Interrater and intrarater reliability of ultrasonographic measurements of acromion-greater tuberosity distance in healthy people

Acromion-greater tuberosity (AGT) distance could potentially be used to assess rotator cuff tears and shoulder subluxation in patients with poststroke hemiplegia. The aim of this study was to assess the interrater and intrarater reliability of ultrasonographic measurements of AGT distance in healthy people prior to testing on patient populations. Twenty healthy individuals (9 male, 11 female) with a mean age of 21 years (SD±2) were recruited. Three final year physiotherapy students (mean age 23 years) recorded the ultrasonographic measurements of AGT distance by using a standardised protocol. Reliability was assessed by intraclass correlation coefficients (ICC) and standard error of measurements (SEM). The mean AGT distances, as measured by rater one, two, and three were 2.24±0.45?cm, 2.27±0.37?cm, and 2.21±0.31, respectively. The interrater reliability coefficient was ICC=0.79, and the intrarater reliability coefficients were 0.88, 0.84, and 0.91 for each rater. The SEM for the AGT distance measurements was ≤0.15?cm for all three raters. Ultrasonographic measurements of AGT distance demonstrate good intrarater and interrater reliability in healthy individuals even when measured by three relatively inexperienced raters. It has potential to provide quantitative measurements for the clinical management of pathologies such as poststroke shoulder subluxation and rotator cuff tears.     

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

Abstract

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.     

Reliability and validity of ultrasonographic measurements of acromion-greater tuberosity distance in poststroke hemiplegia

Kumar P, Bradley M, Gray S, Swinkels A. Reliability and validity of ultrasonographic measurements of acromion-greater tuberosity distance in poststroke hemiplegia.

Objectives

The primary aim of this study was to assess the intrarater reliability of ultrasonographic measurements of acromion-greater tuberosity (AGT) distance in patients with stroke using portable ultrasound. A secondary aim was to determine the discriminant validity of the ultrasonographic technique by comparison of AGT distance measurements of stroke-affected and unaffected shoulders.

Design

Test–retest design.

Setting

Two local National Health Service hospitals in the South West of England.

Participants

Patients with first-time stroke (N=26; 16 men, 10 women; mean age ± SD, 71±10y) with 1-sided weakness who gave informed consent were recruited.

Interventions

Not applicable.

Main Outcome Measures

Portable diagnostic ultrasound was used to record measurements on day 1 and again within a fortnight. Bedside measurements were undertaken by a single physical therapist with patients seated upright in a standard hospital chair. Intraclass correlation coefficients (ICCs) and standard errors of measurement were used to assess reliability. Minimum detectable change (MDC90) scores were used to estimate the magnitude of change that is likely to exceed measurement error. Repeated-measures analysis of variance (ANOVA) was used to assess discriminant validity.

Results

Mean ± SD AGT distances on the stroke-affected side and unaffected side were 2.3±0.6cm and 1.9±0.3cm, respectively. ICC for within-day reliability was .98 for the affected shoulder and .95 for the unaffected shoulder. Corresponding values for between-day reliability were .94 and .76. The standard error of measurement for both affected and unaffected shoulders was less than 0.2cm. Within-day MDC90 for the affected shoulder and the unaffected shoulder was ±0.2cm and ±0.1cm, respectively. Repeated-measures ANOVA showed a significant difference between mean AGT distance for the affected and unaffected shoulders.

Conclusions

Ultrasonographic measurement of AGT distance demonstrates both intrarater reliability and discriminant validity and has the potential to assess shoulder subluxation in patients with stroke. Research into interrater reliability and concurrent validity of ultrasonographic measurements of AGT distance in patients with stroke is required.     

