Orthopedic Tests Research Articles

Mobile technology and cumulative trauma symptomology among millennials

Introduction Technology use among the millennial population is increasing and related postural compromise may lead to cumulative trauma disorder symptomology. The aim of this study was to explore trends of hand-held mobile technology use and upper extremity cumulative trauma disorder symptomology among a sample of millennials. Methods A convenience sample of graduate students ( n = 42) was used for the study. Demographic and technology use information was obtained through self-report using the smartphone screen time tracking feature. Cumulative trauma disorder symptomology was assessed through administration of various orthopedic special tests. Results On average, participants spent 2 h and 23 min per day using hand-held mobile devices. Out of 42 participants, 54.8% tested positive for at least one orthopedic special test. The symptomatic group spent 2 h and 29 min using hand-held mobile devices, while the asymptomatic group spent 2 h and 4 min. The most common positive orthopedic special tests were Finkelstein’s test ( n = 19; 36%), hyperabduction (Wright’s) test ( n = 13; 25%), and the elbow flexion test ( n = 10; 18.9%), indicating symptoms associated with De Quervain’s tenosynovitis, thoracic outlet syndrome, and cubital tunnel syndrome, respectively. Discussion Results were consistent with prior research on time spent using hand-held mobile technology and cumulative trauma disorder among millennials. Additionally, a difference in mean time spent using mobile technology between the asymptomatic and symptomatic groups was found, suggesting a relationship which warrants further research.

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review.

To determine the diagnostic validity of high-resolution ultrasound and orthopaedic special tests in diagnosing long head of the biceps tendon pathologies in patients with shoulder pain. Systematic review with meta-analysis tools. MEDLINE, CINAHL and EMBASE. Included studies had to report on the diagnostic validity of orthopaedic special tests or high-resolution ultrasound (HRUS) compared with a reference standard for diagnosing long head of the biceps tendon target conditions (superior labrum anterior and posterior lesions, long head of the biceps tendon tendinopathy, dislocation, effusion or rupture). Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool. Of the 30 included studies, 8 focused on high-resolution ultrasound and 22 on orthopaedic special tests. High-resolution ultrasound proved highly specific for the diagnosis of long head of the biceps tendon pathologies. Pooled positive (LR+) and negative (LR-) likelihood ratios were 38.00 and 0.24 for dislocation, respectively, and 35.50 and 0.30 for complete rupture, respectively. The accuracy of orthopaedic special tests varied greatly across studies. The only test of value was Yergason's ma-noeuvre in confirming proximal long head of the biceps tendon pathologies except superior labrum anterior and posterior lesion (high specificity): the summary LR+ and LR- were 2.56 and 0.70, respectively. High-resolution ultrasound is reliable to confirm suspected long head of the biceps tendon pathologies. There is insufficient evidence to recommend individual orthopaedic special tests.

Reliability of specific clinical tests and MRI in the diagnosis of rotator cuff tears in comparison with arthroscopy

Purpose Imaging for rotator cuff injury may provide false-positive and false-negative results. Moreover, many studies have questioned both the accuracy and reliability of orthopedic special tests of the shoulder. Herein, this study evaluates the sensitivity, specificity, and accuracy of specific clinical tests and MRI of rotator cuff tears in relation to arthroscopic findings. Patients and methods This study was conducted on 45 patients (27 males and 18 females), who were diagnosed clinically to have rotator cuff tears and/or biceps tendon pathology. Mean patients’ age was 26.18 years old. The special clinical tests for rotator cuff tears included in this study were Jobe’s test for supraspinatus tear, drop arm test for infraspinatus tear, lift-off test for subscapularis tear, and speed test for biceps tendinitis. Thereafter, all patients underwent radiographs, MRI, and shoulder arthroscopy. Results Jobe’s test showed sensitivity, specificity, and accuracy of 85.7, 75, and 80.4%, respectively, whereas those of MRI were 85.7, 87.5, and 86.6%, respectively. Drop arm test showed sensitivity, specificity, and accuracy of 100, 69.2, and 84.6%, respectively, whereas those of MRI were 100% for each. Lift-off test showed sensitivity, specificity, and accuracy of 50, 76.9, and 63.5%, respectively, whereas those of MRI were 100, 92.3, and 96.2%, respectively. Speed test showed 80% for each of sensitivity, specificity, and accuracy, whereas those of MRI were 80, 100, and 90%, respectively. Conclusion We could conclude that Jobe’s test and MRI had good correlation with arthroscopy in the diagnosis of supraspinatus tear. Drop arm test had weak correlation whereas MRI had good correlation with arthroscopy in the diagnosis of infraspinatus tear. Lift-off test slightly overestimated the diagnosis of subscapularis tear, whereas MRI findings were close to those of arthroscopy. Speed test and MRI correlated fairly well with arthroscopy in the diagnosis of biceps tendon pathology.

