Intertester reliability of clinical shoulder instability and laxity tests in subjects with and without self-reported shoulder problems

Abstract

ObjectiveFirst, to investigate the intertester reliability of clinical shoulder instability and laxity tests, and second, to describe the mutual dependency of each test evaluated by each tester for identifying self-reported shoulder instability and laxity.MethodsA standardised protocol for conducting reliability studies was used to test the intertester reliability of the six clinical shoulder instability and laxity tests: apprehension, relocation, surprise, load-and-shift, sulcus sign and Gagey. Cohen’s kappa (κ) with 95% CIs besides prevalence-adjusted and bias-adjusted kappa (PABAK), accounting for insufficient prevalence and bias, were computed to establish the intertester reliability and mutual dependency.ResultsForty individuals (13 with self-reported shoulder instability and laxity-related shoulder problems and 27 normal shoulder individuals) aged 18–60 were included. Fair (relocation), moderate (load-and-shift, sulcus sign) and substantial (apprehension, surprise, Gagey) intertester reliability were observed across tests (κ 0.39–0.73; 95% CI 0.00 to 1.00). PABAK improved reliability across tests, resulting in substantial to almost perfect intertester reliability for the apprehension, surprise, load-and-shift and Gagey tests (κ 0.65–0.90). Mutual dependencies between each test and self-reported shoulder problem showed apprehension, relocation and surprise to be the most often used tests to characterise self-reported shoulder instability and laxity conditions.ConclusionsFour tests (apprehension, surprise, load-and-shift and Gagey) out of six were considered intertester reliable for clinical use, while relocation and sulcus sign tests need further standardisation before acceptable evidence. Furthermore, the validity of the tests for shoulder instability and laxity needs to be studied.

Heavy shoulder strengthening exercise in people with hypermobility spectrum disorder (HSD) and long-lasting shoulder symptoms: a feasibility study

“…The objective measurements (additional file 5 ) included seated maximum isometric voluntary contraction of shoulder scaption in 45°, internal rotation (IR), and external rotation (ER) in neutral with hand-held dynamometry (IsoForce Dynometer EVO2; Medical Device Solutions AG) [ 46 , 48 ]; passive shoulder range of motion using supine ER and IR with the shoulder abducted to 90° and elbow flexed to 90°, measured with a digital inclinometer (Halo, Halo Medical Devices, Subiaco, Australia) [ 46 , 47 ]; and shoulder flexion proprioception (low range 55° ± 10°, mid-range 90° ± 10°, and high range 125° ± 10°) [ 48 ]. Joint mobility and laxity parameters were assessed using load and shift, sulcus sign, Gagey, apprehension, relocation, release [ 49 ], Rotés Qúerol [ 50 ], shoulder total rotation test (positive if sum of IR and ER range of motion > 180°), and the shoulder flexion test [ 51 ].…”

“…proprioception (low range 55°± 10°, mid-range 90°± 10°, and high range 125°± 10°) [48]. Joint mobility and laxity parameters were assessed using load and shift, sulcus sign, Gagey, apprehension, relocation, release [49], Rotés Qúerol [50], shoulder total rotation test (positive if sum of IR and ER range of motion > 180°), and the shoulder flexion test [51].…”

Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study

“…Clinical anterior shoulder instability was evaluated by the three instability and pain-provocative tests of apprehension, relocation and surprise [34], recently shown to be reliable in patients with and without self-reported shoulder instability and laxity [35]. Briefly, patients were placed in supine lying with the shoulder being tested placed close to the edge of the examination table.…”

Competitive swimmers with hypermobility have strength and fatigue deficits in shoulder medial rotation

“…The strengths of the study are the strict inclusion criteria, group similarity in demographics and the standardised procedures in isokinetic and EMG measurements to ensure reliable data Seitz & Uhl, 2012). Also, the standardized procedures used in the selected clinical tests for shoulder instability provide satisfactory reliability (Eshoj et al, 2017). The strict inclusion criteria of healthy swimmers may also be a strength, since it was possible to study the clear effect of GJHS in swimmers without pain interference.…”