Measurements Of Internal Rotation Research Articles

Understanding overall shoulder function and health: the value of specific quantitative vs. qualitative shoulder range of motion on patient-reported outcome measures

Hypothesis and BackgroundIt is known that, though widely used, shoulder range of motion (ROM) measurements are not standardized and have a high rate of intra- and interobserver differences. Particularly, the inconsistency in quantitative and qualitative measurements and their relationship to patient-reported outcome measures (PROMs) make shoulder health difficult to determine. MethodsThis was a prospective study of 147 patients who presented with a chief complaint of shoulder pain to the orthopedic sports medicine and shoulder clinic of a single fellowship-trained surgeon. Measured by one examiner, quantitative ROM measurements were taken with a goniometer and qualitative ROM measured by the anatomic level that the patient could reach. The following PROMs were used as well: American Shoulder and Elbow Surgeons Shoulder Score (ASES), Single Assessment Numeric Evaluation (SANE), Shoulder Pain and Disability Index (SPADI), Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), 12-Item Short Form Health Survey (SF-12), and Patient-Reported Outcomes Measurement Information System pain interference short form 6a (PROMIS 6a). Statistical analysis was performed with SPSS using Pearson correlation and two-sample t-test. Benjamini-Hochberg correction was used to determine p-value at which statistical significance was reached to correct for multiple comparisons. ResultsQualitative internal rotation (IR), (the hand behind back reach test) and qualitative forward flexion (FF) correlated with all goniometer angle measurements and PROMs (both shoulder and general health scores). These qualitative measures proved to be an appropriate proxy for IR and FF goniometer measurements. Qualitative external rotation (ER) was not a good substitute for quantitative ER measurement. Quantitative ER correlated with all PROMs. As ROM increased when measured by quantitative ER, qualitative IR, and qualitative FF, shoulder and general health PROMs incrementally increased as well. Discussion/ConclusionQualitative IR measurement, the hand-behind-back reach test, is an adequate substitution for IR goniometer angle as well as a strong representation of global shoulder ROM, shoulder health, and general health while factoring in patient age. Qualitative FF measurement is also an appropriate proxy for quantitative FF and represents global shoulder and general health without factoring in age. Quantitative ER via goniometer angle, is a better assessment of the shoulder than qualitative ER and is a representation of overall shoulder and general health. We recommend the use of quantitative ER, qualitative IR, and qualitative FF measurements to best understand a patient’s overall shoulder health and its impact on their overall health.

Internal Rotation Measurements: Correlation between Vertebral Body Level and Goniometer Measurements on Functional Outcome Scores.

Reverse total shoulder arthroplasty (rTSA) has shown success in the treatment of end-stage glenohumeral pathology. However, one major shortcoming has been the lack of internal rotation (IR), which can have significant functional consequences. Much research has been conducted to maximize IR after rTSA, but the literature is unclear which measurement of IR represents the "gold standard" between vertebral level and goniometer-based measurements. Patients were prospectively enrolled into one of three groups: postoperative from rTSA, subacromial pain (SA), and normal. IR measurements were obtained either by the vertebral body level, by which radiographic markers indicated the highest level that the patient was able to reach on the body midline; or by using a goniometer while the shoulder was in 90-degree abduction as the patient stood upright. Comparisons between the radiographic vertebral level and goniometer IR measurements showed significant correlations within the normal (r = - 0.43, P = 0.02) and SA pain groups (r = - 0.44, P = 0.02). The rTSA group did not quite reach statistical significance (P = 0.11), but had a moderate correlation coefficient (r = - 0.33). Accuracy of visual IR measurements was also significant. All rTSA group vertebral level measurements were within two vertebral levels, while only 84.6% of IR measurements by goniometer were within 15 degrees. Visual vertebral level measurements were found to be more accurate for the SA pain group (86.2 vs 66.7%). A comparison of the two primary IR measurement methods for shoulders was shown to have a correlation. This would allow for direct comparison of different literature using only one measurement method. While the correlation is not yet strong enough to allow for conversion between the two measurement types, creating a matched cohort taking into account other factors may lead to the correlation reaching this point.

The effectiveness of high-intensity laser therapy on pain, range of motion, functional capacity, quality of life, and muscle strength in subacromial impingement syndrome: a 3-month follow-up, double-blinded, randomized, placebo-controlled trial.