ХВИЛЬОВА СТРУКТУРА ГЕМОДИНАМІЧНИХ ПОКАЗНИКІВ В ОСІБ ІЗ РІЗНИМ ВИХІДНИМ РІВНЕМ СЕРЦЕВОГО ВИКИДУ ТА КРОВОНАПОВНЕННЯ ОРГАНІВ ГРУДНОЇ КЛІТКИ

Introduction . Wave fe atures of the duration of cardiointervals (t-R-R) and s troke volume of blood are considered as a reflection of the dynamics of regulatory processes in the body. Significant differences in healthy young men in values of cardiac index and blood supply of the thoracic organs condition on the peculiarities of regulation of the cardiovascular system. Purpose . To find out the peculiarities of the wave structure of oscillations (t-R-R) and s troke volume of blood (SV) in individuals with different baseline cardiac output and blood supply. Methods . The resulting time series were analyzed by 5-min implementations of secuential SV and t-R-R in «Caspico» program . For the duration of the cardiointervals, three main spectral components were distinguished: HF (0.15-0.4 Hz), LF (0.04-0.15 Hz), VLF (0-0.04 Hz), and total spectrum power (TP), the power of high-frequency oscillations in normalized units (HFnorm). For SV, such indicators were HF sv , LF sv , VLF sv , TP sv and HF norm SV , respectively. Results . At rest, the highest t- R - R oscillation power in the LF and HF ranges was established in hypokinetics, the SV oscillation power in the 0.04-0.15 Hz frequency band was significantly higher in hyperkinetics compared to eukinetics, in HF norm SV - it was probably higher in hyperkinetics than hypokinetics. When functional tests were performed, the greatest differences between groups of individuals with different typology by cardiac output were observed at dosed physical activity: HFnorm in hypokinetics was authentically smaller than in the representatives of other groups, LF was larger than in eukinetics, and HF was lower than in hyperkinetics. The initial level of blood supply of the thorax also authentically influenced the peculiarities of oscillations of the hemodynamic indicators of healthy young men under different conditions. At rest in the supine position, individuals with low levels of blood supply of thoracic organs had authentically a higher power of high-frequency oscillations t-R-R than men with an average value of this index, and relatively larger intergroup differences were observed in the parameters of SV oscillations. According to the indicators of the wave structure of t-R-R and SV with active orthopedic testing and with mental load, the lowest activation of the sympathetic nervous system was observed in the group of men with low initial level of blood supply of the thoracic organs. . Originality . The peculiarities of the regulatory rhythms of hemodynamics are revealed in persons with different typology by the level of cardiac output and blood supply of the thoracic organs . Significant differences in the power of oscillations of cardio-interval duration and stroke volume are shown in persons of different types of hemodynamics at rest and at the dosed physical activities. Conclusions . At rest and mainly at physical activity , the features of hemodynamics oscillations have been found between persons with different initial levels of cardiac output, which are of compensatory nature for maintaining cardiac output for hypokinetics, and are caused by different levels of blood supply in the thoracic organs. The wave structure of the regulatory rhythms of hemodynamics and its changes at loads significantly depend on the initial level of blood supply of the thorax , which is shown by the relatively less tension of the mechanisms of regulation in persons of the extreme groups. Taking into account individual-typological characteristics of a person can increase the diagnostic value of methods of analysis and evaluation of the wave structure of hemodynamic parameters, as well as identify new directions in preventive medicine and health insurance.

