Dr Sarah Walmsley

Objective The purpose of this study was to determine the intrarater reliability and reproducibility of a standardized procedure for measuring passive shoulder movement in asymptomatic individuals. Methods A single assessor used a digital inclinometer and standardized protocol to measure the passive range of motion of 7 shoulder movements in 168 asymptomatic shoulders. Following a warm-up maneuver, 3 measurements were taken for each movement on 2 occasions. Both shoulders were measured using a standardized order of movement. Selection of measurement beginning with left or right shoulder was randomly determined. The entire process was repeated 7 days later to assess reproducibility. Intraclass correlation coefficients (ICCs) with 95% confidence intervals and standard errors of measurement (SEMs) were calculated to assess the intrarater reliability of the methods. Results The intrarater reliability of our methods was substantial for total shoulder flexion (ICC = 0.82, SEM = 12.3°), whereas all other movements demonstrated moderate reliability (ICC range = 0.64-0.75) except external rotation in neutral abduction, for which reliability was classed as slight (ICC = 0.28, SEM = 31°). Moderate reliability was evident for all movements on follow-up at 7 days (ICC range = 0.60-0.77). Conclusions These methods of measurement have moderate to substantial reliability for the majority of tested passive shoulder movements, with moderate reliability sustained after 1 week, in a large sample of asymptomatic individuals.

Background. Adhesive capsulitis is often difficult to diagnose in its early stage and to differentiate from other common shoulder disorders. Objective. The aim of this study was to validate any or all of the 8 clinical identifiers of early-stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study. Design. This was a cross-sectional study. Methods. Sixty-four patients diagnosed with early-stage adhesive capsulitis by a physical therapist or medical practitioner were included in the study. Eight active and 8 passive shoulder movements and visual analog scale pain scores for each movement were recorded prior to and immediately following an intra-articular injection of corticosteroid and local anesthetic. Using the local anesthetic as the reference standard, pain relief of >70% for passive external rotation was deemed a positive anesthetic response (PAR). Results. Sixteen participants (25%) demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (odds ratio [OR] =0.26, P=.03), pain at the end of range of all measured active movements (OR=0.06, P=.02), and global loss of passive glenohumeral movements (OR=0.23, P=.02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR. Limitations. The lack of a recognized reference standard for diagnosing early-stage adhesive capsulitis remains problematic in all related research. Conclusions. None of the clinical identifiers for early-stage adhesive capsulitis previously proposed by expert consensus have been validated in this study. Clinicians should be aware that commonly used clinical identifiers may not be applicable to this stage. © 2014 American Physical Therapy Association.

Objectives: To evaluate patients clinically diagnosed with early stage primary/idiopathic adhesive capsulitis to determine the existence of any pattern of movement loss and associated pain that may facilitate early recognition. Design: Cross-sectional study. Setting: Private upper limb specialty clinic, Newcastle, Australia. Participants: Fifty-two patients clinically diagnosed with early stage adhesive capsulitis by a medical practitioner or physiotherapist. Main outcome measures: Percentage loss of active and passive ranges of eight shoulder movements and the pain level at the end of each movement. The reason for limitation of movement was also recorded. Results: Factor analysis clearly identified two groups for percentage loss of active range of movement. Notably external rotation movements grouped separately from other movements. A single group emerged for percentage loss of passive range of movement suggesting a non-specific global loss. For both pain at the end of active range of movement and passive range of movement two groups emerged, however the delineation between the groups was less clear than for percentage loss of active range of movement suggesting a pattern of end range pain may be less useful in identifying patients in this stage. Conclusions: External rotation movements in neutral and abduction generally group together and behave differently to other shoulder movements in patients clinically diagnosed with early stage primary/idiopathic adhesive capsulitis. In particular external rotation in abduction has emerged as the most painfully limited movement in this sample. This study provides preliminary evidence of patterns of range of movement and end range pain that require testing in a population of mixed shoulder diagnoses to determine their diagnostic utility for early stage adhesive capsulitis.

Objective The purpose of this exploratory study was to determine if increased vascularity in the rotator interval area of the glenohumeral joint capsule could be visualized with power Doppler ultrasonography (PDUS) in patients with a clinical diagnosis of early-stage adhesive capsulitis. Methods Demographic and clinical characteristics from a consecutive series of 41 patients diagnosed with early-stage adhesive capsulitis were recorded and examination with PDUS was undertaken. Images were reviewed by 3 musculoskeletal radiologists, and consensus was determined on the presence of increased signal in the rotator interval area. Results Consensus was achieved on the presence of increased signal in 12 (29%) of the 41 cases. Participants with an increased PDUS signal did not demonstrate a characteristic set of identifying features, suggesting that those with increased vascularity may not constitute a distinct subgroup. Conclusion This study found that some patients diagnosed with early-stage adhesive capsulitis demonstrated increased vascularity in the rotator interval area when examined with PDUS. These findings suggest that PDUS may have the potential to assist in the identification of increased vascularization in early stages of this disorder. Further research in the use of PDUS in diagnosing early-stage adhesive capsulitis is warranted. © 2013 National University of Health Sciences.