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Pain Physician. 2011 Nov;14(6):531-7.

Ultrasound-guided interventional release of rotator interval
and posteroinferior capsule for adhesive capsulitis of
the shoulderusing a specially designed needle.
Ahn K, Jhun HJ, Choi KM, Lee YS.
Source
Chronic Pain Management Center, Cha Biomedical Center, Kangnam Cha Hospital, Cha
University, Seoul, and Center for Interventional Pain Management, Daejeon Woori Hospital,
Daejeon, Republic of Korea.
Abstract
BACKGROUND:
Adhesive capsulitis is a common but poorly understood disorder of the shoulder. Various treatments have been developed to manage this condition, but the efficacy of these treatments
is controversial. We developed an ultrasound-guided, minimally invasive interventional technique to manage adhesive capsulitis of the shoulderusing a specially designed needle.
OBJECTIVE:
To describe the methodological approach of our intervention.
STUDY DESIGN:
Technical report.
SETTING:
Pain management clinic.
METHODS:
Thirteen participants with adhesive capsulitis of the shoulder underwent ultrasound-guided interventional release of the rotator interval and posteroinferior capsule using a specially
designed curved Round Needle. A convex ultrasound probe was placed along the oblique coronal plane over the supraspinatus muscle and acromion. Under ultrasonographic guidance,
the needle was passed through the supraspinatus muscle and superior labrum and reached the rotator interval. It was moved forward and backward until no resistance was felt. After
finishing the rotator interval release, the needle was inserted toward the posteroinferior capsule. While the operator released the adhesion in the posteroinferior capsule by moving the
needle forward and backward, an assistant gradually abducted the shoulder. When full abduction of the affected shoulder was achieved, the intervention was completed.
RESULTS:
Following our intervention, significant improvements in pain levels, glenohumeral range of motion, and Quick Disability of the Arm, Shoulder, and Hand scores were attained at follow-
up.
LIMITATIONS:
Technical report only. Efficacy of this technique is beyond the scope of the article.
CONCLUSION:
Ultrasound-guided interventional release of the rotator interval and posteroinferior capsule appears to have clinical significance in the management of adhesivecapsulitis of the shoulder.
PMID:

22086094

[PubMed - in process]
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BMC Musculoskelet Disord. 2008 Jan 29;9:12.
Interventional microadhesiolysis: a new nonsurgical
release technique for adhesive capsulitis of the shoulder.
Ahn K, Lee YJ, Kim EH, Yang SM, Lim TK, Kim YS, Jhun HJ.
Source
Department of Occupational and Environmental Medicine, College of Medicine, Korea
University, Ansan, Republic of Korea. kangahn2003@yahoo.com
Abstract
BACKGROUND:
A nonsurgical intervention, interventional microadhesiolysis, was developed to release adhesions in joints and soft tissues. This paper introduces the procedure and evaluates the
efficacy of the intervention for adhesive capsulitis of the shoulder.
METHODS:
Ten patients (five men and five women) with primary adhesive capsulitis of the shoulder were treated at a chronic pain management center in Korea. Three specially made needles are
used in interventional microadhesiolysis: the Round, Flexed Round, and Ahn's needles. A Round Needle is inserted on the skin over middle of supraspinatus and advanced under the
acromion and acromioclavicular joint (subacromial release). A Flexed Round Needle is inserted two-fingers caudal to the inferior border of the scapular spine and advanced over the
capsule sliding on the surface of infraspinatus muscle-tendon fascia. The capsule is released while an assistant simultaneously passively abducts the shoulder to full abduction
(posteroinferior capsule release). An Ahn's Needle is inserted on the skin over the lesser tubercle and advanced under the coracoid process sliding on the surface of the subscapularis
muscle (subcoracoid release).
RESULTS:
After the patients underwent interventional microadhesiolysis, the self-rated pain score or severity declined significantly (p < .01), the shoulder range of motion increased significantly (p <
.01), and joint effusion in the affected shoulder decreased or disappeared in nine of ten patients on magnetic resonance imaging compared to their initial status.
CONCLUSION:
Our findings suggest that interventional microadhesiolysis is effective for managing adhesive capsulitis of the shoulder.
PMID:

18230127

[PubMed - indexed for MEDLINE]
PMCID: PMC2











Acta Orthop Traumatol Turc. 2010;44(4):285-92. doi: 10.3944/AOTT.2010.2367.
Comparison of the outcomes of two different exercise
programs on frozen shoulder.
Celik D.
Source
Department of Orthopedics and Traumatology, Faculty of Medicine, İstanbul University,
İstanbul, Turkey. deryacavga@hotmail.com
Abstract
OBJECTIVES:
The aim of the study was to compare the effects of two different exercise programs on pain, range of motion (ROM), and functional results in frozen shoulder.
METHODS:
Twenty-two female and 7 male patients [mean age 52.1 years (range 38-65 years)] were randomly allocated into two groups: 14 in the first group and 15 in the second group. The
patients were treated for 6 weeks (30 sessions) at hospital under the supervision of physical therapist. Both groups were treated with transcutaneous electrical nerve stimulation, cold
pack, and nonsteroidal antiinflammatory drugs; and were given glenohumeral ROM exercises. The scapulothoracic exercises were performed only by the second group. Functional
results were assessed using the modified Constant score, pain was assessed using visual analog scale (VAS), and ROM was measured with a goniometer. Assessments were
performed before treatment and repeated at 6 and 12 weeks of treatment.
RESULTS:
In both groups, the Constant score and ROM were increased, and VAS was decreased at the end of 6 and 12 weeks. The modified Constant score was not significantly different between
the groups before and after treatment. VAS score was better in the second group at 6 weeks (p<0.01). Improvement in ROM was significantly better in the second group at 12 weeks
(p=0.005).
CONCLUSION:
In addition to glenohumeral ROM exercises, scapulothoracic exercises contribute to decreasing pain and increasing ROM in patients with frozen shoulder.
PMID:

21252605

[PubMed - indexed for MEDLINE]
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Am J Phys Med Rehabil. 2011 Sep;90(9):738-45.
Maximizing total end range time is safe and effective for
the conservative treatment of frozen shoulder patients.
Dempsey AL, Mills T, Karsch RM, Branch TP.
Source
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of
Medicine, Lexington, USA.
Abstract
OBJECTIVE:
The purpose of this retrospective cohort study was to compare range of motion, subjective outcomes, and the prevalence of reoperation in groups of frozen shoulderpatients with either
low or moderate/high irritability treated with the same total end range time-maximizing protocol.
DESIGN:
A total of 36 patients were treated with the total end range time-maximizing protocol (12 patients with low irritability and 24 patients with moderate/high irritability). American Shoulder and
Elbow Society Standardized Shoulder Assessment Form (ASES) scores and external rotation and abduction were recorded before and after the rehabilitation protocol and were
compared between the two groups.
RESULTS:
For both groups, external rotation and abduction of the involved shoulder significantly increased from pretreatment to posttreatment, and the posttreatment external rotation and
abduction of the involved shoulder did not differ from those of the uninvolved shoulder. There were no differences between the groups in either external rotation (P = 0.71) or abduction
(P = 0.46). ASES scores were significantly lower and pain scores were significantly higher for the moderate/high irritability group both before and after treatment than for the low irritability
group; however, the moderate/high irritability group demonstrated significantly greater gains in both ASES and pain scores. One patient in the low irritability group underwent a lysis of
adhesions.
CONCLUSIONS:
We conclude that a total end range time-maximizing rehabilitation protocol is a safe, effective treatment option for patients with frozen shoulder.
PMID:

21430510

[PubMed - indexed for MEDLINE]