Characterization of polyurethane-based synthetic vertebrae for spinal cement augmentation training

Vertebral augmentation techniques are used to stabilize impacted vertebrae. To minimize intraoperative risks, a solid education of surgeons is desirable. Thus, to improve education of surgeons as well as patient safety, the development of a high-fidelity simulator for the surgical training of cement augmentation techniques was initiated. The integrated synthetic vertebrae should be able to provide realistic haptics during all procedural steps. Synthetic vertebrae were developed, tested and validated with reference to human vertebrae. As a further reference, commercially available vertebrae surrogates for orthopedic testing were investigated. To validate the new synthetic vertebrae, characteristic mechanical parameters for tool insertion, balloon dilation pressure and volume were analyzed. Fluoroscopy images were taken to evaluate the bone cement distribution. Based on the measurement results, one type of synthetic vertebrae was able to reflect the characteristic parameters in comparison to human vertebrae. The different tool insertion forces (19.7 ± 4.1, 13.1 ± 0.9 N, 1.5 ± 0.2 N) of the human reference were reflected by one bone surrogate (11.9 ± 9.8, 24.3 ± 3.9 N, 2.4 ± 1.0 N, respectively). The balloon dilation pressure (13.0 ± 2.4 bar), volume (2.3 ± 1.5 ml) of the synthetic vertebrae were in good accordance with the human reference (10.7 ± 3.4 bar, 3.1 ± 1.1 ml). Cement application forces were also in good accordance whereas the cement distribution couldn’t be reproduced accurately. Synthetic vertebrae were developed that delivered authentic haptics during transpedicular instrument insertion, balloon tamp dilation and bone cement application. The validated vertebra model will be used within a hybrid simulator for minimally invasive spine surgery to educate and train surgeons.

TREATING GROIN AND HIP FLEXOR PAIN USING PRIMAL REFLEX RELEASE TECHNIQUE™: A CASE SERIES

The nervous system plays a significant role in groin/hip flexor pain which is a common complaint in the active population. Patient examinations that lack consideration of the nervous system's involvement may result in chronic pain and dysfunctional breathing patterns due to continuously excited (also known as "up-related") primal reflexes. Primal Reflex Release Technique™ (PRRT™) is a novel treatment paradigm that was designed to calm primal reflexes from their excitatory state. The purpose of this case series was to describe the effects of down-regulating primal reflexes using PRRT™ on pain, function, and breathing pattern dysfunction in subjects who presented with groin and hip flexor pain and exhibited hyperesthesia to TriggerRegions™ in areas of respiration. Six subjects with acute groin and/or hip flexor pain were examined using a battery of tests including muscle integrity strength and range-of-motion (ROM) measurements, special orthopedic tests, breathing functionality and PRRT™ rib palpation assessments. If subjects were determined to be potential PRRT™ responders through PRRT™ rib palpation assessments, the technique was performed according to PRRT™ guidelines. Outcome measures including the Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS), the Global Rating of Change (GRoC) Scale, and the Disability in the Physically Active (DPA) Scale were collected to determine the effects of the treatment. All subjects demonstrated full resolution of pain as reported on the Numeric Pain Rating Scale, and the change was statistically (p = 0.001) and clinically significant. All subjects returned to optimal function as reported on the Patient Specific Functional Scale, and the change was both clinically (minimal detectable change) and statistically significant (p = 0.001). All subjects returned to normal breathing function as observed through the seated assessment of lateral expansion test. The number of treatments (mean = 1.83 ± 1.16) and time to the resolution of symptoms was minimal (mean = 2.833 ± 2.56 days). By assessing and treating abnormal breathing patterns, postulated to be a result of a sustained excitatory nervous system, subjects returned to full activity, without pain, in less than three days. After a two-week follow-up, subjects remained functionally pain free. Considering the state of the nervous system in the presentation of musculoskeletal pain and not focusing all treatment on local muscle structures may be beneficial. A multifaceted assessment approach is needed to determine other pain factors. Level 4.

