Articles
Measuring shoulder internal rotation range of motion: A comparison of 3 techniques,☆☆,,★★,,♢♢

https://doi.org/10.1053/apmr.2002.34815Get rights and content

Abstract

Awan R, Smith J, Boon AJ. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil 2002;83:1229-34. Objective: To compare the reliability of shoulder internal rotation (IR) range of motion (ROM) measured using 3 different methods: standard technique, manual scapular stabilization technique, and visual inspection technique. Design: Prospective study. Setting: Clinic-based sports medicine center. Participants: Convenience sample of 56 unimpaired high-school athlete volunteers. Interventions: Not applicable. Main Outcome Measures: Shoulder IR ROM was measured by using a digital inclinometer with each of the 3 techniques. All measurements were performed independently by 2 groups of examiners and repeated to determine intra- and interrater reliabilities. Results: IR ROM measurements obtained with the scapula stabilized or by visual inspection were significantly less than when measured with the standard technique (P=.001). Intrarater reliability was good or excellent for all 3 methods (intraclass correlation coefficients=.63–.71), was similar for the scapular stabilization and visual inspection techniques, and was superior to that previously reported for similar measurements. In general, interrater reliability was lower than intrarater reliability for all measurements. Conclusion: Because the visual inspection and scapular stabilized techniques control for accessory scapulothoracic motion, these techniques may represent more valid measures of glenohumeral motion than the standard technique. Both the visual inspection and scapular stabilized techniques exhibited equally acceptable reliability for clinical use. However, because the visual inspection technique may be applied by a single examiner, we recommend its use to measure shoulder IR ROM in the clinical setting. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Participants

Three hundred forty junior-high and high-school athletes attending the annual preparticipation physical examination program at our institution were given the opportunity to participate in the study. Of these, 56 athletes (32 men, 24 women; age range, 13–18y) volunteered for the current study. Inclusion criteria included (1) no history of neurologic disease, arthritis, connective tissue disorder, or shoulder/neck injury or surgery and (2) informed consent (parental consent was obtained if the

Results

Ninety-three percent of the 56 unimpaired individuals (30/32 men, 22/24 women) participating in this study were right-hand dominant. The ANOVA did not reveal any significant interaction between arm dominance and measurement technique (NSS vs SS vs VI). Therefore, the data in tables 1 through 4 are presented in terms of right and left arms, irrespective of arm dominance.

The mean values for shoulder IR and ER using the 3 measurement techniques are presented in table 2. Shoulder rotation

Discussion

The current study represents an extension of our previous investigation showing the reliability of shoulder IR ROM measurements using the scapular stabilization technique.13 As previously discussed, manual scapular stabilization minimizes or prevents accessory scapulothoracic motion while the examiner measures glenohumeral IR.12, 13 Therefore, the IR-SS technique is thought to represent a more valid measure of glenohumeral IR.12, 13 The challenge of the IR-SS technique is that it typically

Conclusion

Shoulder ER and IR motions as measured with the techniques used in the current study exhibit acceptable reliability for clinical use. Shoulder IR ROM measured with either the scapular stabilized (IR-SS) or visual inspection (IR-VI) techniques results in significantly less IR when compared with the standard technique (IR-NSS), in which accessory scapulothoracic motion may occur. Therefore, the IR-SS and IR-VI may represent more valid measures of glenohumeral internal rotation. The IR-VI

Acknowledgements

We thank Dirk Larson, MS, and Terry M. Therneau, PhD, of the Department of Biostatistics, Mayo Clinic, for their statistical contribution to this study, and Jeff Brault, DO, PT, Dave Schroeder, PT, Katie Altman, MD, and Nicole Detman, MS, from the Mayo Clinic Sports Medicine Center, for their technical assistance.

References (22)

  • F Jobe et al.

    The shoulder in sports

  • Cited by (118)

    • Reliability of visual inspection and palpation to assess relative flexibility of the shoulder

      2021, Journal of Bodywork and Movement Therapies
      Citation Excerpt :

      The results of this study indicated that both physical palpation and visual inspection were reliable methods for measuring the relative flexibility of shoulder IR when measured by the same examiner using a smart phone application. The visual inspection intra-rater reliability measures were consistent with those reported previously (Awan et al., 2002). The correlation between the measures was also good indicating that either method could be utilized reliably in the clinic.

    View all citing articles on Scopus

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    ☆☆

    Reprint requests to Jay Smith, MD, Dept of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905, e-mail [email protected].

    Suppliers

    ★★

    a. Saunders digital inclinometer; Saunders Group Inc, 4250 Norex Dr, Chaska, MN 55318-3047.

    b. SAS Institute Inc, SAS Campus Dr, Cary, NC 27513.

    ♢♢

    c. MathSoft Engineering & Education Inc, 101 Main St, Cambridge, MA 02142-1521.

    View full text