Survey on Knowledge, Use, and Diagnostic Applicability of Special Tests for Rotator Cuff Involvement in Clinical Practice.

Background: Recently, researchers have commented that shoulder special tests cannot identify the structure causing rotator cuff symptoms and should only be considered pain provocation tests. Others have disagreed, reporting that special tests were able to accurately detect the presence of rotator cuff involvement. Purpose: The purpose of this study was to determine the knowledge, use, and perceived effectiveness of 15 selected special tests utilized to examine patients with possible rotator cuff dysfunction. Study Design: Descriptive study using survey. Methods: An electronic survey was returned by 346 members of the Academies of Orthopedic and Sports Physical Therapy through list serves. Descriptions and pictures for 15 special tests of the shoulder were included in the survey. Information regarding years of clinical experience and American Board of Physical Therapy Specialties (ABPTS) specialist certification in Sports or Orthopedics was collected. Respondents were asked if they could identify and use the special tests to evaluate dysfunction of the rotator cuff - and how confident they were in ability of the tests to diagnose dysfunction of the rotator cuff. Results: The four tests most readily known by respondents included the empty can, drop arm, full can, and Gerber's tests, and the four tests used regularly by the respondents included the infraspinatus, full can, supraspinatus, and champagne toast tests. The infraspinatus, champagne toast, external rotation lag (ERLS), and the belly-off tests were found to be the be most useful for establishing a diagnosis of the muscle-tendon complex involved. Years of experience and clinical specialization was not relevant to knowledge or use or these tests. Conclusions: This study will allow clinicians and educators to understand which special tests are easily identified, regularly used, and perceived as helpful for the diagnosis of muscles involved in a rotator cuff dysfunction. Level of Evidence: 3b.

Test retest reliability and minimal detectable change of a novel submaximal graded exercise test in the measurement of graded exercise test duration.

Measurement of graded exercise test duration is clinically important and can be assessed by maximal graded exercise testing. Yet, limitations of maximal graded exercise testing exist. An alternative to maximal graded exercise testing is submaximal graded exercise testing. However, no studies have investigated the reliability of a submaximal graded exercise test in the measurement of graded exercise test duration. The purpose of this study was to determine the test-retest reliability and minimal detectable change (MDC) of a novel submaximal graded exercise test in the measurement of graded exercise test duration. Fifteen people (4 men, 11 women) with a mean age of 26.20 years (SD = 9.04) participated in this study. A novel submaximal graded exercise test was used to measure graded exercise test duration for each participant. Endpoints of the test were either 85% of age-predicted maximum heart rate or voluntarily stopping the test, whichever endpoint occurred first. Heart rate and graded exercise test duration were constantly measured throughout the test. Graded exercise test duration was defined as the total duration (minutes) of the test. For all participants, the submaximal graded exercise test was conducted at baseline and 48-72 hours thereafter. The intraclass correlation coefficient for the test-retest reliability of the test in determining graded exercise test duration was 0.94 (95% CI = 0.83-0.98). The MDC of the test in the measurement of graded exercise test duration was 0.86 minutes. The results suggest that clinicians can use this novel submaximal graded exercise test to reliably measure graded exercise test duration with a measurement error, as expressed by the MDC, of 0.86 minutes.

Intrarater reliability of CROM measurement of cervical spine active range of motion in persons with and without neck pain.

STUDY DESIGN: Clinical measurement, intrarater reliability study. OBJECTIVES: To determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range-of-motion device (CROM). BACKGROUND: Cervical spine AROM data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical AROM measurements using the CROM. METHODS AND MEASURES: Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical AROM measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized. RESULTS: The intraclass correlation coefficients (ICC3,1) for the subjects without neck pain ranged from 0.87 for flexion (95% confidence interval [CI]: 0.76-0.95) to 0.94 for left rotation (95% CI: 0.87-0.97). The standard error of the measurement ranged from 2.3 degrees to 4.0 degrees . The ICCs for the subjects with neck pain ranged from 0.88 for flexion (95% CI: 0.73-0.95) to 0.96 for left rotation (95% CI: 0.91-0.98). The standard error of the measurement ranged from 2.5 degrees to 4.1 degrees . Minimal detectable change ranged from 5.4 degrees for left rotation in the subjects without neck pain to 9.6 degrees for flexion in the subjects with neck pain. CONCLUSION: Intrarater reliability for cervical AROM measurement of persons with and without neck pain is sufficient to consider use of the CROM in clinical practice, although changes between 5 degrees to 10 degrees are needed to feel confident that a real change in spine mobility has occurred.

