Reliability of Clinical Assessment Methods to Measure Scapular Upward Rotation: A Critically Appraised Topic

Abstract

Clinical Scenario: Assessing movement of the scapula is an important component in the evaluation and treatment of the shoulder complex. Currently, gold-standard methods to quantify scapular movement include invasive technique, radiation, and 3D motion systems. This critically appraised topic focuses on several clinical assessment methods of quantifying scapular upward rotation with respect to their reliability and clinical utility. Clinical Question: Is there evidence for noninvasive methods that reliably assess clinical measures of scapular upward rotation in subjects with or without shoulder pathologies? Summary of Key Findings: Four studies were selected to be critically appraised. The quality appraisal of diagnostic reliability checklist was used to score the articles on methodology and consistency. Three of the 4 studies demonstrated support for the clinical question. Clinical Bottom Line: There is moderate evidence to support reliable clinical methods for measuring scapular upward rotation in subjects with or without shoulder pathology. Strength of Recommendation: There is moderate evidence to suggest there are reliable clinical measures to quantify scapular upward rotation in patients with or without shoulder pathology. Keywords: scapula, CAT, clinical assessment Clinical ScenarioQuantifying movement of the scapula is an important component in the evaluation and treatment of the shoulder complex due to its role in scapulohumeral rhythm during overhead motion. 1-3 Scapular upward rotation has been identified to be an essential component of glenohumeral elevation. 4 Restrictions in the scapular upward rotation have been linked to pathologies such as impingement, instability, and tendinopathies. 4,5 Challenges clinicians face when measuring scapular motion include the deep position of the scapula under the overlaying musculature and soft tissue, and along with its multidirectional axis of rotation. 1,6,7 To accurately quantify scapular movement, fluoroscopy, and intracortical pinning have been utilized as the gold-standard methods of scapular assessment. 8,9 However, due to the obstacles behind radiography and 3D instrumentation, such as radiation, invasive technique, cost for equipment, and time investment, it has become apparent that there is a clinical need for a reliable and valid noninvasive method to measure scapular kinematics. 10,11 In the literature, different assessment methods have been reported, focusing on the reliability of each respective method. In this critically appraisal topic (CAT), several methods of quantifying scapular kinematics are appraised for their respective reliability and clinical utility of each method designed to measure scapular upward rotation. Focused Clinical QuestionIs there evidence for noninvasive methods that reliably assess clinical measures of scapular upward rotation in subjects with or without shoulder pathologies? Summary of Search• The initial literature search using the Boolean Operators:Term (TX) scapular rotation, OR TX scapular motion, AND TX upward rotation...

Reliability and Validity of a Clinical Assessment Tool for Measuring Scapular Motion in All 3 Anatomical Planes

“…15 These findings, supported by subsequent studies, serves as grounds to demonstrate the use of gravity-referenced digital inclinometers as reliable and valid for measuring scapular motion in the frontal and sagittal planes. 13,14,[16][17][18][19] While a digital inclinometer is a non-invasive and portable clinical assessment tool to objectively measure scapular motion in the frontal and sagittal plane, it is not capable of measuring the scapular motions of internal and external rotation in the transverse plane due to their reliance on gravity-referenced sensors. However, new advancements in the development of a novel electric goniometer, equipped with an inertial measurement unit (IMU), affords the ability to clinically measure scapular motion in the transverse plane.…”