An assessment of the interexaminer reliability of tests for shoulder instability

doi:10.1016/j.jse.2003.09.002

Journal of Shoulder and Elbow Surgery

Volume 13, Issue 1, January–February 2004, Pages 18-23

https://doi.org/10.1016/j.jse.2003.09.002 Get rights and content

Abstract

Accurate noninvasive clinical tests of shoulder instability are important in assessing and planning treatment for glenohumeral joint instability. An interexaminer agreement trial was undertaken to estimate the reliability of commonly used clinical tests for shoulder instability. Thirteen patients with a history suggestive of instability, who had been referred to a shoulder specialist for treatment of their symptomatic shoulders, were examined by four examiners of differing experience. Good to excellent interexaminer agreement was found for most variations of the load-and-shift test, with the best agreement in the 90° abducted position for the anterior direction (intraclass correlation coefficient [ICC] = 0.72) and in the 0° abducted position for the posterior (ICC = 0.68) and inferior (ICC = 0.79) directions. Fair to good interexaminer reliability was found for the sulcus sign (ICC = 0.60). With regard to the provocative tests, agreement was best when apprehension was used as the criterion for a positive test and was better for the relocation (ICC = 0.71) and release tests (ICC = 0.63) than for the apprehension (ICC = 0.47) and augmentations tests (ICC = 0.48). Reliability was poor (ICC < 0.31) when pain was used as the criterion for a positive test. These results indicate that the load-and-shift, sulcus, and provocative tests (apprehension, augmentation, relocation, and release) are reliable clinical tests for instability in symptomatic patients when care is taken with respect to arm positioning and if apprehension is used as the criterion for a positive provocative test.

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.

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Original articleAn assessment of the interexaminer reliability of tests for shoulder instability☆

Abstract

Section snippets

Materials and methods

Load-and-shift test

Discussion

Acknowledgements

Clin Sports Med

Shoulder instability and impingement in throwing athletes

Med Sci Sports Exerc

Reliability of five methods for assessing shoulder range of motion

Aust J Physiother

Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement

Orthop Rev

The diagnosis and treatment of anterior instability in the throwing athlete

Clin Orthop

Intra- and interobserver reproducibility of the shoulder laxity examination

Am J Sports Med

Mechanics of glenohumeral instability

Clin Sports Med

Original article
An assessment of the interexaminer reliability of tests for shoulder instability☆