Orthopedic Special Tests Research Articles

Orthopedic special tests necessary for Physical Therapy Education

Orthopedic special tests necessary for Physical Therapy Education

Accuracy of Orthopedic Shoulder Test in Detecting Rotator Cuff Tears and Retears: A Narrative Review

The purpose of this review is to discuss the accuracy of orthopedic tests in detecting rotator cuff tears and retears, while developing new, more sensitive and specific clinical exam tools. With the ever-increasing population and consequent increased incidence of shoulder pathology, there is a vertical trend in medical cost as physical diagnosis is evermore substituted by imaging diagnosis. Unfortunately, clinical examination maneuvers have demonstrated variable specificity and sensitivity for primary rotator cuff tears, leading to the dependance of imaging modalities. Currently, there is no clinical exam maneuver that accurately confirms clinical suspicions of a rotator cuff retear following repair. Future studies focusing on the sensitivity and specificity of special orthopedic tests identifying retears would support a more accurate clinical diagnosis of rotator cuff retears. The goal of this narrative review is to outline the current trends in diagnosing rotator cuff tears and retears while demonstrating how current imaging studies have shown especially poor reliability in detecting this injury. This research project intends to present how a thorough and proper clinical exam that incorporates several orthopedic special tests, it can achieve an early and non-expensive accurate diagnosis.

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.

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.

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.

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.

Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review

Purpose The purpose of this review is to systematically explore and summarise the validity and reliability of telerehabilitation (TR)-based physiotherapy assessment for musculoskeletal disorders. Method A comprehensive systematic literature review was conducted using a number of electronic databases: PubMed, EMBASE, PsycINFO, Cochrane Library and CINAHL, published between January 2000 and May 2015. The studies examined the validity, inter- and intra-rater reliabilities of TR-based physiotherapy assessment for musculoskeletal conditions were included. Two independent reviewers used the Quality Appraisal Tool for studies of diagnostic Reliability (QAREL) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool to assess the methodological quality of reliability and validity studies respectively. Results A total of 898 hits were achieved, of which 11 articles based on inclusion criteria were reviewed. Nine studies explored the concurrent validity, inter- and intra-rater reliabilities, while two studies examined only the concurrent validity. Reviewed studies were moderate to good in methodological quality. The physiotherapy assessments such as pain, swelling, range of motion, muscle strength, balance, gait and functional assessment demonstrated good concurrent validity. However, the reported concurrent validity of lumbar spine posture, special orthopaedic tests, neurodynamic tests and scar assessments ranged from low to moderate. Conclusion TR-based physiotherapy assessment was technically feasible with overall good concurrent validity and excellent reliability, except for lumbar spine posture, orthopaedic special tests, neurodynamic testa and scar assessment.

Acute Pain and Dysfunction of Shoulder Musculature - Football Strong Safety

HISTORY: A 22-year old collegiate football strong safety presented with acute posterior right shoulder pain that increased with shoulder flexion and abduction. The patient injured himself diving to catch a ball in practice and reported a “dead arm” feeling after hitting the ground. He rated his pain 6 out of 10 on the Numeric Rating Scale (NRS) and denied change in symptoms for the next two days following onset. The patient had been treated with rest and ice. The patient had a previous history of bilateral labral pathology, but reported being otherwise healthy. PHYSICAL EXAMINATION: Examination 3 days post-injury revealed palpable tender points (TP) at the posterior shoulder. The patient exhibited decreased active flexion (135°) and abduction (130°) on the affected side and reported pain rated 3 out of 10 on the NRS during active horizontal adduction, flexion and abduction. Manual muscle testing indicated a 4 out of 5 strength for the supraspinatus, infraspinatus, and teres major musculature. Orthopedic special tests were negative for labral pathology, shoulder impingement, and shoulder laxity. The neurological examination was unremarkable. DIFFERENTIAL DIAGNOSIS: 1. Rotator Cuff Strain 2. Glenoid Labrum Tear 3. Brachial Plexus Neurapraxia TESTS and RESULTS: Not Applicable FINAL/WORKING DIAGNOSIS: Rotator Cuff Inhibition TREATMENT AND OUTCOMES: 1. Initially, patient treated with active arm motions (i.e., shoulder flexion, shoulder abduction, and single-arm wall push-up) on the “good” side (i.e., uninvolved side) using static holds at end range or repetitions. Post treatment measures indicated improvements of 37° in flexion and 45° in abduction on the involved side, and a two point decrease in pain on the NRS. 2. Patient maintained improvements from first treatment at subsequent visit. Cervical and thoracic spine were rechecked and cleared. Posterior shoulder TPs were still present and were treated by maintaining a position of comfort for 60 seconds. Patient reported a resolution of pain with all shoulder motion following this treatment. Dynamic neuromuscular stabilization with perturbations was then performed in a PNF D2 shoulder pattern to reestablish neuromuscular control. 3. After two follow-up treatments the patient was discharged and remained asymptomatic at one month follow-up.

