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Ten subjects were assessed by 11 examiners (three physical therapy students, three physical therapists experienced in rehabilitation, and five physical therapists experienced in orthopedics) to determine intrarater and interrater agreement for an assessment procedure involving palpation and observation of iliac crest heights. The results of two separate trials in a single session showed that both groups of experienced physical therapists had slightly higher intrarater and interrater agreement than student physical therapists. Findings suggest that a need exists to improve the reliability of this commonly used physical therapy assessment procedure.

Increased pressure in the carpal tunnel has been identified as one possible cause of the pain and paresthesias associated with carpal tunnel Syndrome,l,6, 11.19.21 Surgical transection of the flexor retinaculum is the primary method of relieving the pressure in the tunnel after conservative measures of rest and immobilization of the wrist have failed.g, lO, 16.22 There has been no direct suggestion that noninvasive procedures might affect the flexor retinaculum; however, Caillet4 mentions that tensing the flexor carpi ulnaris can tense or relax the flexor retinaculum via their common attachment to the pisiform bone. Nonsurgical modification of the flexor retinaculum may be possible via its medial-proximal attachment to the pisiform bone.24 The flexor retinaculum has three other bony attachments: the hamate, the scaphoid, and the trape~ium.'~ The pisiform however is the most mobile, although the amounts of active and passive movements are nowhere recorded in medical literature.18 The pisiform is in the most favorable position4 to modify the tension on the retinaculum for several reasons. First, the pisiform is attached to the proximal, thinner bandz2 of the * Ms. Engles completed this study in partial fulfillment of the requirements for the degree of Master of Science in Orthopaedic Physical Therapy at the lnstitute of Graduate Health Sciences, Atlanta, GA. Ms. Engles is currently in private practice in San Diego, CA. retinaculum which could be more easily stretched, tensed, or relaxed than the thicker, distal band. Second, the pisiform is mobile in medial and lateral directions in parallel with the retinac~lum.~ Further, in studies of the pressure in the carpal tunnel with wrist movement, Tanzer" and Smith et a1.20 both reported that pressure elevations were greatest in the proximal portion of the carpal tunnel.The purpose of this study was to determine if a medial or lateral position of the pisiform bone could affect the pressure in the carpal tunnel. If either position decreased the pressure, then positioning .or moving the pisiform bone in the direction of the decrease (as in joint mobilization of the pisiform described by Kaltenborn8 and Parisq5) might be a useful addition to the conservative treatment of carpal tunnel syndrome. METHODFour cadaveric subjects (three males, one female) were obtained at a medical center in the Southwest within 24-48 hours postmortem. Subjects were maintained in a chilled room at 10°C until testing.23 Ages of the subjects were 55, 62, 67, and 74 years. The criteria for admission to the study were: no evidence of surgery or trauma to the volar hand or forearm and range of motion of the wrist of at least 50" flexion, 60" extension, 20" ulnar deviation, and 10" radial deviation." The forearm of each subject, randomly ordered, was positioned on a stabilizing 47