A Practical Procedure for Measuring the Stiffness of Foam like Materials

Polymer foams are used extensively in everyday life, from disposable packaging and soft furnishings through to engineering applications such as core structural materials in the marine industry or bone analogue materials for orthopaedic device testing. In the engineering field it is important that the mechanical behaviour of these materials is characterised correctly, as computationally based predictions of structural performance rely heavily on accurate input data. Mechanical property data from standard physical tests such as uniaxial compression are subject to artefacts including non-uniformity of applied loading, test fixture-sample contact conditions, and test machine compliance. These are well-documented problems, which techniques such as extensometry and point tracking of marker pairs attempt to resolve. In particular, in addition to being non-contact, the use of individual marker pairs can reveal non-linear behaviours because of alignment issues. In the current work, a practical, accurate experimental methodology is introduced to investigate this issue. Uniaxial compression tests were conducted on cellular polyurethane foam blocks. Both faces of the foam specimens were monitored using point tracking on multiple marker pairs to account for misalignment. Sample deformation was simultaneously measured by test-machine crosshead displacement. The Young’s modulus and Poisson’s ratio were calculated in both cases. To verify the measurements, digital volume correlation (DVC) was applied. DVC is a full-field non-contact strain measurement method that interrogates the interior structure of the foam to determine the physical response. Results demonstrated that misalignment effects could easily be followed during testing, which averaged out on both front and back surfaces to produce a single modulus value. Considerable differences were evident between crosshead displacement calculated modulus and point tracking, indicating that artefacts can lead to substantial errors, as evidenced in the published literature.

Is Bony Hip Morphology Associated With Range of Motion and Strength in Asymptomatic Male Soccer Players?

Study Design Cross-sectional cohort study. Objectives To investigate the relationship between musculoskeletal screening findings and bony hip morphology in asymptomatic male soccer players. Background Athletes with femoroacetabular impingement (FAI) syndrome have cam and/or pincer morphology, pain on orthopaedic testing, and often reduced hip range of motion (ROM) and strength. However, cam and pincer morphology is also common in asymptomatic hips. Therefore, it is currently unknown whether the ROM and strength deficits observed in athletes with FAI syndrome result from the variance in their bony hip morphology or from their hip condition. Methods Male professional soccer players in Qatar were screened specifically for hip/groin pain in 2 consecutive seasons. The screening battery included pain provocation, ROM and strength tests, and hip radiographs. Univariate and multivariate regression analyses, using generalized estimating equations, evaluated the relationship between musculoskeletal screening findings and each bony hip morphological variant (cam, large cam, pincer, and acetabular dysplasia). Results Asymptomatic hips with cam and large cam morphology were associated with lower internal rotation ROM and bent-knee fall-out, and with a higher likelihood of pain on provocation testing. Pincer morphology was associated with lower abduction ROM and higher abduction strength. Acetabular dysplasia was associated with higher abduction ROM. Each association was weak and demonstrated poor or failed discriminatory power. Conclusion Bony hip morphology is associated with hip joint ROM and abduction strength, but musculoskeletal screening tests have a poor ability to discriminate between the different morphologies. J Orthop Sports Phys Ther 2018;48(4):250-259. doi:10.2519/jospt.2018.7848.

Correction of pseudoscoliosis (lateral thoracic translation posture) for the treatment of low back pain: a CBP<sup>®</sup> case report

[Purpose] To present the case of a total reduction of pseudoscoliosis spinal deformity in an adult female suffering from recurrent back pains. [Participant and Methods] A 29 year old female suffering from recurrent back pains was diagnosed with lateral thoracic translation posture; aka pseudoscoliosis. The patient was initially given 12 treatments of relief care including spinal manipulative therapy, then another 24 treatments receiving the same plus mirror image® translation traction and exercises. [Results] The patient achieved a complete reduction of the lateral thoracic translation posture (pseudoscoliosis) as indicated on a post-treatment radiograph after 36 total treatments. Most orthopedic tests became normalized and the patients back pains were significantly improved after the correction of posture, but only slight improvements after the initial 12 sessions of manipulative therapy only. [Conclusion] Pseudoscoliosis is structurally reducible by use of CBP® mirror image® lateral translation traction methods and exercises and led to the resolution of back pains in this case. The diagnosis of pseudoscoliosis as opposed to true scoliosis is very important and likely underdiagnosed in common practice. Upright radiographic imaging is essential to differentiate these two spinal disorders and offers no harm to the patient. Comprehensive assessment including routine use of x-ray is recommended to differentiate between spinal disorders.

