoking activity, and VAS and ROM measures were repeated.

Results

A two-factor analysis of variance with repeated measures on pre/post activity demonstrated lower medial rotation measures for the instability group, but no differences for lateral rotation or total range (p < 0.05). A “warm-up” effect was noted, with greater ROM found in each group post activity, with a greater increase noted among controls. Analysis of the ratio of lateral rotation to medial rotation ROM found a significantly greater ratio in the instability group. VAS pain scores were greater in the instability group.

Conclusion

Shoulder subluxation is not necessarily associated with increased rotation ROM, therefore total ROM findings should not be used to screen for instability. Imbalances in rotation ROM may be associated with symptomatic shoulder instability and may have implications for treatment.     

Concentric Internal and Eccentric External Fatigue Resistanc of the Shoulder Rotator Muscles in Female Tennis Players

Background

Shoulder muscle imbalance is a potential shoulder injury risk factor in athletes performing overhead sports. While normative functional peak strength of concentric external to concentric internal shoulder muscle fatigue data is available, comparisons of functional eccentric external to concentric internal shoulder rotator muscle fatigue resistance, which impacts muscle imbalance throughout the duration of play, have not been studied in this population.

Objectives

To assess fatigue resistance of the internal and external shoulder rotator muscles in female tennis players.

Methods

Fifteen female collegiate tennis players were tested bilaterally for shoulder concentric internal and eccentric external peak torque production throughout 20 maximal repetitions on a Kin-Com isokinetic dynamometer. Twelve t - tests were conducted to evaluate for differences in peak torque, relative fatigue ratios, and functional peak torque ratios between extremities and mode of activation during the first, as well as, last five repetitions that were conducted.

Results

Non-dominant concentric internal and eccentric external peak torque production significantly decreased throughout the twenty repetitions. Neither dominant concentric internal peak torque decrements and eccentric peak torque decrements were not significantly different across the twenty contractions.These changes in peak torque upon subsequent repetitions resulted in relative fatigue ratios of dominant eccentric external rotation that were significantly greater than non-dominant eccentric external rotation. Relative fatigue ratios of dominant concentric internal rotation did not differ from non-dominant concentric internal rotation.

Conclusions

The data suggest that eccentrically activated external shoulder rotator muscles could possibly adapt to overhead activities by becoming more fatigue resistant.     

THE RELATIONSHIP BETWEEN PASSIVE GLENOHUMERAL TOTAL ROTATION AND THE STRENGTH OF THE INTERNAL AND EXTERNAL ROTATOR MUSCLES,A PRELIMINARY STUDY

Background

There is little research on how the amount of shoulder joint range of motion, specifically glenohumeral rotation, may be related to the muscle strength of the rotator cuff muscles. A long held belief is that a joint with excessive range of motion needs sufficient muscular strength for stability. However, no studies have examined this concept.

Purpose

The purpose of this study was to see if total arc of glenohumeral joint rotation (External rotation [ER]+Internal rotation [IR]) could predict peak isometric muscle strength of the IR or ER muscles of the shoulder.

Study Design

Cross‐sectional study design

Methods

Fifty‐three participants (41 females, 12 males) participated in the study. Passive glenohumeral joint internal rotation and external rotation motion was measured for each participant with a standard goniometer. Isometric muscle force of the ER and IR muscles were tested using a handheld dynamometer in three positions: end range ER, neutral 0°, and end range IR. Data were analyzed using a non‐parametric tree based regression method (CART) and then cross‐validated.

Results

The results showed that those with an increased total arc of motion of glenohumeral rotation (greater than 165.0°) had less muscle isometric muscle strength in all tests positions than those with less glenohumeral rotation.

Conclusion

Decreased force of the ER and IR muscles of the shoulder was noted in those with increased total arc glenohumeral rotation ( > 165.0°), specifically those with increased glenohumeral internal rotation ( > 80.0°) when compared to those with glenohumeral rotation ( < 165.0°) and glenohumeral internal rotation ( < 80.0°). Future studies should include more males and attempt to develop strategies to assist those with larger excursions of shoulder rotation who may be at risk of developing shoulder problems.

Level of Evidence

Level 2     

Glenohumeral Joint Range of Motion in Elite Male Golfers: A Pilot Study

Background

Shoulder injuries account for up to 17% of all golf related musculoskeletal injuries. One cause may be the repetitive stresses applied to the lead shoulder during the backswing and follow-through phases, which may contribute to the frequency of these injuries. The “elite” golfer may be pre-disposed to developing a shoulder injury based upon the reported adaptations to the glenohumeral joint.

Objective

To examine and compare bilateral glenohumeral joint rotational range of motion in elite golfers using standard goniometric procedures.

Methods

Twenty-four “elite” male golfers were recruited for this study. Glenohumeral internal (IR) and external rotation (ER) passive range of motion was measured bilaterally at 90° of abduction using a standard universal goniometer. Paired t-tests were utilized to statistically compare the rotational range of motion patterns between the lead and the trailing shoulder.

Results

No statistical differences existed between each shoulder for mean IR or mean ER measures. This finding was consistent throughout different age groups. External rotation measurements were greater than IR measurements in both extremities.

Discussion and Conclusion

Unlike other sports requiring repetitive shoulder function, the “elite” golfers sampled in this pilot investigation did not demonstrate a unique passive range of motion pattern between the lead and trailing shoulders. Factors, including subjects'' age, may have confounded the findings. Further studies are warranted utilizing cohorts of golfers with matching age and skill levels. Additional shoulder range of motion measures should be evaluated.     

