Shoulder pain is a very common musculoskeletal complaint, and individuals with shoulder pain comprise a significant percentage of patients seeking medical attention. Lifetime prevalence of shoulder pain has been reported to range from 7% to 36% of the population.11,13 Rotator cuff pathology and subacromial impingement are among the most common diagnoses made in the shoulder region.

he use of isokinetic dynamometers to analyze the strength of the shoulder rotator cuff muscles in overhead athletes has provided valuable information for the evaluation, rehabilitation, and conditioning of these athletes. Numerous test positions and speeds of testing have been described to improve sports specificity and identify test p e sitions which best measure strength for each muscular activity (1,(3)(4)(5)(6)8,9, 16,18,20). The greatest values for lateral rotator strength have been reported with testing in the scapular plane or 90" of forward flexion (8), while testing in the neutral position has produced the greatest values for the medial rotators (l6,18). Testing in the seated position, with the shoulder abducted to 90" and the elbow flexed to 90" (parallel to the horizontal plane), has been recommended because the subject is easily stabilized, and this position closely a p proximates the position of the arm during the late cocking phase of throwing. However, this position may produce symptoms in some patients, limiting maximal effort and affecting test results. For this reason, some evaluators have recommended alternate test positions (3).Most studies have focused on the concentric strength of the shoulder

Context: Little is known about the relationship among sex, generalized joint hypermobility, and glenohumeral joint instability.Objective: To examine the relationship among sex, generalized joint hypermobility scores, and a history of glenohumeral joint instability within a young, physically active cohort and to describe the incidence of generalized joint hypermobility within this population.Design: Cross-sectional cohort study. Setting: United States Military Academy at West Point, New York.Patients or Other Participants: Of the 1311 members of the entering freshman class of 2010, 1050 (80%) agreed to participate.Main Outcome Measure(s): Generalized joint hypermobility was assessed using the Beighton Scale. A history of glenohumeral joint instability was identified via a baseline questionnaire.Results: Most participants (78%) had no signs of generalized joint hypermobility. Only 11 volunteers (1.5%) had Beighton Scale scores of 4 or greater. Logistic regression analysis revealed a relationship between generalized joint hypermobility and a history of glenohumeral joint instability (P 5 .023). When sex and race were controlled, those with a total Beighton Scale score of $2 were nearly 2.5 times as likely (odds ratio 5 2.48, 95% confidence interval 5 1.19, 5.20, P 5 .016) to have reported a history of glenohumeral joint instability. A relationship was observed between sex and nearly all individual Beighton Scale items. Although women had higher total Beighton Scale scores than men, sex (P 5 .658) and race (P 5 .410) were not related to a history of glenohumeral joint instability when other variables in the model were controlled.Conclusions: In these participants, generalized joint hypermobility and a history of glenohumeral joint instability were associated.Key Words: military athletes, sex differences, joint injuries, shoulder injuries Key PointsN When the influences of sex and race were controlled, a relationship was observed between generalized joint hypermobility and a history of glenohumeral joint instability.N Participants with a history of glenohumeral joint instability had higher total Beighton Scale scores than did participants with no such history. N Participants with a Beighton Scale score of 2 or greater were nearly 2.5 times more likely to have experienced an episode of glenohumeral joint instability than were participants with lower scores when sex and race were held constant.

Hamstring and patellar tendon autografts provide similar objective, subjective, and functional outcomes when assessed at least 2 years after anterior cruciate ligament reconstruction.

Abstract-This study examined the convergent construct validity of a new performance-based assessment instrument called the Comprehensive High-Level Activity Mobility Predictor (CHAMP) as a measure of high-level mobility in servicemembers (SMs) with traumatic lower-limb loss (LLL). The study was completed by 118 SMs. Convergent construct validity of the CHAMP was established using the 6-minute walk test (6MWT) as a measure of overall mobility and physical function and the Amputee Mobility Predictor (AMP) as a measure of basic prosthetic mobility. The known group methods construct validity examined disparities in high-level mobility capability among SMs with different levels of LLL. The CHAMP score demonstrated a strong positive relationship between 6MWT distance (r = 0.80, p < 0.001) and AMP score (r = 0.87, p < 0.001), respectively. In addition, the CHAMP can discriminate between different levels of LLL. Study findings support the CHAMP as a valid performance-based assessment instrument of high-level mobility for SMs with traumatic LLL.

No abstract

Objectives-Foot and leg muscle strength and size are crucial to proper function. It is important to assess these characteristics reliably. Our primary objective was to compare the measurement of still images to cine loops. The secondary purpose was to determine interoperator and intraoperator reliability between operators of different experience levels using video clips and internal and external landmarks.Methods-Twelve healthy volunteers participated in our study. Internal (navicular tuberosity) and external (lateral leg length at 30% and 50% from the knee joint line) landmarks were used. Two operators each captured and later measured still and cine loop images of selected foot and leg muscles.Results-The 12 participants included 8 male and 4 female volunteers (mean age AE SD, 23.5 AE 1.9 years). Good to excellent intraoperator and interoperator reliability was seen (intraclass correlation coefficient range of 0.946-0.998). The use of cine loops improved the intraclass correlation coefficients for both intraoperator and interoperator reliability (0.5%-4% increases). The use of cine loops decreased the intraoperator standard error of the measurement and limits of agreement of the novice operator (decreases of 45%-73% and 24%-51%, respectively), and these became comparable to those of experienced operators using still images. The interoperator standard errors of the measurement dropped by 42% to 53%, whereas the limits of agreement dropped by 27% to 40%. No substantial changes were noted in the tibialis anterior across reliability metrics.Conclusions-Improved protocols that take advantage of using internal bony landmarks and cine loops during both the image-gathering and measurement processes improve the reliability of research examining muscle size changes in the lower leg or foot associated with muscle changes due to exercise, injury, disuse, or disease.

No abstract