Eficácia de um protocolo de exercícios em cadeia cinética fechada para indivíduos com dor femoropatelar

Introduo: Acredita-se que resultados controversos quanto melhor abordagem teraputica para a Dor Femoropatelar (DFP) estejam relacionados a no padronizao dos voluntrios antes das avaliaes com relao ao nvel de estresse articular. Objetivo: Verificar a eficcia de um protocolo de fortalecimento para indivduos com DFP submetidos a um protocolo de estresse articular prvio s avaliaes a fim de padronizar os indivduos. Mtodos: Participaram 24 indivduos (14 DFP /10 controle). Utilizou-se testes ortopdicos, teste funcional step down, escalas e questionrios para dor e funcionalidade. O grupo DFP realizou um protocolo de fortalecimento durante trs meses. Resultados: Melhora nos testes ortopdicos, no teste funcional step down (p=0,000) e em todos os questionrios e escalas (p=0,000) foram observadas. O grupo DFP assemelhou-se ao grupo controle em relao ao teste funcional e aos questionrios (p0,05). Concluso: O protocolo foi efetivo, o grupo DFP assemelhou-se ao grupo controle aps a interveno.

Pediatric Scoliosis and Kyphosis: An Overview of Diagnosis, Management, and Surgical Treatment.

Evaluation of pediatric spinal deformity requires knowledge of special orthopaedic testing and radiographic interpretation. The determination of recommendations for treatment of spinal abnormalities in children can be challenging and at times complex, as treatment options are dependent upon a variety of factors. The etiology of scoliosis or kyphosis, presence or absence of vertebral anomalies, symptoms, magnitude of the curve, physiologic/skeletal age, and evidence of and risk of progression all require consideration and play a role in the shared decision-making process. This article provides an overview of relevant information and includes research outcomes to support the care of pediatric patients with spinal deformities. [Pediatr Ann. 2017;46(12):e472-e480.].

Consistency of commonly used orthopedic special tests of the shoulder when used with the McKenzie system of mechanical diagnosis and therapy

BackgroundShoulder Orthopedic Special Tests (OSTs) are used to assist with diagnosis in shoulder disorders. Issues with reliability and validity exist, making their interpretation challenging. Exploring OST results on repeated testing within Mechanical Diagnosis and Therapy (MDT) shoulder classifications may offer insight into the poor performance of these tests. ObjectivesTo investigate in patients with shoulder complaints, whether MDT classifications affect the agreement of OST results over the course of treatment. MethodsAn international group of MDT clinicians recruited 105 patients with shoulder problems. Three commonly used OSTs (Empty Can, Hawkins-Kennedy, and Speed's tests) were utilized. Results of the OSTs were collected at sessions 1, 3, 5 and 8, or at discharge from an MDT classification-based treatment. The Kappa statistic was utilized to determine the agreement of the OST results over time for each of the MDT classifications. ResultsThe overall Kappa values for Empty Can, Hawkins-Kennedy and Speed's tests were 0.28 (SE = 0.07), 0.28 (SE = 0.07) and 0.29 (SE = 0.07), respectively. The highest level of agreement was for Articular Dysfunction for the Empty Can test (0.84, SE = 0.19). For shoulder Derangements, there was no agreement for any of the OSTs (P values > 0.05). ConclusionThe lack of agreement when the OSTs were consecutively tested in the presence of the MDT Derangement classification contrasted with the other MDT classifications. The presence of Derangement was responsible for reducing the overall agreement of commonly used OSTs and may explain the poor consistency for OSTs.

Orthopedic In-Training Examination Question Metrics and Resident Test Performance.