TESTING INFRASPINATUS AND DELTOID MUSCLES WITH NEW TECHNIQUE TO DECREASE DELTOID ACTIVITY DURING TESTING USING EMG ANALYSIS.

BACKGROUND: Muscle strength testing of an injured infraspinatus muscle (IM) is confounded by actions of synergistic muscles such as the posterior deltoid (PD). HYPOTHESIS/PURPOSE: The purpose of this study was to describe a condition for testing of the IM that results in less EMG activity of the PD musculature. The researchers hypothesized that greater inhibition of the PD could be achieved through active adduction (AA), creating reciprocal inhibition of the PD. STUDY DESIGN: Prospective cohort descriptive study. METHODS: Thirty-four (19 females and 15 males) right-handed subjects between the ages of 22- 31 (mean 24.2 years + /- 6.2) with no previous history of shoulder surgery or pathology participated. Surface electrodes were placed over the muscle bellies of the IM and PD of the right shoulder along with a ground electrode over the C7 spinous process. EMG activity was recorded during resisted external rotation in four different testing conditions (seated active and passive adduction, and side-lying active and passive adduction). The order of test positions was randomly assigned, and each subject completed all four positions with appropriate rest. During AA conditions, subjects were asked to adduct the humerus against a sphygmomanometer (using 80% maximum force output) while maximal effort external rotation was manually resisted. RESULTS: PD activity was significantly less during AA than with no AA (p<0.05) in both test positions. No significant difference occurred between IM EMG activity in the various test conditions. CONCLUSION: The results of this study suggest that clinicians can reduce activity of the PD without reducing activity of the IM by using AA of the humerus before applying manual resistance to test the IM during manual muscle testing. LEVELS OF EVIDENCE: 1b.

COMPARISON OF DRY NEEDLING VS. SHAM ON THE PERFORMANCE OF VERTICAL JUMP.

INTRODUCTION: Dry needling has been reported to decrease pain in subjects having myofascial trigger points, as well as pain in muscle and connective tissue. OBJECTIVE: The purpose of the study was to compare the effects on the ability to perform a two-legged vertical jump between a group who received one bout of dry needling and a group who received one bout of a sham treatment. METHODS: Thirty-five healthy students (19 males, 16 females) were recruited to participate in this study (mean age 22.7+/- 2.4 years). The subjects were randomly divided into two groups- dry needling (n=18) vs sham (n=17). The dry needling group received needling to four sites on bilateral gastrocnemius muscles; two at the medial head and two at the lateral head. The sham group had the four areas of the gastrocnemius muscle pressed with the tube housing the needle, but the needle was never inserted into the skin. Two-legged vertical jump was measured with chalk marks on the wall before and after the dry needling and sham treatments. RESULTS: Analysis with a t-test indicated that the dry needling group significantly increased vertical jump height 1.2 inches over the sham group. CONCLUSION: One bout of dry needling showed an immediate effect at significantly increasing vertical jump height in healthy, young adults. Future research is needed to determine if dry needling has any long-term effects. LEVEL OF EVIDENCE: 2b.

Use of an inclinometer to measure flexibility of the iliotibial band using the Ober test and the modified Ober test: differences in magnitude and reliability of measurements.

STUDY DESIGN: Test-retest design to evaluate the reliability of the measurement of iliotibial (IT) band flexibility using an inclinometer to measure the hip adduction angle. OBJECTIVES: The primary objective was to determine the intrarater reliability of the Ober test and the modified Ober test for the assessment of IT band flexibility using an inclinometer to measure the hip adduction angle. A secondary objective was to determine if a difference existed between the measurements of IT band flexibility between the Ober and modified Ober test. BACKGROUND: The Ober test and the modified Ober test are frequently used for the measurement of IT band flexibility. To date, data documenting the objective measurement of flexibility of the IT band is scarce in the literature. METHODS AND MEASURES: Sixty-one subjects, with a mean age of 24.2 (SD = 4.3) years, were measured during 2 measurement sessions over 2 consecutive days. During each measurement session, subjects were positioned on their left side and, with an inclinometer at the lateral epicondyle of the femur, hip adduction was measured during the Ober test (knee at 90 degrees of flexion) and the modified Ober test (knee extended). If the limb was horizontal, it was considered to be at 0 degrees, if below horizontal (adducted), it was recorded as a positive number, and if above horizontal (abducted), it was recorded as a negative number. RESULTS: The ICC values calculated for the intrarater reliability of the repeated measurement were 0.90 for the Ober test and 0.91 for the modified Ober test. Results of the dependent t test indicated a significantly greater range of motion of the hip in adduction using the modified Ober test as compared to the Ober test. DISCUSSION AND CONCLUSION: The use of an inclinometer to measure hip adduction using both the Ober test and the modified Ober test appears to be a reliable method for the measurement of IT band flexibility, and the technique is quite easy to use. However, given that the modified Ober test allows significantly greater hip adduction range of motion than the Ober test, the 2 examination procedures should not be used interchangeably for the measurement of the flexibility of the IT band.