Usage and Perceived Value of Video Podcasts by Professional Physical Therapist Students in Learning Orthopedic Special Tests

INTRODUCTIONOver past 20 years, use of multimedia instruction in education has been rapidly evolving due to advances in technology, computer accessibility, and an increasing level of comfort with technology by both students and faculty. Examples of computer-assisted learning (CAL) include material presented on DVD/CD, podcasts, video streaming, and downloadable media files. These technologies allow students easy access to resources outside of class that can then be used to enhance face-to-face classroom instruction and support active learning.1'3 It is estimated that 71%-80% percent of physical therapist education programs are utilizing CAL.1'6 These courses ranged from basic science to clinical skills courses. It is likely that use of CAL has become more prevalent since publication of these studies.CAL has been used to facilitate acquisition of cognitive and psychomotor skills in physical therapist education program curriculums7,8 as well as other health professional programs such as occupational therapy,9 nursing,10,11 dentistry,12 and medicine.13'15 In cognitive domain, there appears to be consensus in physical therapy literature that CAL is as effective as traditional lecture in teaching of anatomy16'18 and biomechanics.19 In psychomotor domain, CAL appears to be as effective as live demonstration in teaching content related to teaching of musculoskeletal examination skills of knee and ankle,2 transfer and gait training,20 manual therapy interventions,8 and orthopedic special tests.21 From student perspective, advantages of using CAL include self-paced learning, flexibility in study time, and improved access to course materials.20One of more recent forms of multimedia instruction include video podcasting. Video podcasting refers to the distribution of audio or video files to subscribers via internet.20 It is considered a type of push technology where new media files are au- tomatically downloaded to subscribers computer as they become available.22 Subscribers can then transfer media to smaller, portable devices, such as smartphones, iPods, and tablet computers. Research has shown that students desire more of these type of learning experiences.23,24iTunes is an example of a proprietary distributer of podcasts. In 2008, iTunes added iTunes U, which provides access to an extensive amount of free educational content from colleges and universities across nation. One common form of video podcasts in colleges and universities is distribution of recordings of lectures for students to review independently or as a standalone learning experience. More recently, video podcasts are being used to supplement, rather than duplicate or replace, traditional classroom instruction time23 and are often used for preclass preparation.2 Several advantages of podcasting and video podcasting noted in literature include convenience of access, flexibility in learning, and portability and content review before exams.11,23'25 From an instructor standpoint, video podcasts appear to be well suited for teaching psychomotor skills because class time is saved when instructors do not have to spend time with live demonstrations.20 This allows more class time for students to develop their hands on skills and greater interaction with instructors.Most studies examining use of multimedia instruction in physical therapist education programs have used instructional CDs,2 videos that could be viewed via a computer-based media player,21 and video incorporated into a PowerPoint presentation.26 In several studies examining student satisfaction with podcasting, an overwhelming positive response was noted.23,24,27,28 Although there have been several articles on student usage, attitudes, and behavior towards CAL, we are aware of only one published study that has examined physical therapist student attitudes and behavior towards use of video podcasting. …

Combining orthopedic special tests to improve diagnosis of shoulder pathology

The use of orthopedic special tests (OSTs) to diagnose shoulder pathology via the clinical examination is standard in clinical practice. There is a great deal of research on special tests but much of the research is of a lower quality implying that the metrics from that research, sensitivity, specificity, and likelihood ratios, is likely to vary greatly in the hands of different clinicians and in varying practice environments. A way to improve the clinical diagnostic process is to cluster OSTs and to use these clusters to either rule in or out different pathologies. The aim of the article is to review the best OST clusters, examine the methodology by which they were derived, and illustrate, with a case study, the use of these OST clusters to arrive at a pathology-based diagnosis.