First administered in November 1963, the orthopedic in-training examination (OITE) is now distributed to more than 4000 residents in over 20 countries and has become important for evaluation of resident fund of knowledge. Several studies have assessed the effect of didactic programs on resident performance, but only recently has it become possible to assess detailed testtaking metrics such as time spent per question. Here, we report the first assessment of resident OITE performance utilizing this full electronic dataset from two large academic institutions.Full 2015 OITE score reports for all orthopedic surgery residents at two institutions were anonymized and compiled. For every question answered by each resident, the resident year, question content or domain, question result (correct or incorrect), and answer speed were recorded. Data were then analyzed to determine whether resident year, result, or domain affected answer speed and whether performance in each subspecialty domain varied based on resident year in training.Data was available for 46 residents and 12,650 questions. Mean answer speed for questions answered correctly, 54.0±48.1 s, was significantly faster than for questions answered incorrectly, 72.2±61.2 s (P<0.00001). When considering both correct and incorrect answers, PGY-1s were slower than all other years (P<0.02). Residents spent a mean of nearly 80 seconds on foot and ankle and shoulder and elbow questions, compared to only 40 seconds on basic science questions (P<0.05).In education, faster answer speed for questions is often considered a sign of mastery of the material and more confidence in the answer. Though faster answer speed was strongly associated with correct answers, this study demonstrates that answer speed is not reliably associated with resident year. While answer speed varies between domains, it is likely that the majority of this variation is due to question type as opposed to confidence. Nevertheless, it is possible that in domains with more tiered experience such as shoulder, answer speed correlates strongly with resident year and percentage correct.

ACC Research Agenda Conference 2018: Peer Reviewer Acknowledgments and Abstracts of Proceedings

ACC Research Agenda Conference 2018: Peer Reviewer Acknowledgments and Abstracts of Proceedings

A protocol for a new methodological model for work-related shoulder complex injuries: From diagnosis to rehabilitation

BackgroundWork-related injuries of the shoulder complex represent a challenge for clinicians because of the large variety of clinical entities involved and the broad anatomic structures that can be affected. Furthermore, commonly performed orthopedic tests have demonstrated limited accuracy for diagnosing the injury despite considerable research efforts. The aim of this study protocol is therefore to describe a comprehensive approach integrating both a clinical- and functional status-based pathology and an adapted rehabilitation prescription.Methods/DesignA longitudinal cohort study will be performed at the Department of Rehabilitation and Medical Assistance of a mutual insurance society for work-related injury management in Spain (Mutua Navarra, Pamplona, Navarra Spain). Patients will be attended by an occupational physician who specializes in work-related injuries and is part of the project team that will systematically visit all the participants. After the medical diagnosis and any requested supplementary evaluations (i.e., radiological examinations), the patients will be referred to the rehabilitation service. Before the physiotherapeutic rehabilitation program is initiated, the patients will undergo a comprehensive functional screening at the biomechanics laboratory. Using a decision-making scheme, the identified functional deficits will be used to customize the individual rehabilitation plan.DiscussionThe proposed objective criteria-based shoulder diagnosis and rehabilitation model could be a new effective strategy for minimizing the time required to regain functional capacity and recover from symptoms among patients with work-related shoulder injuries.Trial registrationThe study protocol has been registered on Clinical Trials.gov as NCT02732002 (April 10th 2016).

Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks, following failed treatment from three previous chiropractors: a CBP® case report with an 8 year follow-up.

[Purpose] To present the outcome of a patient, having sciatica and MRI-verified disc herniation/sequestration who underwent Chiropractic BioPhysics® (CBP®) protocol designed to improve the lumbar lordosis. [Subject and Methods] A 56-year-old male suffered from chronic low back pain and recent sciatica due to lumbar disc herniation despite being under continuous care from three previous chiropractors. Radiographic analysis revealed a lumbar hypolordosis and MRI confirmed disc herniation and sequestration at L4–L5. Generalized decreased lumbar range of motion and multiple positive orthopedic and neurologic tests were present. [Results] After 26 treatments of CBP lumbar extension traction over 9-weeks a total reduction of the disc herniation and sequestration occurred with concomitant improvement in neurologic symptoms. Continuing maintenance treatments, an 8 year follow-up shows no relapse of condition and patient remained in good health. [Conclusion] A patient with lumbar disc herniation/sequestration was successfully treated with CBP technique procedures including lumbar extension traction that achieved a significant healing of herniation and significant reduction in symptoms not obtained following traditional chiropractic procedures alone. The quick reduction in lumbar disc herniation would appear to be related to a segmental disc unloading force produced during extension traction procedures for increasing the lumbar curvature.

