Yaari Lee S, Mullaney Michael J, Fukunaga Takumi, Thein Ran, McHugh Malachy P, Nicholas Stephen J
Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA.
Int J Sports Phys Ther. 2020 Dec;15(6):1073-1079. doi: 10.26603/ijspt20201073.
BACKGROUND/PURPOSE: Greater humeral retroversion has been associated with shoulder and elbow injuries. Methods for measuring torsion include radiography, computed tomography (CT) and sonography (US) which may be costly or unavailable. A palpation method might be a reliable alternative to imaging techniques. The purpose of the current study was to examine the construct validity of the palpation technique for humeral torsion by (1) determining if a side-to-side difference in humeral torsion (HT) could be detected in a cohort of baseball pitchers using the palpation technique and (2) compare the side-to-side difference in HT obtained through the palpation method to the US method.
Clinical assessment of HT by palpation is reliable and is as accurate as sonographic HT measurements among overhead athletes.
Twenty collegiate and high school pitchers were assessed. Bilateral shoulder passive external rotation (ER) and internal rotation (IR) range of motion were measured. Humeral torsion was indirectly measured using sonographic and palpatory methods. Paired t-tests were used to determine HT side-to-side difference measured by US versus palpation. Pearson's correlation coefficient (r) was used to determine the relationship between HT side-to-side difference detected by palpation and US, and relationships among IR and ER of the shoulder and HT side to-side difference measurements.
There was significantly greater HT in dominant versus nondominant arm assessed by both palpation (5°±5, p=0.0004) and ultrasound (9°±11, p=0.0007). There was a positive correlation between both methods of HT measurement (r = 0.522, p=0.018). Palpation significantly underestimated HT as compared to US measurements (difference 4°±9, p=0.048). Difference in IR between shoulders correlated with HT measured by palpation (r=-0.651, p=0.002) and US (r=0.569, p=0.009). Increased ER in the dominant versus nondominant arm correlated with the side-to-side difference in HT measured by both palpation (r = 0.509, p=0.02) and US (r = 0.602, p=0.005).
Greater HT on the dominant versus nondominant shoulder via palpation indicated this method can be used to assess HT in pitchers. HT assessed by palpation correlated with HT assessed by US. However, the magnitude of side-to-side difference in HT was smaller with palpation compared to US, and the two techniques should not be used interchangeably. Nevertheless, assessment of HT via palpation is a reliable and practical method and its use should be encouraged.
Level 3, measurement study.
背景/目的：肱骨后倾增加与肩部和肘部损伤有关。测量扭转的方法包括放射摄影、计算机断层扫描（CT）和超声检查（US），这些方法可能成本高昂或无法使用。触诊方法可能是成像技术的可靠替代方法。本研究的目的是通过以下方式检验肱骨扭转触诊技术的结构效度：（1）确定使用触诊技术能否在一组棒球投手中检测到肱骨扭转（HT）的左右差异；（2）将通过触诊方法获得的HT左右差异与US方法进行比较。
通过触诊对HT进行临床评估是可靠的，并且在过头运动运动员中与超声HT测量一样准确。
对20名大学和高中投手进行评估。测量双侧肩部被动外旋（ER）和内旋（IR）活动范围。使用超声和触诊方法间接测量肱骨扭转。配对t检验用于确定通过US与触诊测量的HT左右差异。Pearson相关系数（r）用于确定触诊和US检测到的HT左右差异之间的关系，以及肩部IR和ER与HT左右差异测量之间的关系。
通过触诊（5°±5，p = 0.0004）和超声（9°±11，p = 0.0007）评估，优势臂的HT均显著大于非优势臂。两种HT测量方法之间存在正相关（r = 0.522，p = 0.018）。与US测量相比，触诊显著低估了HT（差异4°±9，p = 0.048）。肩部之间IR的差异与通过触诊（r = -0.651，p = 0.002）和US（r = 0.569，p = 0.009）测量的HT相关。优势臂与非优势臂ER的增加与通过触诊（r = 0.509，p = 0.02）和US（r = 0.602，p = 0.005）测量的HT左右差异相关。
通过触诊发现优势肩与非优势肩的HT更大，表明该方法可用于评估投手中的HT。通过触诊评估的HT与通过US评估的HT相关。然而，与US相比，触诊时HT的左右差异幅度较小，这两种技术不应互换使用。尽管如此，通过触诊评估HT是一种可靠且实用的方法，应鼓励使用。
3级，测量研究。