Interrater and Intrarater Reliability and Minimum Detectable Change of Ultrasound for Active Myofascial Trigger Points in Upper Trapezius Muscle in Individuals With Shoulder Pain

ObjectiveWe sought to investigate the interrater and intrarater reliability of ultrasound and the minimum detectable change (MDC) for the trigger points (TrPs) active in the upper trapezius (UT) muscle in individuals with shoulder pain.MethodsForty individuals with shoulder pain were investigated for the presence of active TrPs in the UT muscle by means of ultrasound for the parameters of gray scale, muscle thickness of UT muscle at rest, and contraction and area of TrPs. The intrarater reliability was performed on 2 days, and interrater reliability on the same day. For the gray scale, the reliability was evaluated using the kappa coefficient (κ), while the other parameters were measured by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and MDC.ResultsFor the gray scale, the intrarater agreement was almost perfect (κ = 1.00) and the interrater agreement was substantial (κ = 0.75). The intrarater and interrater reliability were excellent for most of the parameters, except for the area of TrPs (intrarater: ICC = 0.71, substantial; interrater: ICC = 0.52, substantial). The MDC for intrarater reliability varied between 0.04 and 0.05 (SEM% between 2.4% and 38.87%), and that for interrater reliability ranged from 0.05 to 0.07 (SEM% between 3.18% and 55.10%), with a higher value for area.ConclusionParameters such as gray scale, resting muscle thickness, and muscle contraction of the UT muscle, obtained through ultrasound, showed excellent intrarater and interrater reliability with low SEM%. The intrarater and interrater reliability for the area deserves a caveat regarding their use.     

Validity and reliability of an internet-based temporal gait assessment tool with healthy adults: a pilot study

OBJECTIVES: To assess in healthy adults the validity and the inter- and intrarater reliability of the Internet-based Shaw Gait Assessment (SGA). DESIGN: Concurrent test-retest reliability and validity study with participants, 4 raters, and the Elite motion analysis system (used as the criterion standard). SETTING: Motion analysis laboratory in a university physical therapy department. PARTICIPANTS: Convenience sample of 16 healthy men and women (age range, 28-53y). INTERVENTION: Each subject performed 2 consecutive walks "at a comfortable pace" on a 6-m walkway. A video camera from the Elite motion analysis system filmed reflective markers, which were attached to subjects' shoes, and the reflective markers provided the criterion standard. Four raters simultaneously recorded each walk by using laptop computers and the SGA. MAIN OUTCOME MEASURES: Paired t test (5% level) for average differences between each test and retest for raters and the Elite; Pearson correlations, limits of agreement, and coefficients of variation (CVs) for validity of the tool; intraclass correlation coefficients (ICCs) for inter- and intrarater reliability. RESULTS: Pearson product moment correlation coefficients between each of the raters and the Elite ranged from .92 to .95 for speed, from .85 to .97 for cadence, from .87 to .92 for step length, from .61 to .84 for left advance limb time, and from .68 to .83 for right advance limb time. Pooled CVs for all variables were below 8% for all raters and the Elite. Pooled ICCs for intrarater reliability were .89 for speed, .99 for cadence, .84 for step length, .76 for left limb advance time, and .84 for right limb advance time. Interrater ICCs were .89 for speed, .82 for cadence, .76 for step length, .66 for left limb advance time, and .81 for right limb advance time. CONCLUSIONS: The SGA is a valid and reliable tool for several key temporal measures of gait in a healthy adult population.     

The reliability in determining the deep fascia displacement of the upper trapezius during cervical movement: A pilot study

BackgroundRestricted shoulder fascia displacement may be an etiological factor for myofascial pain syndrome. A diagnostic ultrasound video can follow deep fascia displacement during active cervical movements. Trackers can be applied to videos to convert deep fascia displacement into data points. This study reports on assessors' reliability in evaluating direction and quantifying upper trapezius' deep fascia displacement during active cervical movements.MethodsPT-Sonographer 1 recorded deep fascia displacement of upper trapezius for three sets using HS1 Konica Minolta diagnostic ultrasound. The recording sequence used was cervical flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation. The three assessors used the tracker to determine direction of deep fascia displacement. PT-Sonographer 1 used the tracker three times in quantifying deep fascia displacement. Intraclass correlation coefficient and Kappa determined the assessors' intra-tester and inter-tester reliability.ResultsTen participants were included in the study with a mean±(SD) age of 37±(6). All the assessors had acceptable intra-tester reliability in determining deep fascia displacement on tracker (ICC≥0.40). All assessors had clinically unacceptable inter-tester reliability in determining deep fascia displacement when tracking right rotation (ICC < 0.40). PT-Sonographer 1 had clinically unacceptable intra-tester reliability in determining deep fascia displacement when tracking left rotation (ICC<0.40).ConclusionWe report clinically acceptable assessors' reliability in determining direction and total deep fascia displacement when tracking diagnostic ultrasound videos of cervical flexion, extension, and lateral flexion. Checking for reliable deep fascia displacements may distinguish MPS from non-MPS individuals increasing the utility of diagnostic ultrasound machine and tracker in clinical practice.     

