Interrater reliability of physical examination tests in the acute phase of shoulder injuries

Abstract Background The physical examination is one of the cornerstones of the diagnostic process in patients with acute shoulder injuries. The discriminative properties of a given examination test depend both on its validity and reliability. The aim of the present study was to assess the interrater reliability of 13 physical examination manoeuvres for acute rotator cuff tears in patients with acute soft tissue shoulder injuries. Methods In a large walk-in orthopaedic emergency department, 120 consecutive patients ≥40 years of age were included in a diagnostic study. Patients who had follow-up within three weeks of an acute shoulder injury without fracture on radiographs were eligible. Four emergency department physicians participated as examiners. In a subset of 48 patients, the physical examination tests were performed by two physicians, randomly chosen by their work rotation. The physicians were blinded to the findings of each other and the results of the ultrasound screening. The interrater reliability was assessed by Cohen’s kappa, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland-Altman plots depending on whether the examination test result was registered as a binary, ordered categorical or continuous numerical variable. Results The median age was 55.5 years, 46% were female. Twenty-seven percent had a rotator cuff full-thickness tear on ultrasound screening; all but one involved the supraspinatus tendon. Cohen’s kappa for binary tests ranged from excellent to fair. Excellent agreement (kappa > 0.8) was found for the inability to abduct above 90° and abduction strength. External rotation strength expressed substantial agreement (kappa 0.7). The lowest scores were registered for Hawkins` test and the external rotation lag sign (kappa 0.25 and 0.40, respectively). The ICCs for active range of abduction and external rotation were 0.93 (0.88–0.96) and 0.84 (0.72–0.91), whereas the SEM was 15 and 9, respectively. Conclusions The results indicate that examination manoeuvres assessing abduction and external rotation range of motion and strength are more reliable than manoeuvres assessing pain in patients in the acute phase of traumatic shoulder injury. The poor agreement observed is likely to limit the validity in the present setting of two commonly used tests. Trial registration The Norwegian Regional Ethics Committee South East (2015/195).

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Shoulder Injuries in Cricketers

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1174 ◽

2015 ◽

Vol 49 (4) ◽

pp. 194-196

Author(s):

Sharad Prabhakar ◽

Radhakant Pandey

Keyword(s):

Rotator Cuff ◽

Shoulder Injuries ◽

Shoulder Injury ◽

Internal Impingement ◽

Scapular Kinematics ◽

Glenohumeral Internal Rotation Deficit ◽

Repetitive Nature ◽

Tissue Changes ◽

Soft Tissue Changes ◽

Very High

ABSTRACT Shoulder injuries are very common in cricketers. Throwing athletes in cricket (both bowlers and fielders) are prone to shoulder injuries secondary to the large amount of forces generated, the resultant very high velocities and the repetitive nature of the throwing action. The shoulder joint has to balance mobility vs stability. Athletes exhibit adaptive changes that develop from the repetitive microtrauma following overhead throwing. The article discusses in detail how altered scapular kinematics, rotator cuff dysfunction with altered muscle strength patterns, internal impingement combined with anatomical adaptive bony and soft tissue changes causing a glenohumeral internal rotation deficit, predispose the cricketer to shoulder injury. How to cite this article Prabhakar S, Pandey R. Shoulder Injuries in Cricketers. J Postgrad Med Edu Res 2015;49(4): 194-196.

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A Study of Right Shoulder Injury in Collegiate and Professional Orchestral Cellists: An Investigation Using Questionnaires and Physical Assessment

Medical Problems of Performing Artists ◽

10.21091/mppa.2012.2014 ◽

2012 ◽

Vol 27 (2) ◽

pp. 65-73 ◽

Cited By ~ 13

Author(s):

Dale Rickert ◽

Margaret Barrett ◽

Mark Halaki ◽

Tim Driscoll ◽

Bronwen Ackermann

Keyword(s):

Rotator Cuff ◽

Future Research ◽

College Level ◽

Shoulder Injuries ◽

Shoulder Injury ◽

Injury Rates ◽

Targeted Interventions ◽

Physical Testing ◽

Shoulder Strength ◽

Two Populations

PURPOSE: Cellists sustain high levels of playing-related injury and are particularly susceptible to right shoulder pain, yet no studies have attempted to propose a mechanism for disease or establish possible causal factors. The aim of this study was to investigate shoulder injury levels and causes in two populations: professional orchestral cellists and college-level student cellists. METHODS: A questionnaire and physical testing protocol was applied to both groups of participants, eliciting information on lifestyle, playing habits, and self-reported injury rates as well as physical data on shoulder strength, range of motion, and signs of injury. RESULTS: Right shoulder injuries are common among both student (20%) and professional (42%) cellists and seem to be associated with measures indicating potential lack of strength in the scapular stabilisers as well as potential degenerative changes in the rotator cuff. Significant differences were found in the lifestyle and playing habits of the two groups. There were increased signs of pain and stiffness in the professionals and evidence of decreased muscular support in the students. Male cellists showed less scapular stability; female cellists, however, generally had higher levels of pain. CONCLUSIONS: These results indicate that injuries at the shoulder, potentially involving impingement-type pathologies, are a common cause of pain in cellists. Based on this study, future research for cello players could focus on targeted interventions, such as exercises for the scapular stabilisers and muscles of the rotator cuff.

