Original ArticlesInterobserver and intraobserver reliability of the measurement of shoulder internal rotation by vertebral level☆
Introduction
Thorough examination of the shoulder joint includes accurate documentation of range of motion. The American Shoulder and Elbow Surgeons recommend documenting active and passive total elevation, active and passive external rotation with the arm at the side, active and passive external rotation with the arm positioned at 90° abduction, and active or passive internal rotation of the shoulder.6 Internal rotation of the shoulder is commonly measured by assessing the point reached on the back by the tip of the extended thumb.7, 14 This method of determining functional internal rotation of the shoulder has been criticized because it does not measure pure internal rotation of the glenohumeral joint; it is affected by concurrent pathologic conditions in the elbow, wrist, or thumb, and it may not be easy to determine bony landmarks in the spine.7, 9, 10
Although measurement of internal rotation by vertebral level is commonly used, little investigation into the reliability of this measurement technique has been performed.11 The purpose of this study is to determine the interobserver and intraobserver reliability of measuring shoulder internal rotation by vertebral level reached by the extended thumb. In addition, the accuracy of these clinical measurements is assessed by a comparison with the actual vertebral level reached as determined radiographically.
Section snippets
Materials and methods
Three volunteers acted as subjects for internal rotation measurement. Their mean age was 28 years (range, 26-29 years). All 3 subjects were men. None of the subjects' shoulders was abnormal. One subject had a history of shoulder subluxation 13 years previously that was treated successfully with rehabilitation. In addition, all 3 subjects were of appropriate weight for height, yielding easily palpable bony landmarks.
Eleven orthopaedic surgeons and 2 physical therapists served as examiners. The
Results
Radiographs demonstrated that internal rotation ranging from T4 to L5 was tested. Interobserver intraclass correlation coefficients for each of 3 rounds of measurements were 0.12, 0.27, and 0.25, respectively. An intraclass correlation coefficient of less than 0.4 indicates poor reliability. Thus interobserver reliability was found to be poor. The mean error for measurement of each of the 3 rounds when the clinical measurements were compared with the radiographic values was 1.15, 1.02, and
Discussion
Internal rotation has been a problematic parameter of measurement in examination of the shoulder. Concerns about contributions from adjacent joints (ie, scapulothoracic and elbow) and difficulty of palpating bony landmarks have been raised with regard to the measurement of shoulder internal rotation by vertebral body reached.7, 10 Although goniometric measurements have been reported widely for measuring reliability of other parameters of shoulder mobility, their use in measuring internal
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Reprint requests: Richard V. Baratta, PhD, Louisiana State University Health Sciences Center, Department of Orthopaedic Surgery, 2025 Gravier St, Suite 400, New Orleans, LA 70112 (E-mail: [email protected]).