Clinical assessment of factors associated with subacromial shoulder impingement: a systematic review

Background: Physiotherapists commonly use orthopaedic special tests to reproduce subacromial shoulder impingement (SIS) pain by increasing compression or tension within the subacromial space. However, these tests do not differentiate between purported extrinsic and intrinsic mechanisms associated with SIS.Objective: To identify, and determine the reliability and validity of clinical tests used to assess extrinsic factors associated with SIS.Method: A scoping review identified tests for extrinsic SIS. A systematic approach was then used to search six electronic databases in July 2016 to identify clinical tests used to measure (1) posterior shoulder range, (2) cervical and/or thoracic posture, (3) 2D scapula movement, (4) rotator cuff strength. The 14 articles included in the review were assessed using a modified Downs and Black quality assessment tool.Results: Moderate quality studies investigated 2D scapula measurements (N = 2), resting pectoralis minor length (N = 2) and rotator cuff strength (N = 5). High quality studies measured forward head position and/or thoracic posture (N = 2) and rotator cuff strength (N = 1).Conclusion: A good level of assessment reliability and significantly less range and strength was identified in those with SIS for: posterior shoulder range (passive shoulder adduction and internal rotation and passive internal rotation in supine); isokinetic peak torque values for internal and external shoulder rotation (isokinetic testing); forward head position (lateral photograph) and thoracic range of motion (tape measure or ultrasound tomography). Good to excellent reliability was reported for lateral scapular slide test positions and resting pectoralis minor muscle length. These clinical tests should be considered for use in SIS assessment.

Inter-rater reliability of the Shoulder Symptom Modification Procedure in people with shoulder pain

BackgroundMusculoskeletal conditions involving the shoulder are common and, because of the importance of the upper limb and hand in daily function, symptoms in this region are commonly associated with functional impairment in athletic and non-athletic populations. Deriving a definitive diagnosis as to the cause of shoulder symptoms is fraught with difficulty. Limitations have been recognised for imaging and for orthopaedic special tests. 1 solution is to partially base management on the response to tests aimed at reducing the severity of the patient's perception of symptoms. 1 (of many) such tests is the Shoulder Symptom Modification Procedure (SSMP). The reliability of this procedure is unknown.Methods37 clinician participants independently watched the videos of 11 patient participants undergoing the SSMP and recorded each patient's response as improved (partially or completely), no change or worse. Inter-rater reliability was assessed by Krippendorff's α, which ranges from 0 to 1.ResultsKrippendorff's α was found to range from 0.762 to 1.000, indicating moderate to substantial reliability. In addition, short (3-hour) and longer (1-day) durations of training were associated with similar levels of reliability across the techniques.ConclusionsDeriving a definitive structural diagnosis for a person presenting with a musculoskeletal condition involving the shoulder is difficult. The findings of the present study suggest that the SSMP demonstrates a high level of reliability. More research is needed to better understand the relevance of such procedures.Trial registration numberISRCTN95412360.

Physiotherapy assessment and diagnosis of musculoskeletal disorders of the knee via telerehabilitation

Introduction Lower limb musculoskeletal disorders place a heavy burden on healthcare systems. Appropriate management of these conditions is critical, however access to appropriate physiotherapy services is difficult for those in geographically remote areas or those with mobility or transport difficulties. The aim of this study was to evaluate the accuracy and reliability of an online musculoskeletal physiotherapy assessment of the knee complex using telerehabilitation compared to traditional face-to-face assessment. Methods In a repeated-measures design, 18 subjects who sought treatment for knee pain underwent a traditional face-to-face assessment and a remote telerehabilitation assessment. Telerehabilitation assessments were conducted with participants performing facilitated self-palpation, self-applied modified orthopaedic tests, active movements and functional tasks. Results Primary pathoanatomical diagnoses were in exact agreement in 67% of cases and were similar in 89% of cases. The system of pathology was found to be in agreement in 17 out of 18 cases (94%). Comparisons of objective findings from the two physical assessments demonstrated substantial agreement (kappa = 0.635) for categorical data and binary data (chi-squared = 400.36; p < 0.001). A high level of intra-rater (89%) and moderate level of inter-rater (67%) reliability was evident for telerehabilitation assessments. Discussion Telerehabilitation assessment of the knee complex appears to be feasible and reliable. This study has implications for clinical practice and the development of physiotherapy services to address the burden of lower limb musculoskeletal pain and disability.