The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer

This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry?=?0.87, intrarater digital inclinometry?=?0.88, interrater goniometry?=?0.92, and interrater digital inclinometry?=?0.89. The minimal detectable change (MDC₉₅) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.     

68例成年人肩宽测量及适宜枕头相应数据研究

目的：通过对68例成年人肩颧距及肩宽的调查、测量和分析,为适宜枕头设计提供依据。方法：68例成年志愿者,用两副平行滑动角尺测量其左右肩颧距（肩峰至同侧颧弓垂直距离）和肩宽（两肩峰间的距离）。结果：男性,肩颧距两侧最大值13.75cm,最小值10.50cm,平均（12.36±0.92）cm;肩宽最大值48.00cm,最小值38.00cm,平均（42.69±2.16）cm。女性,肩颧距两侧最大值13.70cm,最小值9.00cm,平均（10.82±1.01）cm;肩宽最大值44.00cm,最小值34.00cm,平均（39.14±2.81）cm。结论：肩颧距及肩宽数据测量为颈曲康复枕设计和改进提供出重要的参考依据。     

Clinical Measures Related to Forward Shoulder Posture: A Reliability and Correlational Study

ObjectivesThe purpose of this study was to examine the reliability of clinical measures related to forward shoulder posture (pectoralis minor index [PMI], scapular index [SI], abduction index [AI], acromion to the wall index [AWI] acromion to the treatment table index [ATI], and thoracic curvature [TC]), and to investigate the association (redundancy) among these measures.MethodsTwenty-one asymptomatic participants participated in this study. Two physiotherapists were trained to perform the clinical measurements. Intraclass correlation coefficients (ICC_2,k) were calculated to assess intra- and interrater reliabilities. Pearson product moment correlation was used to investigate the existence of possible redundancy between the measures that showed high intra- and interrater reliabilities.ResultsThe measures showed ICCs between 0.30 and 0.97. Five measures, PMI, SI, AWI, ATI, and TC, showed appropriate values for intrarater reliability (ICCs 0.77-0.94), and 3 measures, AWI, ATI, and TC, for interrater reliability (ICCs 0.82-0.85). Among measures that showed acceptable intra- and interrater reliability values, 2 measures were redundant, showing high association (AWI vs ATI) (r = 0.80, P < .001).ConclusionFor PMI, SI, AWI, ATI, and TC measures, adequate values of intrarater reliability were observed. For AWI, ATI, and TC, adequate values of interrater reliability were found. Two pairs of measures were highly associated (PMI with SI; AWI with ATI), which indicates redundancy among them. Our results suggest that, when the same examiner performs the assessment, the combined use of the PMI, AWI, and TC measures allows a quick but comprehensive evaluation of the presence of forward shoulder posture.     

Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study

BACKGROUND AND PURPOSE: The Lateral Scapular Slide Test (LSST) is used to determine scapular position with the arm abducted 0, 45, and 90 degrees in the coronal plane. Assessment of scapular position is based on the derived difference measurement of bilateral scapular distances. The purpose of this study was to assess the reliability of measurements obtained using the LSST and whether they could be used to identify people with and without shoulder impairments. Subjects. Forty-six subjects ranging in age from 18 to 65 years (X=30.0, SD=11.1) participated in this study. One group consisted of 20 subjects being treated for shoulder impairments, and one group consisted of 26 subjects without shoulder impairments. METHODS: Two measurements in each test position were obtained bilaterally. From the bilateral measurements, we derived the difference measurement. Intraclass correlation coefficients (ICC [1,1]) and the standard error of measurement (SEM) were calculated for intrarater and interrater reliability of the difference in side-to-side measures of scapular distance. Sensitivity and specificity of the LSST for classifying subjects with and without shoulder impairments were also determined. RESULTS: The ICCs for intrarater reliability were .75, .77, and .80 and .52, .66, and .62, respectively, for subjects without and with shoulder impairments in 0, 45, and 90 degrees of abduction. The ICCs for interrater reliability were .67, .43, and .74 and .79, .45, and .57, respectively, for subjects without and with shoulder impairments in 0,45 and 90 degrees of abduction. The SEMs ranged from 0.57 to 0.86 cm for intrarater reliability and from 0.79 to 1.20 cm for interrater reliability. Using the criterion of greater than 1.0 cm difference, sensitivity and specificity were 35% and 48%, 41% and 54%, and 43% and 56%, respectively, for 0, 45, and 90 degrees of abduction. Sensitivity and specificity based on the criterion of greater than 1.5 cm difference were 28% and 53%, 50% and 58%, and 34% and 52%, respectively, for the 3 scapular positions. CONCLUSION AND DISCUSSION: Our results suggest that measurements of scapular positioning based on the difference in side-to-side scapular distance measures are not reliable. Furthermore, the results suggest that sensitivity and specificity of the LSST measurements are poor and that the LSST should not be used to identify people with and without shoulder dysfunction.     

Ultrasound Strain Imaging in Assessment of Biceps Muscle Stiffness and Dynamic Motion in Healthy Adults

We prospectively evaluated the feasibility of using ultrasound strain imaging (USI) to assess biceps brachii muscle (BBM) stiffness and dynamic motion in 10 healthy adults. The BBM axial deformation was produced by external compression with a sandbag (1.0 kg) tied onto the transducer. The BBM lateral movement was produced by manual passive elbow flexion and extension. By use of 2-D speckle tracking, captured 5-s real-time ultrasound data of BBM were processed to estimate axial strain, representing muscle stiffness, and lateral strain and tissue velocity, representing muscle dynamic motion. Axial (lateral) strain ratio was defined as BBM strain divided by subcutaneous soft tissue strain. There was no significant difference in lateral strain or tissue velocity between the left and right BBM (lateral strain ratio: 4.69 ± 0.07 vs. 4.51 ± 0.08 for extension, 4.82 ± 0.09 vs. 4.69 ± 0.11 for flexion; tissue velocity: 1.58 ± 0.32 cm/s vs. 1.78 ± 0.85 cm/s for extension, ?2.03 ± 0.63 vs. ?2.03 ± 0.59 for flexion; all p values > 0.05) or between men and women (lateral strain ratio: 4.52 ± 0.06 vs. 4.67 ± 0.1 for extension, 4.71 ± 0.11 vs. 4.83 ± 0.09 for flexion; tissue velocity, cm/s: 1.76 ± 0.76 vs. 1.66 ± 0.65 for extension, ?2.21 ± 0.65 vs. ?1.88 ± 0.52 for flexion, all p values > 0.05). The difference in axial stain between men and women was significant (axial strain ratio: 3.09 ± 0.43 vs. 3.52 ± 0.26, p = 0.02). Inter- and intra-observer reliability in performing USI of the BBM was good (all intra-class correlation coefficients [ICCs] >0.75). Our results suggest that USI seems to be feasible for and reproducible in estimating BBM mechanical properties and motion dynamics in healthy adults.     