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Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120931764 ◽

2020 ◽

Vol 12 (5) ◽

pp. 478-487 ◽

Cited By ~ 1

Author(s):

Camille Tooth ◽

Amandine Gofflot ◽

Cédric Schwartz ◽

Jean-Louis Croisier ◽

Charlotte Beaudart ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Rotator Cuff ◽

Range Of Motion ◽

Training Load ◽

Shoulder Injuries ◽

Shoulder Injury ◽

Overhead Athletes ◽

Modifiable Factors ◽

And Training

Context: Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking. Objectives: To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature. Data Sources: A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus. Study Selection: Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score. Results: Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries. Conclusion: Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.

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Rotator Cuff Training for Pitchers

Journal of Sport Rehabilitation ◽

10.1123/jsr.7.4.285 ◽

1998 ◽

Vol 7 (4) ◽

pp. 285-299 ◽

Cited By ~ 2

Author(s):

Michael E. Powers

Keyword(s):

Rotator Cuff ◽

Internal Rotation ◽

High Speed ◽

External Rotation ◽

Shoulder Abduction ◽

Muscular Endurance ◽

Shoulder Injuries ◽

Three Stages ◽

Two Stages

This paper reviews the role of the rotator cuff during two key phases of the pitching sequence and presents a training program for these muscles. The program uses a periodization design consisting of three stages, beginning with a high-resistance/low-repetition eccentric strengthening stage. This is followed by a low-resistance/high-repetition stage for training muscular endurance. The core exercises for these two stages are prone external rotation in the 90/90 position, prone horizontal abduction, side-lying D2 flexion pattern, supine internal rotation in the 90/90 position, prone elevation with 100° of shoulder abduction and external rotation, and standing scapular plane elevation. The final stage of the program uses high-speed functional exercises: 90/90 external rotation, 90/90 internal rotation, D2 PNF flexion pattern, D2 PNF extension pattern, supine plyometric 90/90 internal rotation with a medicine ball, and the “arm whip” through the D2 PNF flexion pattern. The goal of this program is to prepare the muscles for the stresses of pitching and prevent shoulder injuries.

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Primary and Secondary Consequences of Rotator Cuff Injury on Joint Stabilizing Tissues in the Shoulder

Journal of Biomechanical Engineering ◽

10.1115/1.4037917 ◽

2017 ◽

Vol 139 (11) ◽

Cited By ~ 4

Author(s):

Hafizur Rahman ◽

Eric Currier ◽

Marshall Johnson ◽

Rick Goding ◽

Amy Wagoner Johnson ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Joint ◽

Treatment Algorithm ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Shoulder Injuries ◽

Joint Stability ◽

Shoulder Injury ◽

Physician Visits ◽

Variable Success Rate

Rotator cuff tears (RCTs) are one of the primary causes of shoulder pain and dysfunction in the upper extremity accounting over 4.5 million physician visits per year with 250,000 rotator cuff repairs being performed annually in the U.S. While the tear is often considered an injury to a specific tendon/tendons and consequently treated as such, there are secondary effects of RCTs that may have significant consequences for shoulder function. Specifically, RCTs have been shown to affect the joint cartilage, bone, the ligaments, as well as the remaining intact tendons of the shoulder joint. Injuries associated with the upper extremities account for the largest percent of workplace injuries. Unfortunately, the variable success rate related to RCTs motivates the need for a better understanding of the biomechanical consequences associated with the shoulder injuries. Understanding the timing of the injury and the secondary anatomic consequences that are likely to have occurred are also of great importance in treatment planning because the approach to the treatment algorithm is influenced by the functional and anatomic state of the rotator cuff and the shoulder complex in general. In this review, we summarized the contribution of RCTs to joint stability in terms of both primary (injured tendon) and secondary (remaining tissues) consequences including anatomic changes in the tissues surrounding the affected tendon/tendons. The mechanical basis of normal shoulder joint function depends on the balance between active muscle forces and passive stabilization from the joint surfaces, capsular ligaments, and labrum. Evaluating the role of all tissues working together as a system for maintaining joint stability during function is important to understand the effects of RCT, specifically in the working population, and may provide insight into root causes of shoulder injury.

