Original articleAn assessment of the interexaminer reliability of tests for shoulder instability☆
Section snippets
Materials and methods
The subjects included in this study were (1) patients whose shoulder was sufficiently symptomatic to warrant referral to an orthopaedic shoulder specialist and (2) those whose history was suggestive of or suspicious for glenohumeral joint instability. Patients were excluded if (1) there was a history of previous surgery or (2) they had significant loss of glenohumeral joint motion (ie, they had less than 30° external rotation, less than 90° forward flexion, or less than 90° abduction or could
Load-and-shift test
More translation in the anterior direction was found when the shoulder was abducted 20° and 90° than when tested in 0° abduction and with the patient sitting. The greatest agreement among examiners was obtained when the shoulder was abducted 90° (ICC = 0.72) (Table I).
Far less translation was noted by all examiners when the humeral head was translated posteriorly than when translated anteriorly. Most translation was noted with the arm at 0° and 90°. All examiners graded the translation as 0
Discussion
The major conclusion of this study was that, in this population of patients with a symptomatic shoulder and histories consistent with or suspicious for glenohumeral joint instability, fair to excellent interexaminer reliability was obtained; however, arm position in the load-and-shift tests and the criteria for a positive provocative test were important.
The load-and-shift tests were more reliable with the patient in the supine position rather than sitting upright. In the anterior direction, the
Acknowledgements
We are grateful to the patients who took part in this study.
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Funded by the St George Hospital/South Eastern Sydney Area Health Service.