Reliability of Different Clinical Techniques for Assessing Foot Posture

ObjectiveThe aim was to determine the interrater and intrarater reliability of navicular drop (NDP), navicular drift (NDT), and the Foot Posture Index-6 (FPI-6), and test–retest reliability of the static arch index (SAI) and dynamic arch index (DAI).MethodsSixty healthy individuals were assessed for intrarater and test–retest reliability. From 60 participants, 30 individuals were assessed for interrater reliability. A digital caliper was used to measure NDP and NDT. Electronic pedography was used to calculate SAI and DAI. The FPI-6 was also performed. All assessments were performed on the dominant foot. The NDP, NDT, SAI, and DAI were repeated 3 times. The NDP and NDT were analyzed separately using both first measurement and the average, but the SAI and DAI were analyzed using only the average. The NDP, NDT, and FPI-6 were conducted by 2 raters to determine interrater reliability and were repeated by a single rater after 5 days from initial assessment to determine intrarater reliability. The SAI and DAI were also repeated after 5 days to determine test–retest reliability.ResultsIntrarater intraclass correlation coefficients (ICCs) were 0.934 and 0.970 for NDP, 0.724 and 0.850 for NDT, and 0.945 for FPI. Interrater ICCs were 0.712 and 0.811 for NDP, 0.592 and 0.797 for NDT, and 0.575 for FPI. Test–retest ICCs of the SAI and DAI were 0.850 and 0.876, respectively.ConclusionNavicular drop is relatively more reliable than other traditional techniques. Also, the FPI-6 has excellent intrarater reliability, but only moderate interrater reliability. The results can provide clinicians and researchers with a reliable way to implement foot posture assessment.     

Intrasession and interrater reliability of rehabilitative ultrasound imaging measures of the deep neck flexors: A pilot study

The purpose of this investigation was to examine the intrasession and interrater reliability of rehabilitative ultrasound imaging (RUSI) to measure the deep neck flexors (DNF). Two investigators traced the DNF muscle borders in eight female subjects aged 33?±?11.2 years. Of the eight subjects, five subjects reported a greater than 6-month history of neck pain, and three subjects were asymptomatic healthy controls. Cross-sectional area (CSA) (cm(2)) of right and left muscle groups were calculated. The intraclass correlation coefficients (ICC) for CSA measures were 0.67 (95% CI: 0.27-0.87) for rater 1 with a standard error of measurement (SEM) of 0.06?cm(2); 0.87 (95% CI: 0.65-0.96) for rater 2 with an SEM of 0.09?cm(2); and 0.68 (95% CI: 0.44-0.87) for interrater reliability between rater 1 and rater 2 with an SEM of 0.11?cm(2). The mean difference between CSA (cm(2)) measures were 0.00?±?0.10?cm(2) for rater 1 and 0.09?±?0.13?cm(2) for rater 2. The mean differences for CSA were 0.04?±?0.12?cm(2). This pilot investigation suggests that RUSI could be used to reliably assess the size of the deep neck flexors.     

The use of electrical stimulation and taping to address shoulder subluxation for a patient with central cord syndrome

BACKGROUND AND PURPOSE: This case report describes the examination, intervention, and outcome of a patient with central cord syndrome (CCS) who participated in acute rehabilitation that included the use of electrical stimulation (ES) and strapping to address shoulder subluxation. The only literature found describing these interventions for shoulder subluxation was for patients with stroke. CASE DESCRIPTION: The patient was a 29-year-old man with CCS and bilateral shoulder subluxation. He received ES over 8 weeks to the anterior and middle deltoid and supraspinatus muscles of the right shoulder. Taping was repeated every 3 to 4 days on both shoulders following over the anterior and middle deltoid muscles up to the acromion. OUTCOMES: The initial shoulder subluxation measurements were 1.5 cm on the right and 1.0 cm on the left. The final measurements were 0.3 cm on the right and 0.2 cm on the left. The patient's American Spinal Injury Association upper-extremity motor scores were 26/50 initially and 48/50 at discharge. CONCLUSION: The use of ES and shoulder taping in conjunction with other rehabilitation may have played a role in reducing the patient's shoulder subluxation.     