Diagnostic Accuracy of Clinical Tests for Assessment of Hamstring Injury: A Systematic Review

Systematic literature review. The diagnosis of a hamstring injury has traditionally relied on various clinical measures (eg, palpation, swelling, manual resistance), as well as the use of diagnostic imaging. But a few studies have suggested the use of specific clinical tests that may be helpful for the diagnostic process. To summarize the current literature on the diagnostic accuracy of orthopaedic special tests for hamstring injuries and to determine their clinical utility. A computer-assisted literature search of the MEDLINE, CINAHL, and Embase databases (along with a manual search of grey literature) was conducted using key words related to diagnostic accuracy of hamstring injuries. To be considered for inclusion in the review, the study required (1) patients with hamstring or posterior thigh pain; (2) a cohort, case-control, or cross-sectional design; (3) inclusion of at least 1 clinical examination test used to evaluate hamstring pathology; (4) comparison against an acceptable reference standard; (5) reporting of diagnostic accuracy of the measures (sensitivity [SN], specificity [SP], or likelihood ratios); and (6) publication in English. SN, SP, and positive and negative likelihood ratios were calculated for each diagnostic test. The search strategy identified 602 potential articles, of which only 3 articles met the inclusion criteria, with only 1 of these 3 articles being of high quality. Two of the studies investigated a single special test, whereas the third article examined a composite clinical assessment employing various special tests. The SN values ranged from 0.55 (95% confidence interval [CI]: 0.46, 0.69) for the active range-of-motion test to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test. The SP values ranged from 0.03 (95% CI: 0.00, 0.22) for the composite clinical assessment to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test, active range-of-motion test, passive range-of-motion test, and resisted range-of-motion test. The use of a single special test demonstrated stronger SP than SN properties, whereas the composite clinical assessment demonstrated stronger SN than SP properties. Very few studies have investigated the utilization of clinical special tests for the diagnosis of hamstring injuries. Further studies of higher quality design are suggested prior to advocating independent clinical utilization of these special tests. Diagnosis, level 3b.

Emotional-based practice

In 1999, David Isaacs and Dominic Fitzgerald offered up seven alternatives to evidence-based practice when faced with a situation where no evidence exists on the topic at hand.1 Their jocular suggestions of (1) eminence-based medicine; (2) vehemence-based medicine; (3) eloquence-based medicine; (4) providence-based medicine; (5) diffidence-based medicine; (6) nervousness-based medicine; and (7) confidence-based medicine reflect the arrogance, nihilism, or lack of confidence displayed during decision making by physicians, nurses, and surgeons. Although meant to be funny, the editorial is decisively accurate and despite being over 10 years old it is not dated in context. Truly, these are the unsightly alternatives to evidence-based practice. I do think one alternative to evidence-based practice is conspicuously absent from this list. This alternative, which I call emotional-based practice, differs from Isaacs and Fitzgerald’s1 suggestions because emotional-based practice is utilized when evidence exists to refute the use of a specific test or intervention (not during a lack of evidence). In other words, the clinician has elected to use the test or intervention despite evidence to the contrary. They elect to do so because they are personally and emotionally attached to the test or intervention. But before we condemn emotional-based practice, let’s discuss how research is disseminated in clinical practice; because quite frankly, this is no easy task. Rogers’2 adoption/innovation curve (Fig. 1), which was first proposed in the late 1950s, has frequently been used as a model for dissemination of innovation or research. The innovation curve suggests that approximately 16% of those (a group called ‘laggards’ by Rogers) involved in the dedicated field (for example, manual therapy) will either be significantly delayed in their adoption of information or will never adopt the information. I think that the number is probably higher. Around 34% falls in the ‘late majority’ group, a group that has been described as a ‘skeptical’ population by others.3 A certain degree of skepticism in healthcare is constructive, as it delays the implementation of a poorly vetted clinical treatment. However, when evidence exists to refute the use of a specific test or intervention, skepticism loses its value. Figure 1 Innovation curve for dissemination of research. In defense of our colleagues who continue to use specific tests or interventions when evidence exists to refute the use, it is worth mentioning that up to 30 000 papers on biomedical literature are published yearly.4 Furthermore, folklore, myth, and information handed down over the generations have duped a number of healthcare professions and the lay public as a whole. For example, myths such as (1) people should drink eight glasses of water in a day to maintain good health; (2) we only use 10% of our brains during normal activities; (3) hair and fingernails continue to grow after death; and (4) reading in dim light ruins your eyesight are accepted as truisms, even though there is no evidence to support these claims.5 People still call chronic Achilles pain, lateral epicondylitis, and rotator cuff injuries ‘tendonitis’, despite that we have known for years that there is generally no inflammatory aspect to the processes.6 It is easy to see why there is the mistake in advocating certain tests or treatment, if we have misinformation. However, when one knows that evidence exists to refute the use of a specific test or intervention, yet he/she elects to use these procedures anyway; that is, emotional-based practice. I would argue that this is the most significant problem that delays our pursuit of evidence in support of manual therapy. I have encountered emotional-based practice a number of times over my 20 years of a clinician but have noticed the feverishness of this more so in the last 3–5 years as evidence has grown and has become more prominent in clinical practice. Specifically, I have witnessed an emotional attachment to particular orthopedic manual therapy procedures (‘fix all’ procedures), orthopedic special tests, screening tests, and diagnoses. Let’s consider the following clinical examples: (1) the use of the straight leg raise (SLR) as confirmatory diagnostic test for a disc herniation; (2) allowing a clinical prediction rule (CPR) to trump clinical reasoning that refutes proper use; and (3) the continued insistence that palpation tests of the sacroiliac joint are diagnostic for sacroiliac joint syndrome.