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Isokinetic Rotator Cuff Functional Ratios and the Development of Shoulder Injury in Collegiate Baseball Pitchers

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2014-0071 ◽

2015 ◽

Vol 20 (3) ◽

pp. 46-52 ◽

Cited By ~ 2

Author(s):

Rachele E. Vogelpohl ◽

Roger O. Kollock

Keyword(s):

Rotator Cuff ◽

Human Performance ◽

Outcome Measure ◽

External Rotation ◽

Peak Torque ◽

Shoulder Injury ◽

Acceleration Phase ◽

Main Outcome Measure ◽

Collegiate Baseball ◽

Baseball Pitchers

Context:Shoulder injury in baseball pitchers is a very common problem and has been linked to an imbalance in rotator cuff strength. Recently, the use of functional shoulder strength ratios has become more popular because they more closely resemble the actions of the shoulder during the throwing motion.Objective:To investigate the link between preseason shoulder rotator cuff functional strength ratios and the development of shoulder pain and injury.Design:Prospective research design.Setting:University human performance laboratory.Patients:Fifteen collegiate baseball pitchers participated in this study. At the end of the baseball season, six (19.5 ± 1.8 years, 73.6 ± 2.8 inches, 198.7 ± 19.1 lbs) developed shoulder injury and were placed in the injured group, and nine (21.0 ± 1.7 years, 73.1 ± 2.3 inches, 207.9 ± 28.1 lbs) did not develop injury and were placed in the noninjured group.Interventions:Isokinetic peak torque was collected concentrically and eccentrically for both shoulder internal rotation (IR) and external rotation (ER) at 60°-s−1, 180°-s−1, and 300°-s−1.Main Outcome Measure:The following functional ratios were calculated from the peak torque measures: concentric ER: concentric IR; eccentric ER: eccentric IR; concentric ER: eccentric IR (cocking phase); and eccentric ER: concentric IR (acceleration phase). Analysis was conducted using an analysis of variance comparing the injured and noninjured groups. A secondary analysis was conducted using an analyses of variance on the concentric and eccentric peak torque for shoulder IR and ER between groups.Results:The acceleration phase functional shoulder ratio was significantly higher (p = .019) in the injured group and a concentric IR peak torque (p = .003) was significantly lower in the injured group compared with the noninjured group.conclusion:Increased acceleration phase ratios and decreased concentric IR peak torque may be linked to the development of shoulder injury during a baseball season.

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Is Muscle Weakness a Risk Factor of the Development of Rotator Cuff Tendinopathy – A Systematic Review

10.21203/rs.3.rs-102394/v1 ◽

2020 ◽

Author(s):

Cheuk-Kin Kwan ◽

Man-Chi Ko ◽

Sai-Chuen Fu ◽

Samuel Ka-Kin Ling ◽

Hio-Teng Leong ◽

...

Keyword(s):

Risk Factor ◽

Rotator Cuff ◽

Muscle Weakness ◽

Odds Ratio ◽

External Rotation ◽

Limited Range ◽

Shoulder Injuries ◽

Limited Range Of Motion ◽

Rotation Strength ◽

Rotator Cuff Tendinopathy

Abstract BackgroundUnderlying muscle weakness may explain the inconsistency in the development of rotator cuff tendinopathy in population with similar activity levels. This systematic review aims to assess existing prospective studies to evaluate whether muscle weakness is a risk factor to the development of rotator cuff tendinopathy. MethodsA systematic search was performed using the PRISMA guidelines. Prospective studies measuring muscle strength or stiffness and the incidence of rotator cuff tendinopathy will be included. Quality assessment was performed with the Newcastle-Ottawa Quality Assessment Scale. ResultsThe search yielded 6 studies, with a total of 523 trained overhead athletes followed up for 1 season. External and internal rotation strength was described as protective factors for the development of rotator cuff tendinopathy, with an odds ratio of 0.940 (p < 0.05) and 0.946 (p < 0.01) respectively for each N/m increased in force generated. Limited range of motion of <106o for shoulder external rotation was also described as a risk factor with an odds ratio of 1.12 (p < 0.001).Imbalance between external and internal rotation strength was reported as a risk factor for shoulder injuries in 2 studies, with a relative risk of 2.57 (p < 0.05) reported in 1 of them. Supraspinatus weakness was also reported as a risk factor for shoulder injuries in 1 study, with no odds ratio or relative risk provided. Due to insufficient data, combination into a meta-analysis was not possible. ConclusionsLimited evidence support that weakness of the external rotators, weakness in the internal rotators, and limited range of motion in external rotation are risk factors to the development of rotator cuff tendinopathy. Very limited evidence support that imbalance in external rotator and internal rotator strength, and supraspinatus weakness are risk factors for rotator cuff tendinopathies. Future cohort studies may improve on existing evidence with investigations on more muscle groups, a longer follow-up time, clearly documented injury history, and a stringent diagnosis to rotator cuff tendinopathy.