The aim of this study was to perform a placebo-controlled assessment of the short- and long-term efficiency of high-intensity laser therapy (HILT) in treatment of subacromial impingement syndrome (SAIS). Sixty-three patients (32 in HILT + exercise and 31 in sham HILT + exercise group) who were diagnosed with SAIS were included. The assessments were performed before (baseline, 0) and after treatment (3rd week/12th week). Active range of motion (ROM) with goniometric measurement, pain with visual analog scale (VAS), shoulder function with Constant-Murley score (CMS), quality of life with SF-36 (short-form 36) health survey, muscle strength using isokinetic device (including peak torque level measurements at shoulder internal rotation (IR) and external rotation (ER) at 120, 180, and 210 degrees) were assessed. Significant improvements were determined in the assessments at the 3rd and 12th week controls in both HILT and control groups. In the comparison of the values of the groups (3rd/12th week), the HILT group had a statistically significant improvement compared with the placebo group; in the active shoulder flexion, IR, and ER ROM measurements; in VAS scores; in CMS activities of daily living, ROM, strength and total scores; in all the sub-parameters of SF-36; and in IR 120,180, 210 and ER 120,180 degree/s peak torque values of isokinetic measurements. In the comparison of both groups, HILT + exercise treatment is more effective in reducing pain and increasing the ROM, functioning, quality of life, and the muscular strength assessed with isokinetic in the short and long term.

Shoulder internal and external rotation strength and prediction of subsequent injury in water-polo players.

Water-polo players have greater isokinetic shoulder strength than age-matched controls. Due to the repetitive demands of throwing, however, water-polo players demonstrate an altered strength ratio, with greater internal rotation (IR) strength relative to external rotation (ER). The relationship between shoulder strength and risk of shoulder injury is unknown. In addition, the effect on test position for strength testing on the reliability of handheld dynamometry (HHD) in this population is not known. The aims were to determine the: (a) Inter-rater reliability of HHD testing of IR and ER strength in two positions: neutral and 90°abduction-90°ER (90-90) and (b) relationship between preseason shoulder strength and occurrence of future injury in sub-elite water-polo players. Two assessors measured shoulder IR and ER strength using HHD in 15 water-polo players across two testing days. Athletes were followed over a 6-month period, and injury was assessed and recorded by the team physiotherapist. Measurement of water-polo players' isometric IR and ER strength in the clinical setting had good to excellent inter-rater reliability; however, systematic error was observed in the neutral position but not the 90-90 position. Irrespective of testing position, the neutral and 90-90 test position showed a significant difference (P=0.01) in absolute preseason IR and ER mean strength between prospectively injured and non-injured players. There was no significant difference in strength ratio or strength normalized for body mass index. These results suggest that preseason strength testing may help identify players at risk of in-season shoulder injury.

Three-dimensional motion analysis for validation of shoulder internal rotation.

10% of the points for the Constant-Murley score (CMS) are allocated for the capacity for internal rotation (IR), measured as unassisted active movement of the dorsum of the hand or the thumb to reach different anatomical landmarks. However, there is little information about the validity of this method and no three-dimensional measurement of the degree of IR that is necessary to reach these landmarks. Sixteen volunteers with healthy shoulders were recruited. The degree of IR was defined using the following landmarks as described in the CMS: (1) lateral aspect of thigh, (2) buttock, (3) sacroiliac joint, (4) level of waist, (5) vertebra T12, (6) interscapular. The validity of IR measurement was assessed by simultaneous 3D motion analysis. Using the thumb as pointer, there were significant increases in IR from 39.3° at position 1 to 80.4° at position 2, followed by 105.1°, 108.6°, 110.1°, and 125.3° at position 3-6. Taking the dorsum of the hand as pointer, there were significant increases in IR between all positions, starting from 71.2° (position 1) and followed by 99.3°, 104.1°, 110.3°, 115.2°, and 119.7° at positions 2 to 6. Comparing the two measurement methods, a significant difference was found for the amount of IR between positions 1 and 2. Measurement of IR as described in the CMS is a suitable method. However, there was an increase of only 10° in IR between positions 3 and 5, which may be hard to measure with a standard goniometer in clinical practice.