THE RELATIONSHIP BETWEEN GLENOHUMERAL JOINT TOTAL ROTATIONAL RANGE OF MOTION AND THE FUNCTIONAL MOVEMENT SCREEN? SHOULDER MOBILITY TEST

Purpose/Background:

Side to side asymmetry in glenohumeral joint rotation correlates with injury risk in overhead athletes. The purpose of the current study was to identify the relationship between side‐to‐side asymmetries in glenohumeral joint total rotational range of motion and shoulder mobility test scores from the Functional Movement Screen™ in collegiate overhead athletes. The authors hypothesized that asymmetries of > 10° in glenohumeral total rotation would not be associated with asymmetrical findings in the Functional Movement Screen™ (FMS) shoulder mobility test.

Methods:

Passive glenohumeral total rotational range of motion and the shoulder mobility test of the FMS were measured during pre‐participation examinations in 121 NCAA male and female Division II collegiate overhead athletes from varied sports. Passive shoulder range of motion was measured in supine at 90° of abduction, with the humerus in the scapular plane using two measurers and a bubble goniometer. A Pearson Chi‐square analysis, p<.05 was used to associate the presence of asymmetries in glenohumeral joint rotation and in the FMS shoulder mobility test in each subject.

Results:

40/114 (35.1%) athletes demonstrated asymmetries in total glenohumeral rotation. 45/114 (39.5%) athletes demonstrated asymmetries in the shoulder mobility test. Only 17 of the 45 subjects who demonstrated asymmetry on the shoulder mobility test also demonstrated glenohumeral joint rotation differences of > 10°. Athletes with asymmetries in rotation of > 10° were not any more likely to have asymmetries identified in the shoulder mobility test (95% CI=.555‐2.658, P=.627).

Conclusions

Glenohumeral joint range of motion is one of multiple contributors to performance on the FMS shoulder mobility test, and alone, did not appear to influence results. The FMS shoulder mobility test should not be used alone as a means of identifying clinically meaningful differences of shoulder mobility in the overhead athlete. Clinicians working with overhead athletes may consider using both assessments as a complete screening tool for injury prevention measures.

Level of Evidence:

Level 3     

VALIDATION OF A NEW METHOD FOR ASSESSING SCAPULAR ANTERIOR‐POSTERIOR TILT

Background:

Electromagnetic tracking systems have enabled some investigators and clinicians to measure tri‐planar scapular motion; yet, they are not practical and affordable options for all clinicians. Currently, the ability to affordably quantify scapular motion is limited to monitoring only the motion of scapular upward rotation, with use of a digital inclinometer.

Hypothesis/Purpose:

The objective of this study was to determine the criterion‐related validity of a modified digital inclinometer when used to measure the motion of scapular anterior‐posterior (AP) tilt.

Materials & Methods:

Thirteen volunteers, free from any history of shoulder injury, reported for a single testing session. Each subject underwent a brief shoulder and posture examination in order to confirm the absence of pathology. Subjects actively performed clinically relevant amounts of humeral elevation in the scapular plane while in a seated position. An electromagnetic tracking system (Ascension Technology, Burlington, VT) and a modified inclinometer (Pro 360, Baseline®, Fabrication Enterprises, White Plains, NY) were used to acquire scapular AP tilt over the same shoulder motions. Criterion‐related validity was determined using Pearson Product Moment correlations.

Results:

Correlation analyses revealed significant moderate to good associations (r = 0.63 to 0.86, p < 0.01) between scapular AP tilt measures obtained with a digital inclinometer and an electromagnetic tracking system.

Conclusions

A modified digital inclinometer is a moderately valid device to use for the quantification of scapular AP tilt. Further study is warranted to establish reliability and to validate use of the device in patients with shoulder injury or pathology. The modified inclinometer expands the clinician''s ability to quantify scapular kinematic motion during the clinical evaluation and rehabilitation process.

Level of Evidence:

Level 3     

GLENOHUMERAL ROTATIONAL RANGE OF MOTION DIFFERENCES BETWEEN FAST BOWLERS AND SPIN BOWLERS IN ELITE CRICKETERS

Background:

The shoulder, particularly the glenohumeral joint with its predominant reliance upon soft tissues for stability is prone to injury among the cricketers who bowl regularly. These shoulder injuries are more common in spin bowlers than fast bowlers. A decreased internal rotational difference and increased external rotational difference exist when comparing the dominant shoulder with non‐dominant shoulder between overarm cricketers and non‐throwing wicket keepers.

Purpose:

To compare the glenohumeral internal and external rotation range of motion differences between fast bowlers and spin bowlers.

Methods:

A cross‐sectional design was utilized for this study. Thirty‐five fast bowlers and 31 spin bowlers from an elite group were recruited based on the selection criteria. Glenohumeral passive internal and external rotational differences between dominant and non‐dominant shoulders were measured using a standardized mechanical inclinometer.

Results:

Independent t‐tests revealed a statistically significant difference for external rotational difference (p=0.005) between fast and spin bowlers and no such difference for internal rotational difference (p=0.549) between them at 0.05 level.

Conclusion:

External rotational difference is significantly different between fast bowlers and spin bowlers but not internal rotational difference.

Level of Evidence:

Level 4