This study has identified unique glenohumeral joint rotational patterning in unilaterally dominant upper extremity athletes that has ramifications for rehabilitation after injury and for both injury prevention and performance enhancement.

Study Design: Repeated measures of shoulder flexibility on nonimpaired subjects and intercollegiate baseball pitchers. 0bjectiws:To present a new objective method of measuring posterior shoulder tightness, define the intratester and intertester reliability of the measurement, and assess its construct validity. Background: Posterior shoulder tightness has been linked to anterior humeral head translation and decreased internal rotation. The reliability of an objective assessment of posterior shoulder tightness has yet to be established in the literature. Methods and Measures: Five repeat measurements were made using a standardized protocol on 21 nonimpaired subjects to determine intratester reliability. To determine intertester reliability, 2 testers (blinded to their measurement) each performed 1 measurement on 49 shoulders. Twenty-two intercollegiate baseball pitchers were measured once by 1 tester to evaluate the construct validity of the measurement. Results Measurements of posterior shoulder tightness performed by the same physical therapist had high reliability (KC dominant = 0.92, nondominant = 0.95). lntertester measures revealed good reliability (KC = 0.80). Pitchers had reduced dominant arm internal rotation and increased external rotation ROM compared to their other arm whereas nonimpaired subjects had less reduction in external rotation compared to the nondominant arm (pitchers: dominant, 109.7 2 2.4; nondominant, 98.9" + 1.6"; nonimpaired subjects: dominant, 95.9" 2 1.5", nondominant, 95.2" + 1.6") and internal rotation (pitchers: dominant, 50.0 + 2.O0, nondominant, 69.5 + 2.5" nonimpaired subjects: dominant, 46.4 + 1.3", nondominant, 50.2 t 1 .4"). Pitchers had significantly greater posterior shoulder tightness compared to nonimpaired subjects (pitchers; dominant, 44.9 2 0.8 cm, nondominant, 37.5 + 0.7 cm, nonimpaired subjects; dominant, 32.9 + 0.8 cm, nondominant, 31.4 2 0.8 cm) and manifested a significant correlation between posterior shoulder tightness and internal rotation (r = -0.61) that was not evident in nonimpaired subjects. Conclusiw: Measurement of posterior shoulder tightness using this technique is objective and reliable when done by the same physical therapist. Validity of this measurement is supported from the observation of athletes thought to have tight posterior structures. Further study is needed to determine the relationship of this measurement to patients diagnosed with shoulder impingement syndrome. I Orthop Sports Phys Research has documented that tight capsular and muscular tissues of the shoulder affect normal shoulder range of motion (ROM) . l W . ' 6 2 7~9 0 .~. 9~~i n i c a l l y , much attention has been given to the effect of tight posterior shoulder tissues on normal glenohumeral joint surface motion. Posterior shoulder tightness creates a need for some athletes to stretch the structures in the region of the shoulder. Clinicians, however, have yet to produce a reliable method of measuring posterior shoulder tissue tightness.The structures of the posterior shoulder inc...

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Purpose of Review Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA. Recent Findings In order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). Summary The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual litigation issues. By using a multifactorial FTA, such as the one described, provides quantitative and qualitatively criteria to make an informed decision in the best interests of the athlete.

Context:Functional testing of patients is essential to clinicians because it provides objective data for documentation that can be used for serial reassessment and progression through a rehabilitation program. Furthermore, new tests should require minimal time, space, and money to implement.Purpose:To determine the test-retest reliability of the Closed Kinetic Chain (CKC) Upper Extremity Stability Test.Participants:Twenty-four male college students.Methods:Each subject was tested initially and again 7 days later. Each subject performed 1 submaximal test followed by 3 maximal efforts. A 45-second rest was given after each 15-second test. The 2 maximal-test scores were averaged and compared with those from the retest.Results:The intraclass correlation coefficient was .922 for test-retest reliability. A paired-samplesttest (.927) was conducted, and the coefficient of stability was .859. The results indicate that the CKC Upper Extremity Stability Test is a reliable evaluation tool.

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T he shoulder joint complex has been described as comprising four distinct anatomical articulations (glenohumeral, sternoclavicular, acromioclavicular, and scapulothoracic) and two physiological joints (scapulothoracic and suprahumeral o r subacromial) (1 O,45). These joints are finely controlled by muscular attachments and proprioceptors found within the joint capsule and musculotendinous unit. Coordinated function of these joints is essential for athletic function. Without appropriate neuromuscular control, the shoulder can become dysfunctional. T h e end result will be poor athletic performance and ultimate clinical svmptomatology.Shutte and Happel (68) have stated that alterations in joint innervation caused by athletic trauma can occur and markedly affect joint function. Shoulder joint kinesthesia can be adversely affected as a result of athletic trauma and lead to a variety of clinical entities that are commonlyThe shoulder complex plays an integral role in performing an athletic skill involving the upper extremity. The intricacy of the neuromotor components controlling shoulder motion and athletic skill is an issue that the sports physical therapist deals with on a daily basis when rehabilitating athletic patients. The purpose of this article is to review neuromotor control of the shoulder complex and describe an exercise routine developed to enhance proprioception, kinesthesia, and neuromuscular control. Clinical research studies examining the strength of the rotator cuff and scapular stabilizers, in addition to joint position sense, are reviewed. The results of these studies are discussed as they apply to the exercises described in the article designed to improve dynamic stability. The results of these studies and implementation of these exercises will help the sports physical therapy clinician assist the athletic patient and improve dynamic and neuromotor control of the shoulder.

The purpose of this study was to examine the test-retest reliability, minimal detectable change (MDC), and determine normative values of 3 upper extremity (UE) tests of function and power. One hundred eighty participants, men (n = 69) and women (n = 111), were tested on 3 UE strength and power maneuvers in a multicenter study to determine baseline normative values. Forty-six subjects returned for a second day of testing within 5 days of the initial assessment for the reliability component of the investigation. Explosive power was assessed via a seated shot-put test for the dominant and nondominant arms. Relationships between the dominant and nondominant arms were also analyzed. A push-up and modified pull-up were performed to measure the amount of work performed in short (15-second) bursts of activity. The relationship between the push-up and modified pull-up was also determined. Analysis showed test-retest reliability for the modified pull-up, timed push-up, dominant single-arm seated shot-put tests, and nondominant single-arm seated shot-put tests to be intraclass correlation coefficient(3,1) 0.958, 0.989, 0.988, and 0.971, respectively. The MDC for both the push-up and modified pull-up was 2 repetitions. The MDCs for the shot put with the dominant arm and the nondominant arm were 17 and 18 in., respectively. The result of this study indicates that these field tests possess excellent reliability. Normative values have been identified, which require further validation. These tests demonstrate a practical and effective method to measure upper extremity functional power.