The Acute Effects of Hold–Relax Proprioceptive Neuromuscular Facilitation With Vibration Therapy on Glenohumeral Internal-Rotation Deficit

Clinicians use various stretching techniques to prevent the onset of and treat glenohumeral internal-rotation deficit (GIRD). It is unknown which stretching technique is the most effective. To investigate the acute effects of hold-relax proprioceptive neuromuscular facilitation (PNF) with and without vibration therapy on internal rotation in individuals with GIRD. 2-within (stretch × time) comparison with repeated measures. Controlled laboratory. 11 male current and former overhead athletes (19.8 ± 1.4 y, 184.5 ± 4.5 cm, 91.8 ± 11.6 kg) who presented with GIRD. At 3 separate sessions, participants performed 1 of 3 randomly assigned stretches: hold-relax PNF (PNF), hold-relax PNF in combination with a whole-body-vibration unit set at 30 Hz (PNF-V), and static stretch (SS). Pretest and posttest maximum passive glenohumeral internal-rotation measurements were taken with a digital protractor. The dependent variables were the mean glenohumeral internal-rotation measurements taken at the pretest and posttest. The influence of stretch (PNF, PNF-V, and SS) and time (pretest and posttest) on mean glenohumeral internal rotation was compared using a 3 × 2 factorial ANOVA with repeated measures on both variables (P ≤ .05). There was a stretch-by-time interaction (F2,20 = 34.697, P < .001). Post hoc testing revealed that the PNF posttest (73.0° ± 10.4°) was greater than the PNF pretest (60.0° ± 11.8°), the PNF-V posttest (74.7° ± 10.0°) was greater than the PNF-V pretest (57.4° ± 10.4°), and the SS posttest (67.0° ± 10.7°) was greater than the SS pretest (60.1° ± 9.4°). When comparing the posttest values, the PNF-V posttest was greater than the SS posttest. All 3 stretches (PNF, PNF-V, and SS) resulted in acute increases in glenohumeral internal rotation in individuals presenting with GIRD. The PNF-V stretch resulted in the greatest increase and would be the most clinically beneficial for patients with GIRD.

Effect of Scapular Stabilization During Horizontal Adduction Stretching on Passive Internal Rotation and Posterior Shoulder Tightness in Young Women Volleyball Athletes: A Randomized Controlled Trial

ObjectiveTo evaluate the effect of scapular stabilization during horizontal adduction stretching (cross-body) on posterior shoulder tightness (PST) and passive internal rotation (IR). DesignRandomized controlled trial with single blinding. SettingAthletic club. ParticipantsAsymptomatic volleyball players who are women with glenohumeral internal rotation deficit (N=60). InterventionsSubjects were randomly assigned to either horizontal adduction stretching with manual scapular stabilization (n=30) or horizontal adduction stretching without stabilization (n=30). Passive stretching was performed for 3- to 30-second holds in both groups. Main Outcome MeasuresRange of motion measurements of PST and IR were performed on the athlete's dominant shoulder prior to and immediately after the intervention. ResultsBaseline mean angular measurements of PST and IR for all athletes involved in the study were 62°±14° and 40°±10°, respectively, with no significant difference between groups (P=.598 and P=.734, respectively). Mean PST measurements were significantly different between groups after the horizontal adduction stretch, with a mean angle of 83°±17° among the scapular stabilization group and 65°±13° among the nonstabilization group (P<.001). Measurements of IR were also significantly different between groups, with a mean angle of 51°±14° among the scapular stabilization group and 43°±9° among the nonstabilization group (P=.006). ConclusionsHorizontal adduction stretches performed with scapular stabilization produced significantly greater improvements in IR and PST than horizontal adduction stretching without scapular stabilization.