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Shoulder injuries in provincial male fast bowlers - predisposing factors

South African Journal of Sports Medicine ◽

10.17159/2413-3108/2004/v16i1a190 ◽

2004 ◽

Vol 16 (1) ◽

pp. 25 ◽

Cited By ~ 1

Author(s):

KD Aginsky ◽

L Lategan ◽

RA Stretch

Keyword(s):

Sports Medicine ◽

External Rotation ◽

Peak Torque ◽

Predisposing Factors ◽

Shoulder Injuries ◽

Shoulder Injury ◽

Video Footage ◽

Shoulder Strength ◽

Shoulder Flexibility ◽

Torque Values

Objectives. To investigate the relationship between shoulder flexibility and isokinetic strength as possible factors that may predispose provincial fast bowlers to shoulder injuries. Design. Twenty-one players, 12 of whom had no history of shoulder injuries and 9 of whom had experienced a shoulder injury to the bowling arm, were assessed for shoulder strength using a Cybex Norm isokinetic dynamometer. Absolute and relative peak torque measures were obtained at isokinetic speeds of 90°/s and 180°/s, with both concentric and eccentric contractions performed. Shoulder flexibility was tested using a Leighton Flexometer in both internal and external shoulder rotation. The players were classified into a front-on (N = 7), semi front-on (N = 7) or side-on (N = 7) bowling action from video footage recorded after a bowling trial in the nets. Results. Shoulder injuries were more common in fast bowlers with a front-on action (N = 5) than the bowlers with a side-on (N = 2) or semi front-on (N = 2) action. Sixteen of the 21 fast bowlers showed low stability ratios compared with gravity corrected functional ratios, indicating an imbalance and the presence of possible dysfunction. The injured group of fast bowlers showed higher concentric weight-normalised torque values for internal rotation at the higher velocity (180°/s) (65.20 ± 10.03 vs. 45.91 ± 10.26 Nm.kg-1 p < 0.009: injured vs. uninjured), which would suggest greater instability when compared with the uninjured players. This imbalance could indicate the presence of a predisposition to impingement syndrome in the injured subjects. There was an increase in the external rotation ranges of movement for both groups, indicating a degree of hypermobility in both groups. The results indicate that the presence of possible dysfunction in the shoulder rotators, combined with a front-on bowling action and external rotation hypermobility, are possible predisposing factors for chronic shoulder injuries in cricket fast bowlers. South African Journal of Sports Medicine Vol.16(1) 2004: 25-28

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Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-097648 ◽

2017 ◽

Vol 52 (18) ◽

pp. 1191-1198 ◽

Cited By ~ 20

Author(s):

Stig Haugsboe Andersson ◽

Roald Bahr ◽

Benjamin Clarsen ◽

Grethe Myklebust

Keyword(s):

Risk Factors ◽

Outcome Measure ◽

External Rotation ◽

Positive Association ◽

Scapular Dyskinesis ◽

Shoulder Injuries ◽

Shoulder Injury ◽

Significant Positive Association ◽

Trauma Research ◽

Rotation Strength

BackgroundShoulder injuries are common among handball players and predominantly characterised by overuse characteristics. Reduced total glenohumeral rotation, external rotation weakness and scapular dyskinesis have been identified as risk factors among elite male handball players.AimTo assess whether previously identified risk factors are associated with overuse shoulder injuries in a large cohort of elite male and female handball players.Methods329 players (168 male, 161 female) from the two upper divisions in Norway were included and tested prior to the 2014–2015 season. Measures included glenohumeral internal and external rotation range of motion, isometric internal and external rotation strength, and assessment of scapular dyskinesis. Players were followed prospectively for one competitive season, with prevalence and severity of shoulder problems registered monthly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A severity score based on players’ questionnaire responses was used as the outcome measure in multivariable logistic regression to investigate associations between candidate risk factors and overuse shoulder injury.ResultsNo significant associations were found between total rotation (OR 1.05 per 5° change, 95% CI 0.98 to 1.13), external rotation strength (OR 1.05 per 10 N change, 95% CI 0.92 to 1.20) or obvious scapular dyskinesis (OR 1.23, 95% CI 0.25 to 5.99) and overuse shoulder injury. A significant positive association was found between greater internal rotation (OR 1.16 per 5° change, 95% CI 1.00 to 1.34) and overuse shoulder injury.ConclusionNone of the previously identified risk factors were associated with overuse shoulder injuries in a mixed-sex cohort of elite handball players.

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