Reliability of visual inspection and palpation to assess relative flexibility of the shoulder

INTRODUCTION

Movement compensations during internal rotation of the shoulder can provoke pain. Reliably observing and measuring compensations in the shoulder using visual and palpatory methods can result in more efficacious treatments of shoulder pathology. Despite this, the reliability of these measures and the relationship between them is unknown.

METHODS

Bilateral shoulders of 33 Doctor of Physical Therapy (DPT) students were measured. Two third-year DPT student examiners used visual inspection and physical palpation to identify the first signs of internal rotation (IR) passive stiffness. Measurements were taken and recorded by a third examiner using the GetMyROM (Version 1.1) iPhone application.

RESULTS

Good intra-rater reliability for both examiners was identified for physical palpation (ICC = 0.896, 95% CI = 0.830, 0.936, ICC = 0.901, 95% CI = 0.839, 0.939) and visual inspection (ICC = 0.813, 95% CI = 0.699, 0.884, ICC = 0.782, 95% CI = 0.667, 0.880). Moderate interrater reliability was found between the examiners for physical palpation (ICC = 0.681, 95% CI = 0.479, 0.797) while poor interrater reliability was found between examiners for visual inspection (ICC = 0.481, 95% CI = 0.234, 0.648). The correlation between physical palpation and visual inspection indicated moderate reliability for both examiners (r = 0.815, p = 0.01, r = 0.832, p = 0.01).

CONCLUSION

The findings of this research study indicate that both physical palpation and visual inspection are reliable methods for measuring relative flexibility of shoulder IR when performed by the same examiner. However, the reliability for both methods decreases when performed by different examiners. Additionally, a strong correlation was found between both measures.