Feuerherd Rebecca, Sutherlin Mark A, Hart Joseph M, Saliba Susan A
Active Edge Wellness Center, West Linn, OR.
University of Virginia, Charlottesville, VA.
Int J Sports Phys Ther. 2014 Dec;9(7):938-47.
PURPOSE/BACKGROUND: Differences in humeral torsion have been observed between overhead athletes and non-athletes. Although humeral torsion may be an adaptive process for athletic performance, it may be associated with injury. Methods for measuring humeral torsion have consisted of radiography, computer tomography, and ultrasound imaging. However, diagnostic imaging may be costly and not available to all clinicians. The implementation of clinical assessments may be an alternative way to measure humeral torsion. Before clinical measures can be recommended, these assessments need to be evaluated for validity and reliability of each test. The purpose of this study was to assess the intratester and intertester reliability of three clinical tests, intratester reliability of ultrasound measures, and the validity of each clinical test to ultrasound measures.
Thirty participants (male: 12, female: 18; age: 20±2 years; height: 174.24±9.35 cm; mass: 70.53±11.06 kg; body mass index: 23.13±2.47 kg/m(2); years in sport: 9±4 years) with experience in overhead sports were assessed for humeral torsion, bilaterally. Humeral torsion was assessed using musculoskeletal ultrasound by a single assessor, and using three separate clinical assessments by two independent assessors. Clinical assessments included the angle of rotation during both the bicipital tuberosity palpation with the shoulder abducted at 90 degrees (Palp90) or 45 degrees (Palp45), and the angle of external rotation during horizontal adduction (HADD).
Intratester reliability for the ultrasound measure was good (ICC=0.907), along with intratester reliability for both assessors across each clinical assessment (ICC's > 0.769). Poor to moderate reliability was observed between assessors for each clinical assessment (ICC=0.256 Palp90, ICC=0.419 Palp45, ICC=0.243 HADD. Only the Palp90 measure had a fair but significant (r=0.326, p=0.011) relationship with ultrasound measures.
Individual assessors can achieve reliable ultrasound, bicipital tuberosity palpation and HADD values across multiple trials; however, these measures are not consistent between assessors. Additionally, only one clinical test had a fair but significant relationship with ultrasound measures. Improved testing procedures may be needed to increase between assessor reliability and strength of relationships to ultrasound measures. Current application of clinical assessments to measure humeral torsion is limited.
3b; Grade of Recommendation C.
目的/背景：已观察到上肢运动运动员与非运动员之间肱骨扭转存在差异。尽管肱骨扭转可能是运动表现的一种适应性过程，但它可能与损伤有关。测量肱骨扭转的方法包括放射摄影、计算机断层扫描和超声成像。然而，诊断成像可能成本高昂，并非所有临床医生都能使用。临床评估的实施可能是测量肱骨扭转的另一种方法。在推荐临床测量方法之前，需要评估这些评估方法中每项测试的有效性和可靠性。本研究的目的是评估三项临床测试的测试者内和测试者间可靠性、超声测量的测试者内可靠性以及每项临床测试与超声测量的有效性。
对30名有上肢运动经验的参与者（男性12名，女性18名；年龄：20±2岁；身高：174.24±9.35厘米；体重：70.53±11.06千克；体重指数：23.13±2.47千克/平方米；运动年限：9±4年）进行双侧肱骨扭转评估。由一名评估者使用肌肉骨骼超声评估肱骨扭转，并由两名独立评估者使用三种不同的临床评估方法进行评估。临床评估包括在肩部外展90度（Palp90）或45度（Palp45）时触摸肱二头肌结节期间的旋转角度，以及水平内收期间的外旋角度（HADD）。
超声测量的测试者内可靠性良好（ICC = 0.907），两名评估者在每项临床评估中的测试者内可靠性也良好（ICC > 0.769）。在每项临床评估中，评估者之间观察到的可靠性从差到中等（Palp90的ICC = 0.256，Palp45的ICC = 0.419，HADD的ICC = 0.243）。只有Palp90测量与超声测量有中等但显著（r = 0.326，p = 0.011）的关系。
个体评估者在多次试验中可以获得可靠的超声、肱二头肌结节触诊和HADD值；然而，这些测量在评估者之间并不一致。此外，只有一项临床测试与超声测量有中等但显著的关系。可能需要改进测试程序，以提高评估者之间的可靠性以及与超声测量关系的强度。目前临床评估在测量肱骨扭转方面的应用有限。
3b；推荐等级C。