Traumatic dislocation of the hip in a high school football player.

BACKGROUND: Although traumatic dislocation of the hip often occurs as a result of automobile accidents, dislocations have been reported to occur during sports activities. OBJECTIVE: Using the experience in treating a 17-year-old high school football player with a posterior dislocation, complicated by involvement of the sciatic nerve, this case report provides background information on hip dislocations and provides a description of the immediate treatment by the physician, followed by 6 weeks of immobilization, and a detailed account of the 5-month intervention. CASE DESCRIPTION: The patient was injured while making a tackle during a high school football game when another player fell on him from behind. The case report describes his plan of care after immediate hip reduction surgery and 6 weeks on crutches. Generally, the program utilized a progression of non-weight-bearing resistance training and stretching in the initial stages of intervention and progressed to weight-bearing activities (on land and in the pool) as the patient was able to tolerate more stress. In addition, the treatment of the sciatic nerve using electrical stimulation during treadmill walking is described. OUTCOMES: The patient was seen in an outpatient physical therapy clinic an average of 2 times per week for 5 months. At the end of 5 months, results of the Lower Extremity Functional Scale (LEFS) indicated that recreational and sporting activities were within normal limits, and the patient was able to return to playing on his high school football team the next year.

Unique positioning for using elastic resistance band in providing strengthening exercise to the muscles surrounding the ankle.

Ankle sprains are among the most common injuries incurred by participants in athletics. Conservative management of the patient after an ankle sprain includes a comprehensive rehabilitation program of which the resistance exercises are a part and are frequently advised by the clinician, many times as part of a home exercise program. The purpose of this Clinical Suggestion is to present a unique method of using elastic resistance band to provide strengthening activities to the inverters, ever-tors, plantarflexors, and dorsiflexors of the ankle. The method is unique, as well as convenient and efficient, as it allows the subject to perform all four exercises with a minimum of change in position, while staying seated in a chair.

Intrarater reliability of 1 repetition maximum estimation in determining shoulder internal rotation muscle strength performance.

The purpose of this study was to determine intrarater reliability of the 1 repetition maximum (1RM) estimation for shoulder internal rotation. The accuracy of the estimated 1RM was determined by establishing the actual 1RM. Fifteen subjects were positioned supine with the shoulder in 0 degrees abduction (position 1) and prone with the shoulder in 90 degrees abduction (position 2). Subjects were placed in both testing positions and performed resisted shoulder internal rotation. A 1RM estimation equation was used to estimate shoulder internal rotation strength. After 1 week, procedures were repeated and intrarater reliability was calculated. One week after 1RM estimation procedures were completed, the accuracy of an estimated 1RM was determined by establishing an actual 1RM. The results indicated excellent intrarater reliability for position 1 (intraclass correlation coefficient [ICC] = 0.99) and position 2 (ICC = 0.96). The correlation coefficients for accuracy indicated excellent concurrent validation was attained for position 1 (ICC = 0.99) and position 2 (ICC = 0.97). Shoulder internal rotation 1RM estimation appears to be reliable and accurate. Clinicians may use submaximal loads to estimate the 1RM and decrease the possibility of injury during actual 1RM strength testing.

Intrarater reliability of the KT1000 arthrometer in determining anterior translation of the glenohumeral joint.

OBJECTIVES: To establish intrarater reliability of the KT1000 arthrometer in determining glenohumeral anterior translation and to determine if a difference existed between measurements of glenohumeral anterior translation in 2 testing positions. DESIGN: Intrarater reliability study. SETTING: Academic laboratory. PARTICIPANTS: Convenience sample of 15 unimpaired volunteers (mean age +/- standard deviation, 25+/-4 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects were positioned supine with the shoulder in 20 degrees of abduction and 0 degrees of external rotation (position 1) and 90 degrees of abduction and 90 degrees of external rotation (position 2). The KT1000 was placed on the shoulder with the tibia sensor pad near the joint line and the patella sensor pad over the coracoid process. Testing involved an anteriorly directed force of 67N. Testing procedures were repeated after 1 week. RESULTS: The intraclass correlation coefficients (ICCs) for intrarater reliability for position 1 (ICC=.93; 95% confidence interval [CI], .81-.98) and for position 2 (ICC=.93; 95% CI, .80-.97) were excellent. The degree of anterior translation measured in position 1 was significantly greater than in position 2 ( t =4.79, P <.01). CONCLUSIONS: Use of the KT1000 to measure glenohumeral anterior translation in the 2 testing positions appears to be a relatively simple, reliable method. Because testing position 1 allowed significantly greater anterior translation than testing position 2, the 2 positions should not be used interchangeably.