Reliability of hip internal rotation range of motion measurement using a digital inclinometer

Assessment of hip internal rotation (IR) is a critical element in the evaluation of a painful hip, yet there currently exists no consistent method of determining this measurement. The purpose of this study is to report the intra-rater and inter-rater reliability of active and passive hip IR measurement using a digital inclinometer. Twenty-five subjects (8 men, 17 women) with asymptomatic hip joints, and no known pathology between the ages of 22 and 42 participated. Two examiners measured hip IR for each subject using a digital inclinometer while visually monitoring pelvic motion. Measurements included passive IR, active IR, and active IR while internally rotating both legs simultaneously. Statistical analysis was performed including intra-rater and inter-rater reliability. There was no significant difference in measured IR values. Mean range of motion values for all techniques and both examiners ranged from 30.7° to 32.8°. Intra-rater reliability for examiner 1 ranged from 0.84 to 0.92. Inter-rater reliability ranged from 0.89 to 0.93. Of the methods utilized, active IR of a single leg was the most responsive technique with a minimal detectable change value of 5.4°. Clinical assessment of hip IR range of motion can be performed efficiently and reliably with a digital inclinometer along with visual monitoring of the pelvis for unwanted motion. Findings from this study support unilateral active hip IR in a seated position as a reliable and responsive technique for obtaining hip IR measurements.

Reliability of Shoulder Internal Rotation Passive Range of Motion Measurements in the Supine Versus Sidelying Position

Clinical measurement, reliability. To compare intrarater and interrater reliability of shoulder internal rotation (IR) passive range of motion measurements utilizing a standard supine position and a sidelying position. Glenohumeral IR range of motion deficits are often noted in patients with shoulder pathology. Excellent intrarater reliability has been found when measuring this motion. However, interrater reliability has been reported as poor to fair. Some clinicians currently use a sidelying position for IR stretching with patients who have shoulder pathology. However, no objective data exist for IR passive range of motion measured in this sidelying position, either in terms of reliability or normative values. Seventy subjects (mean age, 36.8 years), with (n = 19) and without (n = 51) shoulder pathology, were included in this study. Shoulder IR passive range of motion of the dominant shoulder or involved shoulder was measured by 2 investigators in 2 positions: (1) a standard supine position, with the shoulder at 90 degrees of abduction, and (2) in sidelying on the tested side, with the shoulder flexed to 90 degrees . Intrarater reliability for supine measurements was good to excellent (ICC3,1 = 0.70-0.93) and for sidelying measurements was excellent (ICC3,1 = 0.94-0.98). Interrater reliability was fair to good for the supine measurement (ICC2,2 = 0.74-0.81) and good to excellent for the sidelying measurement (ICC2,2 = 0.88-0.96). The mean (range) value of the dominant shoulder sidelying IR passive range of motion was 40 degrees (11 degrees to 69 degrees ) for healthy subjects and 25 degrees (-16 degrees to 49 degrees) for subjects with shoulder pathology. For subjects with shoulder pathology, measurements of shoulder IR made in the sidelying position had superior intrarater and interrater reliability compared to those in the standard supine position.

An examination chair to measure internal rotation of the hip in routine settings: a validation study

To determine the performance of a newly developed examination chair as compared with the clinical standard of assessing internal rotation (IR) of the flexed hip with a goniometer. The examination chair allowed measurement of IR in a sitting position simultaneously in both hips, with hips and knees flexed 90 degrees, lower legs hanging unsupported and a standardized load of 5 kg applied to both ankles using a bilateral pulley system. Clinical assessment of IR was performed in supine position with hips and knees flexed 90 degrees using a goniometer. Within the framework of a population-based inception cohort study, we calculated inter-observer agreement in two samples of 84 and 64 consecutive, unselected young asymptomatic males using intra-class correlation coefficients (ICC) and determined the correlation between IR assessed with examination chair and clinical assessment. Inter-observer agreement was excellent for the examination chair (ICC right hip, 0.92, 95% confidence interval [CI] 0.89-0.95; ICC left hip, 0.90, 95% CI 0.86-0.94), and considerably higher than that seen with clinical assessment (ICC right hip, 0.65, 95% CI 0.49-0.77; ICC left hip, 0.69, 95% CI 0.54-0.80, P for difference in ICC between examination chair and clinical assessment <or=0.001). The average range of motion (ROM) obtained with examination chair and clinical assessment were similar (difference 1.1 degrees, 95% CI - 0.7-2.8 degrees, P=0.23), and the correlation was strong (Pearson's coefficient, 0.75, 95% CI 0.62-0.84). The use of the examination chair resulted in a precise assessment of hip IR in our population-based inception cohort study of young asymptomatic males. It was strongly correlated with standard clinical assessment of IR but was considerably more reliable.