Journal of Orthopaedic & Sports Physical Therapy - Cort J. Cieminski, PT, PhD, ATR

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

Thu, 22 Apr 2010 00:00:00 EST

Jason B. Lunden, Mike Muffenbier, M. Russell Giveans, Cort J. Cieminski

STUDY DESIGN: Clinical measurement, reliability. OBJECTIVE: 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. BACKGROUND: 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. METHODS: 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°of abduction, and (2) in sidelying on the tested side, with the shoulder flexed to 90°. RESULTS: Intrarater reliability for supine measurements was good to excellent (ICC_3,1 = 0.70-0.93) and for sidelying measurements was excellent (ICC_3,1 = 0.94-0.98). Interrater reliability was fair to good for the supine measurement (ICC_2,2 = 0.74-0.81) and good to excellent for the sidelying measurement (ICC_2,2 = 0.88-0.96). The mean (range) value of the dominant shoulder sidelying IR passive range of motion was 40° (11° to 69°) for healthy subjects and 25° (–16° to 49°) for subjects with shoulder pathology. CONCLUSIONS: 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.

J Orthop Sports Phys Ther 2010;40(9):589-594, Epub 22 April 2010. doi:10.2519/jospt.2010.3197

KEY WORDS: glenohumeral joint, goniometry, motion, rehabilitation

Three-Dimensional Acromioclavicular Joint Motions During Elevation of the Arm

Fri, 07 Dec 2007 00:00:00 EST

Rachael M. Teece, Angela S. Lloyd, Andrew P. Kaiser, Paula M. Ludewig, Cort J. Cieminski, Jason B. Lunden

STUDY DESIGN: Descriptive laboratory study. OBJECTIVES: To determine the 3-dimensional motions occurring between the scapula relative to the clavicle at the acromioclavicular joint during humeral elevation in the scapular plane. BACKGROUND: Shoulder pathology is commonly treated through exercise programs aimed at correcting scapular motion abnormalities. However, little is known regarding how acromioclavicular joint motions contribute to normal and abnormal scapulothoracic motion. METHODS AND MEASURES: Thirty subjects (16 males, 14 females) participated. Subjects with positive symptoms on clinical exam or past history of shoulder pathology, trauma, or surgery were excluded. Electromagnetic surface motion analysis was performed tracking the thorax, clavicle, scapula, and humerus. Subjects performed 3 repetitions of scapular plane abduction. Passive motion data were also collected for scapular plane abduction from cadaver specimens. Data were analyzed using within-session reliability and descriptive statistics as well as repeated measures analyses of variance (ANOVAs) to determine the effect of elevation angle from rest to 90º humeral elevation. Reliability was determined from repeated trials in the same session without removing sensors or redigitizing landmarks. RESULTS: Angular values were highly repeatable within session (ICC>0.94; SEM, < 2.3°). During active scapular plane abduction from rest to 90°, average acromioclavicular joint angular values demonstrated increased internal rotation (approximately 4.3°), increased upward rotation (approximately 14.6°), and increased posterior tilting (approximately 6.7°) (P<.05). Passive motions on cadavers demonstrated similar kinematic patterns.
CONCLUSIONS: Significant motion occurs at the acromioclavicular joint during active humeral elevation, contributing to scapular motion on the thorax. This information provides a foundation for understanding normal acromioclavicular joint motion as a basis for further investigation of pathology and rehabilitation approaches.

J Orthop Sports Phys Ther. 2008;38(4):181-190, published online 7 December 2007. doi:10.2519/jospt.2008.2386

KEY WORDS: human movement system, kinematics, scapula, shoulder

Scapular Angular Positioning at End Range Internal Rotation in Cases of Glenohumeral Internal Rotation Deficit

Tue, 27 Feb 2007 00:00:00 EST

Michael R. Borich, Jolene M. Bright, David J. Lorello, Terry Buisman, Paula M. Ludewig, Cort J. Cieminski
Study Design: Controlled laboratory study. Objectives: Investigate the relationship between glenohumeral internal rotation range-of-motion deficit and 3-dimensional scapular angular positioning during active arm movements in participants with recent participation in overhead sports activity. Background: Subacromial impingement is one of the most common shoulder pathologies and is multifactorial in etiology. Posterior glenohumeral joint capsule tightness has been theorized to contribute to one potential causal factor: abnormal scapular positioning. Methods and Measures: Twenty-three subjects, who had participated in competitive sports involving overhead activity within the last 5 years, were categorized into 2 groups based on the degree of glenohumeral internal rotation deficit (20% deficit threshold). Scapular angular positioning of subjects performing shoulder internal rotation from 90° flexion and abduction shoulder positions was evaluated using 3-dimensional electromagnetic surface tracking. Additional sensors monitored trunk and humeral motion. Scapular position data at end range glenohumeral internal rotation, along with glenohumeral internal rotation range of motion measurements, were used to analyze the relationship between glenohumeral internal rotation deficit and scapular position using 2-way ANOVA and regression analyses. Results: The internal rotation deficit group had significantly greater scapular anterior tilt (9.2° difference, P = .04) across positions, as compared to the control group. Regression analysis demonstrated a significant association between glenohumeral internal rotation deficit and scapular position (tilting) during flexed internal rotation (r² = 0.37, P = .03) and for scapular position (anterior tilting and upward rotation) during abducted internal rotation (r² = 0.35, P = .036). Conclusions: These findings demonstrate a significant relationship between glenohumeral internal rotation deficit and abnormal scapular positioning, particularly increased anterior tilt. This relationship identifies a possible mechanism for development of excessive scapular anterior tilt.

J Orthop Sports Phys Ther. 2006; 36(12):926- 934. doi:10.2519/jospt.2006.2241

Key Words: biomechanics, rotator cuff, scapula, shoulder