Study Design: Prospective cohort study. Objectives: To determine the effect of rotator cuff tear size on shoulder strength and range of motion. Background: Patients with rotator cuff pathology typically present with weakness and motion loss in various motions. The extent to which the presence of a rotator cuff tear and the size of the tear affect strength and range of motion is not well understood. Methods and Measures: Sixty-one patients scheduled for surgery, with a diagnosis of a rotator cuff tear and/or subacromial impingement, underwent examination for shoulder pain, function, range of motion, and strength. The extent of rotator cuff pathology was documented during subsequent surgery (presence of tear, tear size, tear thickness). Results: There were 10 massive tears, 15 large tears, 13 medium tears, 12 small tears, and 11 rotator cuffs without a tear. Patients had marked weakness in abduction strength at 90° and 10° of abduction, in external rotation strength at 90°, and in the ‘‘full can test’’ (all, P<.0001). Marked range of motion losses in shoulder flexion and external rotation at 0° and 90° abduction (all, P<.001) were also observed. Abduction strength deficit at 10° was affected by rotator cuff tear size (P<.0001). Twenty of 25 patients with large or massive tears had deficits greater than 50%, compared with only 1 of 11 patients with no tear, 2 of 12 patients with a small tear, and 5 of 13 patients with a medium tear (P<.0001). Other strength and range of motion deficits or indices of pain and function were unaffected by tear size. Conclusions: Weakness of greater than 50% relative to the contralateral side in shoulder abduction at 10° of abduction was indicative of a large or massive rotator cuff tear.

J Orthop Sports Phys Ther. 2005;35(3):130-135. doi: 10.2519/jospt.2005.1626

Key Words: handheld dynamometer, shoulder muscle strength

Study Design: Evaluation of agreement between assessors. Objective: To evaluate agreement between an expert in selective tissue tension (STT) and 3 other trained assessors, all using STT in conjunction with a preliminary clinical history, on their diagnostic labeling of painful shoulders. Background: Consensus on diagnostic labeling for shoulder pain is poor, hampering interpretation of the evidence for interventions. STT, a systematic approach to physical examination and diagnosis, offers potential for standardization, but its reliability is contentious. Methods and Measures: Four trained assessors, 1 of whom was considered an expert, separately assessed 56 painful shoulders in 53 subjects (32 male [mean ± SD age, 51 ± 13 years], 21 female [mean ± SD age, 57 ± 12 years]), using STT in conjunction with a preliminary clinical history. Assessors labeled each painful shoulder as ‘‘rotator cuff lesion,’’ ‘‘bursitis,’’ ‘‘capsulitis,’’ ‘‘other diagnosis,’’ or ‘‘no diagnosis.’’ Combinations of diagnoses were allowed. Results: A diagnosis was made in every case, with less than 7% of the diagnoses being combined. With the diagnostic categories pooled, agreement (kappa and 95% confidence interval [CI]) between the expert assessor and each of the other assessors was good, ranging from 0.61 (0.44-0.78) to 0.75 (0.60-0.90). For single diagnostic categories, agreement between the expert and each of the others (dichotomized data) ranged from 0.35 (–0.03-0.73) to 0.58 (0.29 0.87) for bursitis; 0.63 (0.40-0.86) to 0.82 (0.65-0.99) for capsulitis; 0.71 (0.49-0.93) to 0.79 (0.61-0.96) for rotator cuff lesions; and from 0.69 (0.35-1.00) to 0.78 (0.48-1.00) for other diagnoses. Conclusions: Overall, STT in conjunction with a preliminary clinical history enables good agreement between trained assessors. Future work is required to evaluate its criterion validity.

J Orthop Sports Phys Ther. 2005;35(3):147-153. doi: 10.2519/jospt.2005.1502

Key Words: orthopedics, physical therapy, tests

We present a clinical commentary of existing evidence regarding popliteus musculotendinous complex anatomy, biomechanics, muscle activation, and kinesthesia as they relate to functional knee joint rehabilitation. The popliteus appears to act as a dynamic guidance system for monitoring and controlling subtle transverse- and frontal-plane knee joint movements, controlling anterior-posterior lateral meniscus movement, unlocking and internally rotating the knee joint (tibia) during flexion initiation, assisting with 3-dimensional dynamic lower extremity postural stability during single-leg stance, preventing forward femoral dislocation on the tibia during flexed-knee stance, and providing for postural equilibrium adjustments during standing. These functions may be most important during mid-range knee flexion when capsuloligamentous structures are unable to function optimally. Because the popliteus musculotendinous complex has attachments that approximate the borders of both collateral ligaments, it has the potential for providing instantaneous 3-dimensional kinesthetic feedback of both medial and lateral tibiofemoral joint compartment function. Enhanced popliteus function as a kinesthetic knee joint monitor acting in synergy with dynamic hip muscular control of femoral internal rotation and adduction, and ankle subtalar muscular control of tibial abduction-external rotation or adduction-internal rotation, may help to prevent athletic knee joint injuries and facilitate recovery during rehabilitation by assisting the primary sagittal plane dynamic knee joint stabilization provided by the quadriceps femoris, hamstrings, and gastrocnemius.

J Orthop Sports Phys Ther. 2005;35(3):165-179. doi: 10.2519/jospt.2005.1414

Key Words: knee, lateral meniscus, lower extremity