Effects of a 4-Week Dynamic Balance-Training Program Supplemented with Graston Instrumented-Assisted Soft Tissue Mobilization for Chronic Ankle Instability

A dynamic balance training program (DPT) and Graston Instrumented-Assisted Soft Tissue Mobilization (GISTM) technique are interventions that have been implemented as treatment options for chronic ankle instability (CAI). Although both have been evaluated individually, there are no published reports with the two treatments combined in a population with CAI. PURPOSE: To investigate the effects of a dynamic balance training program with GISTM technique on improving dynamic postural control, range of motion, pain and disability in subjects with CAI. METHODS: Thirty-six healthy, physically active individuals (5 female, 31 male; age= 17.7±1.9 yrs; ht=175.3±14.6 cm) with a history of CAI as determined by an Instability Questionnaire and orthopedic special tests volunteered to be in this study. Subjects were randomly assigned to three groups: both treatments (DBT/GISTM, n=13), DBT and a sham GISTM treatment (DBT/GISTM-S, n=12), or DBT and control- no GISTM (DBT/C, n=11). All groups participated in a 4-week DBT program consisting of low impact and dynamic activities that was progressed from week to week. The DBT/GISTM and DBT/GISTM-S groups received the GISTM treatment or sham treatment twice a week for 8 minutes before performing the DBT program. Pre- and Post-test measurements included the Foot and Ankle Ability Measures (FAAM), FAAM Sport, the Visual Analog Scale (VAS), ankle range of motion (ROM) in four movements, and the Star Excursion Balance Test (SEBT) in three directions. RESULTS: Subjects in all groups demonstrated differences between pre to post-test with post-test results showing improvement for disability (FAAM, P<0.001 and FAAM Sport, P<0.001) and pain (VAS, P<0.001). ROM improvements were noted for plantarflexion (P=0.001), inversion (P<0.001) and eversion (P<0.001) and SEBT in the direction of anterior (P<0.001), posteromedial (P<0.001) and posterolateral (P<0.001) pre to post-test as well. The ranges with percent change scores for groups were disability (10.4%-30.6%), pain (87.2%-100%), ROM (0% to 44.9%), and SEBT (5.7% to 17.4%). No other results were significant, especially differences between groups. CONCLUSIONS: Dynamic postural control, ROM, pain and disability improved pre to post-test for subjects with CAI following a 4-week dynamic balance-training program with GISTM.

Overview of Wrist and Hand Orthopaedic Special Tests

Overview of Wrist and Hand Orthopaedic Special Tests

Interexaminer reliability of orthopaedic special tests used in the assessment of shoulder pain

Orthopaedic special tests (OST) are commonly used in the assessment of the painful shoulder to assist to rule-in or rule-out specific pathology. A small number of tests with high levels of diagnostic accuracy have been identified but interexaminer reliability data is variable or lacking. The aim of this study was to determine the interexaminer reliability of a group of OST with demonstrated diagnostic accuracy at primary care level. Forty consecutive subjects with shoulder pain were recruited. Six tests were performed by two examiners (physiotherapists) on the same day. Tests included the active compression test, Hawkins–Kennedy test, drop-arm test, crank test, Kim test and belly-press test. ‘Fair’ reliability (kappa 0.36–0.38) was observed for the active compression test (labral pathology), Hawkins–Kennedy test and crank test. Prevalence of positive agreements was low for the active compression test (acromioclavicular joint), drop-arm test, Kim test and belly-press test. Prevalence and bias adjusted kappa (PABAK) values indicated ‘substantial’ reliability (0.65–0.78) for these tests. The active compression test (acromioclavicular joint), belly-press tests (observation and weakness), Kim test and drop-arm test demonstrate acceptable levels of interexaminer reliability in a group of patients with sub-acute and chronic shoulder conditions.

Overview of Elbow Orthopedic Special Tests

Overview of Elbow Orthopedic Special Tests

Overview of Shoulder Orthopedic Special Tests

Overview of Shoulder Orthopedic Special Tests

Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests

Objective:To compile and critique research on the diagnostic accuracy of individual orthopaedic physical examination tests in a manner that would allow clinicians to judge whether these tests are valuable to...