二维剪切波弹性成像技术对血液透析患者肱二头肌受损情况的量化评估

摘 要 目的 探讨二维剪切波弹性成像技术在维持性血液透析患者肱二头肌受损情况中的价值。方法 测量长透组、短透组及对照组各30名患者的肱二头肌肌肉厚度和浅侧脂肪厚度、及其剪切波速度，比较三组间各指标的变化情况。结果 （1）肱二头肌中段肌肉厚度测量中长透组（右1.98±0.35cm，左1.99±0.32cm）厚于对照组（右1.92±0.21cm，左1.94±0.19cm）和短透组（右1.81±0.30cm，左1.82±0.30cm），其中长透组和短透组间差异有统计学意义（p＜0.05）。（2）肱二头肌中段浅侧脂肪厚度测量中对照组（右0.40（0.34，0.51）cm，左0.40（0.35，0.51）cm）厚于长透组（右0.35（0.30，0.48）cm，左0.37（0.30，0.51）cm）和短透组（右0.30（0.26，0.42）cm，左0.32（0.27，0.46）cm），其中短透组和对照组间差异有统计学意义（p＜0.05）。（3）肱二头肌及浅侧脂肪剪切波速度测量中对照组速度最高（右3.72±0.25m/s、3.27（3.15，3.38）m/s，左3.76±0.19m/s、3.22（3.14，3.36）m/s），其次是短透组（右3.47±0.26m/s、3.09（2.97，3.27）m/s，左3.48±0.24m/s、3.08（3.00，3.20）m/s），再次是长透组（右3.17±0.33m/s，2.85（2.69，3.07）m/s、左3.17±0.27m/s、2.88（2.73，3.07）m/s），各组间差异有统计学意义（p＜0.05）。结论 超声作为一种无创便捷评估维持性血液透析患者肱二头肌及其浅侧脂肪厚度及弹性模量变化的影像检查方法，可用于肌肉功能受损程度的量化评估。     

Interrater and Intrarater Reliability of a Handheld Myotonometer in Measuring Mechanical Properties of the Neck and Orofacial Muscles

ObjectiveThe purpose this study was to investigate the reliability of a handheld myotonometer in measuring the mechanical properties of the neck and orofacial muscles in asymptomatic individuals.MethodsThe study included 16 healthy participants. The mechanical properties (frequency, decrement, stiffness, relaxation time, and creep) of the selected muscles were measured with a MyotonPRO myotonometer (Mumeetria Ltd, Tallinn, Estonia). The sternocleidomastoid, upper trapezius, cervical extensor, and masseter muscles were selected to determine the reliability of the device. Measurements were performed by 2 examiners to determine interrater reliability; for intrarater reliability, an examiner repeated the measurements 1 week after the first measurements.ResultsThe results revealed moderate to excellent intrarater and interrater reliability (intraclass correlation coefficients: 0.50-0.95) in measuring muscle mechanic properties. The standard error of measurement in the tested muscles ranged from 0.3 to 0.8 Hz for frequency, from 7.4 to 20.9 N/m for stiffness, from 0.1 to 0.2 for decrement, and from 0.8 to 1.4 ms for relaxation time. The minimum detectable change ranged from 0.8 to 2.2 Hz for frequency, from 20.5 to 57.9 N/m for stiffness, from 0.2 to 0.6 for decrement, from 2.2 to 3.9 ms for relaxation time, and from 0.2 to 0.3 for creep. In addition, the coefficients of variation were below 9.1% for all the assessed parameters.ConclusionThe obtained results demonstrate that the MyotonPRO device is a reliable and repeatable tool to quantify the frequency, stiffness, decrement, relation time, and creep of the neck and orofacial muscles in asymptomatic individuals.     

Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls

BackgroundThe reduction of the subacromial space has traditionally been linked to rotator cuff pathology. The contribution of this narrowing, both in the development and maintenance of rotator cuff tendinopathy, is still under debate. The objective of the present study was compare the acromiohumeral distance at 0 and 60 degrees of active shoulder abduction in scapular plane, static position, in both symptomatic and contralateral shoulders, between participants with unilateral rotator cuff related shoulder pain, and in asymptomatic participants.MethodThis was a cross-sectional observational study. Seventy-six participants with chronic shoulder pain were assessed. Forty participants without shoulder pain were also recruited to compare the acromiohumeral distance with symptomatic participants. The acromiohumeral distance was measured at 0 and 60 degrees of active shoulder abduction in all the groups by ultrasound imaging. Mean differences between symptomatic versus contralateral shoulders, and versus healthy controls, were calculated.FindingsThere were no statistical significant differences (p > .05) in the acromiohumeral distance at 0 degrees of shoulder elevation between the groups. However, significant differences were found at 60° between symptomatic and contralateral shoulder groups (0,51 mm; 95% CI: −0.90 to −0.12).InterpretationsDifferences in shoulder pain perception at 0° are not attributable to acromiohumeral distance differences. However, treatments focused on increasing AHD at 60° could be prescribed, as a significantly reduced AHD was found in symptomatic shoulders when compared with contralateral shoulders. Further research is needed to determine, not only static differences in AHD, but also dynamic differences.     

Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects.

The purposes of this study were to identify the incidence of postural abnormalities of the thoracic, cervical, and shoulder regions in two age groups of healthy subjects and to explore whether these abnormalities were associated with pain. Eighty-eight healthy subjects, aged 20 to 50 years, were asked to answer a pain questionnaire and to stand by a plumb line for postural assessment of forward head, rounded shoulders, and kyphosis. Subjects were divided into two age groups: a 20- to 35-year-old group (mean = 25, SD = 63) and a 36- to 50-year-old group (mean = 47, SD = 2.6). Interrater and intrarater reliability (Cohen's Kappa coefficients) for postural assessment were established at .611 and .825, respectively. Frequency counts revealed postural abnormalities were prevalent (forward head = 66%, kyphosis = 38%, right rounded shoulder = 73%, left rounded shoulder = 66%). No relationship was found between the severity of postural abnormality and the severity and frequency of pain. Subjects with more severe postural abnormalities, however, had a significantly increased incidence of pain, as determined by chi-square analysis (critical chi 2 = 6, df = 2, P less than .05). Subjects with kyphosis and rounded shoulders had an increased incidence of interscapular pain, and those with a forward-head posture had an increased incidence of cervical, interscapular, and headache pain.     

Range of Motion in Older Women

This study had three purposes: to compare the active neck and upper extremity range of motion (ROM) in healthy older women with expected estimates; to consider if right and left side measures were similar; and to determine the degree of ROM loss with advancing age. Sixty-one older women, living independently in the community, were measured at the neck, shoulder, elbow, forearm, and wrist on the right and left sides using a standard protocol. ROM was less than expected by 14_ to 30_ for neck lateral flexion (26.00_ ?8.72_ on right; 26.41_ ?7.67_ on left), shoulder abduction (154.62_D 21.37_ on right; 150.25_ ?21.65_ on left), shoulder flexion (158.23_ ?19.55_ on right; 159.20_ ?8.73_ on left), shoulder internal rotation (52.92_ ?8.99_ on right; 53.74_ ?9.94_ on left), and shoulder external rotation (76.05_ ?16.31_ on right; 72.44_ ?15.37 on left). Some differences were noted between right and left side ROM. Linear regression for age and range suggested that range decreased with age by an average of approximately 1_ per year in right shoulder abduction, right shoulder flexion, and right and left shoulder external rotation.     

超声测量育龄期未生育女性腹直肌间隙

目的 观察超声测量育龄期未生育女性腹直肌间隙（IRD）的价值。方法 随机选取330名接受体检的育龄期健康女性，分别于其平卧及屈膝卧位下，采用高频超声探头于脐上3 cm、紧贴脐上缘、紧贴脐下缘及脐下3 cm处测量IRD，即左、右侧腹直肌内缘的距离；于脐水平测量左右侧腹直肌厚度。结果 平卧和屈膝状态下，育龄期未生育女性脐上3 cm处IRD宽度分别为（10.46±3.91）和（10.82±3.87）mm，紧贴脐上缘处IRD宽度分别为（11.84±4.54）和（12.36±4.52）mm，紧贴脐下缘处分别为（9.53±3.72）和（9.76±3.95）mm，脐下3 cm处宽度分别为（5.87±2.46）和（6.13±2.65）mm；其脐上3 cm处左、右侧腹直肌厚度分别为（10.05±1.41）和（10.26±1.40）mm、（9.73±1.24）和（9.85±1.28）mm。屈膝卧位下，各部位IRD宽度（除脐下缘处）大于平卧下（P均<0.05），且IRD宽度在紧贴脐上缘处最大、脐下3 cm处最小（（P均<0.001）；左、右侧腹直肌厚度在屈膝卧位下大于平卧下（P均<0.05）。结论 超声测量IRD安全、便捷；育龄期未生育女性正常IRD在不同状态及不同位置均有所不同。