The patient was a 16-year-old adolescent male who was referred to an orthopaedic surgeon by his pediatrician for a chief complaint of persistent right shoulder pain and crepitus that limited his ability to participate in sporting activities. The patient’s progressively worsening right shoulder pain and crepitus, despite no history of injury, was a concern. Therefore, conventional radiographs were completed, which demonstrated an area of radiolucency involving the humeral head. Due to concern for intra-articular pathology, a magnetic resonance arthrogram was ordered, which demonstrated findings consistent with an osteochondritis dissecans lesion of the humeral head.

J Orthop Sports Phys Ther 2012;42(10):886. doi:10.2519/jospt.2012.0417

KEY WORDS: arthrogram, crepitus, magnetic resonance imaging, radiography, shoulder

SYNOPSIS: Injuries to the posterolateral corner of the knee pose a significant challenge to sports medicine team members due to their complex nature. Identifying posterolateral corner injuries is paramount to determining proper surgical management of the injured athlete, with the goal of preventing chronic pain, instability, and/or surgical failure. Postoperative rehabilitation is based on the specific structural involvement and surgical procedures. A firm understanding of the anatomy and biomechanics of the structures of the posterolateral corner is essential for successful rehabilitation outcomes. Emphasis is placed on protection of the healing surgical repair/reconstruction, with gradual restoration of range of motion, strength, proprioception, and dynamic function of the knee. The purpose of this paper is to provide an overview of the anatomy, biomechanics, and mechanism of injury for posterolateral corner injuries, with a review of clinical examination techniques for identifying these injuries. Furthermore, a review of current surgical management and postoperative guidelines is provided. LEVEL OF EVIDENCE: Diagnosis/therapy, level 5.

J Orthop Sports Phys Ther 2010;40(8):502-516; Epub 13 May 2010. doi:10.2519/jospt.2010.3269

KEY WORDS: fibular collateral ligament, multiligamentous knee injuries, rehabilitation

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

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