Eccentric Training and Static Stretching Improve Hamstring Flexibility of High School Males.

OBJECTIVE: To determine if the flexibility of high-school-aged males would improve after a 6-week eccentric exercise program. In addition, the changes in hamstring flexibility that occurred after the eccentric program were compared with a 6-week program of static stretching and with a control group (no stretching). DESIGN AND SETTING: We used a test-retest control group design in a laboratory setting. Subjects were assigned randomly to 1 of 3 groups: eccentric training, static stretching, or control. SUBJECTS: A total of 69 subjects, with a mean age of 16.45 +/- 0.96 years and with limited hamstring flexibility (defined as 20 degrees loss of knee extension measured with the thigh held at 90 degrees of hip flexion) were recruited for this study. MEASUREMENTS: Hamstring flexibility was measured using the passive 90/90 test before and after the 6-week program. RESULTS: Differences were significant for test and for the test-by-group interaction. Follow-up analysis indicated significant differences between the control group (gain = 1.67 degrees ) and both the eccentric-training (gain = 12.79 degrees ) and static-stretching (gain = 12.05 degrees ) groups. No difference was found between the eccentric and static-stretching groups. CONCLUSIONS: The gains achieved in range of motion of knee extension (indicating improvement in hamstring flexibility) with eccentric training were equal to those made by statically stretching the hamstring muscles.

Strapped versus unstrapped technique of the prone press-up for measurement of lumbar extension using a tape measure: differences in magnitude and reliability of measurements.

OBJECTIVES: To determine (1) the reliability of the prone press-up to measure lumbar extension using a strap and not using a strap to control pelvic movement in experienced clinicians and students and (2) if a difference exists between the magnitude of lumbar extension range of motion between the strapped and unstrapped condition. DESIGN: Prospective study. SETTING: Academic laboratory. PARTICIPANTS: Convenience sample of 63 unimpaired volunteers (mean age +/- standard deviation, 25.95+/-5.75 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Lumbar extension was measured in the prone position by using a tape measure to measure the perpendicular distance of the sternal notch to the support surface while using a strap and not using a strap to control pelvic movement. All measurements were performed independently by 2 groups of examiners (1 experienced group, 1 student group) and repeated to determine intrarater and interrater reliabilities. RESULTS: Intrarater and interrater reliability were good or excellent for all methods and all measurement group comparisons (intraclass correlation coefficient range, .82-.91). Additionally, the amount of lumbar extension, as measured by the prone press-up, during the strapped condition was significantly greater than with the unstrapped condition. CONCLUSION: Use of a tape measure while the subject performs a prone press-up appears to be a reliable method for the measurement of lumbar extension. This technique is reliable whether the examiner is experienced or inexperienced and whether or not the subject has the pelvis secured with a strap.

Serial casting vs combined intervention with botulinum toxin A and serial casting in the treatment of spastic equinus in children.

PURPOSE: Serial casting has been an effective tool used by physical therapists to increase ankle dorsiflexion range of motion and improve functional gait. The purpose of this retrospective study was to determine whether injection with botulinum toxin type A (BtA) before serial casting vs serial casting alone was associated with any changes in (1) the number of weeks necessary to reach the desired dorsiflexion range of motion and (2) the number of degrees of dorsiflexion range of motion gained per week of casting. METHOD: Data were obtained through review of records maintained on patients undergoing serial casting. Thirty subjects comprised the two groups of 15 patients each. One group had received BtA before serial casting while the other group had received no BtA before serial casting. Data were analyzed using two t tests to determine whether there were significant differences, and the appropriate statistical adjustment (Bonferroni) was applied. RESULTS: Fewer weeks were required to reach the goal of 15 to 20 degrees of ankle dorsiflexion (or plateau) for the group receiving BtA than for the group that did not receive BtA. Results also indicated that the group receiving BtA had a significantly greater increase in range of motion per week than the group that received no BtA. CONCLUSIONS: Using serial casting in conjunction with BtA may achieve range of motion goals in less time than serial casting alone.