Int J Rehabil Res. 2009 Sep;32(3):193-8.
Continuous passive motion provides good pain control in
patients with adhesive capsulitis.
Dundar U, Toktas H, Cakir T, Evcik D, Kavuncu V.
Source
Department of Physical Medicine and Rehabilitation, Kocatepe University, Faculty of
Medicine, Afyonkarahisar, Turkey. umitftr@yahoo.com
Abstract
Painful stiffening of the shoulder, 'frozen shoulder' is a common cause of shoulder pain and disability. Continuous passive motion (CPM) is an established method of preventing joint
stiffness and of overcoming it. A randomized, comparative prospective clinical trial was planned to compare the early response with different rehabilitation methods [CPM vs.
conventional physiotherapy treatment (CPT) protocol] for adhesive capsulitis taking into consideration the clinical efficacy. A total of 57 patients with frozen shoulder were included in this
study. Patients were assigned randomly to receive daily CPM treatments or CPT protocol. Parameters were measured at baseline, and at weeks 4 and 12. All patients were evaluated
with respect to pain (visual anologue scale) at rest, pain at movement, pain at night, measurement of range of motion (shoulder flexion, abduction, internal-external rotation were
assessed), constant functional shoulder score and the shoulder pain and disability index. The first group (n=29) (CPM group) received CPM treatments for 1 h once a day for 20 days
during a period of 4 weeks. The second group (n=28) (CPT group) had a daily physiotherapy treatment protocol including active stretching and pendulum exercises for 1 h once a day for
20 days during a period of 4 weeks. All patients in both groups were also instructed in a standardized home exercise programme consisting of passive range of motion and pendulum
exercises to be performed every day. In both groups, statistically significant improvements were detected in all outcome measures compared with baseline. Pain reduction, however,
evaluated with respect to pain at rest, at movement and at night was better in CPM group. In addition the CPM group showed better shoulder pain index scores than the CPT group.
CPM treatment provides better response in pain reduction than the conventional physiotherapy treatment protocol in the early phase of treatment in adhesive capsulitis.
PMID:

19011582

[PubMed - indexed for MEDLINE]














edicina (Kaunas). 2005;41(1):30-8.
Shoulder function in patients with frozen shoulder before
and after 4-week rehabilitation.
Jürgel J, Rannama L, Gapeyeva H, Ereline J, Kolts I, Pääsuke M.
Source
Institute of Exercise Biology and Physiotherapy, University of Tartu, Jakobi 5, 51014, Tartu,
Estonia. Jelena.Jyrgel@kliinikum.ee
Abstract
This study evaluated changes in shoulder function in patients with frozen shoulder after 4-week rehabilitation combining exercise with electrical therapy and massage.
MATERIAL AND METHODS:
Ten patients with frozen shoulder (mean +/- standard error (SE) age 50.2+/-4.6 years) and 10 control subjects (49.8+/-4.6 years) participated in the study. Standard goniometric
measurements were used to assess shoulder flexion, extension, abduction, adduction, internal and external rotation active range of motion. Isometric maximal force of the shoulder
flexors, abductors, adductors, internal and external rotators was measured by hand-held dynamometer. Shoulder muscle isometric endurance was characterized by net impulse
assessed during weight (30% of maximal force) holding in hand till exhaustion. Shoulder pain was assessed by visual analogue scale.
RESULTS:
Before rehabilitation, patients with frozen shoulder had less (p<0.05) active range of motion and shoulder muscle maximal force for all measured directions, and less (p<0.05) net impulse
during shoulder muscle isometric endurance test for involved extremity compared to controls. In patients with frozen shoulder, shoulder f lexion, abduction, adduction and adduction active
range of motion, maximal force of shoulder muscles in all measured force directions and net impulse during shoulder muscle isometric endurance test for involved extremity increased
(p<0.05) after rehabilitation. No significant changes in shoulder internal and external rotation active range of motion for i nvolved extremity in patients with frozen shoulder were observed
with rehabilitation.
CONCLUSION:
A 4-week rehabilitation program improved shoulder flexion, extension, abduction and adduction active range of motion in patients with frozen shoulder coupled with non-significant
changes in external and internal rotation range of motion. A significant increase in shoulder muscle isometric strength and endurance and decrease in shoulder pain in patients with
frozen shoulder was observed after treatment.
PMID:

15687748

[PubMed - indexed for MEDLINE]
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Electromyogr Clin Neurophysiol. 2007 Jul;47(4-5):205-13.
Shoulder muscle strength and fatigability in patients with
frozen shoulder syndrome: the effect of 4-week
individualized rehabilitation.
Sokk J, Gapeyeva H, Ereline J, Kolts I, Pääsuke M.
Source
Institute of Exercise Biology and Physiotherapy, University of Tartu, Tartu, Estonia.
Abstract
The effect of 4-week individualized rehabilitation on shoulder muscle strength and fatigability was evaluated in 10 patients with frozen shoulder syndrome (FSS) in comparison of 10 age-
and gender-matched healthy control subjects. Isometric maximal voluntary contraction (MVC) force of the shoulder flexors was measured by hand-held dynamometer. Isometric
endurance of the shoulder muscles was characterized by endurance time and net impulse (NI) assessed during weight (30% MVC) holding in hand until exhaustion. Fatigability of
deltoideus, infraspinatus and trapezius muscles during isometric endurance test was assessed by electromyogram (EMG) power spectrum median frequency (MF) slope per minute.
Rehabilitation in patients with FSS consisted of exercise therapy in swimming pool and gymnasium, electrical therapy and massage. Before rehabilitation, patients with FSS had less (p <
0.05) isometric MVC force and NI during endurance test compared to the control. MF slope in patients with FSS for involved extremity was higher (p <0.05) for the deltoideus muscle and
less for the infraspinatus muscle before rehabilitation compared to the controls. Shoulder pain was decreased (p < 0.05) and isometric MVC force and NI in endurance test in patients for
involved extremity were increased after rehabilitation. No significant changes in endurance time and MF slope for infraspinatus and trapezius muscles in patients for involved extremity
were observed after rehabilitation, whereas MF slope for deltoideus muscle was increased. It was concluded that in patients with FSS, 4-week rehabilitation decreased shoulder pain and
improved MVC force of the shoulder flexors and isometric working capacity of these muscles during endurance test.
PMID:

17711038

[PubMed - indexed for MEDLINE]














Phys Ther. 2005 Nov;85(11):1128-38.
Scapular muscle tests in subjects with shoulder pain and
functional loss: reliability and construct validity.
Michener LA, Boardman ND, Pidcoe PE, Frith AM.
Source
Department of Physical Therapy, Room 100, West Hospital Basement, Virginia
Commonwealth University-Medical College of Virginia Campus, Richmond, VA 23298, USA.
lamichen@vcu.edu
Abstract
BACKGROUND AND PURPOSE:
Scapular muscle performance evaluated with a handheld dynamometer (HHD) has been investigated only in people without shoulder dysfunction for test-retest reliability of data obtained
with a single scapular muscle test. The purpose of this study was to assess the reliability, error, and validity of data obtained with an HHD for 4 scapular muscle tests in subjects with
shoulder pain and functional loss.
SUBJECTS AND METHODS:
Subjects (N=40) with shoulder pain and functional loss were tested by measuring the kilograms applied with an HHD during 3 trials for muscle tests for the lower trapezius, upper
trapezius, middle trapezius, and serratus anterior muscles. Concurrently, surface electromyography (sEMG) data were collected for the 4 muscles. The same procedures were performed
24 to 72 hours after the initial testing by the same tester. Muscle tests were performed 3 times, and the results were averaged for data analysis.
RESULTS:
Intraclass correlation coefficients for intratester reliability of measurements of isometric force obtained using an HHD ranged from .89 to .96. The standard error of the measure (90%
confidence interval [CI]) ranged from 1.3 to 2.7 kg; the minimal detectable change (90% CI) ranged from 1.8 to 3.6 kg. Construct validity assessment, done by comparing the amounts of
isometric muscle activity (sEMG) for each muscle across the 4 muscle tests, revealed that the muscle activity of the upper trapezius and lower trapezius muscles was highest during their
respective tests. Conversely, the isometric muscle activity of the middle trapezius and serratus anterior muscles was not highest during their respective tests.
DISCUSSION AND CONCLUSION:
In people with shoulder pain and functional loss, the intrarater reliability and error over 1 to 3 days were established using an HHD for measurement of isometric force for the assessment
of scapular muscle performance. Error values can be used to make decisions regarding individual patients. Construct validity was established for the lower and upper trapezius muscle
tests; therefore, these tests are advocated for use. However, construct validity was not demonstrated for the serratus anterior and middle trapezius muscle tests as performed in this
study. Further investigation of these muscle tests is warranted.
PMID:

16253043

[PubMed - indexed for MEDLINE]
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Phys Ther. 2005 Nov;85(11):1128-38.
Scapular muscle tests in subjects with shoulder pain and
functional loss: reliability and construct validity.
Michener LA, Boardman ND, Pidcoe PE, Frith AM.
Source
Department of Physical Therapy, Room 100, West Hospital Basement, Virginia
Commonwealth University-Medical College of Virginia Campus, Richmond, VA 23298, USA.
lamichen@vcu.edu
Abstract
BACKGROUND AND PURPOSE:
Scapular muscle performance evaluated with a handheld dynamometer (HHD) has been investigated only in people without shoulder dysfunction for test-retest reliability of data obtained
with a single scapular muscle test. The purpose of this study was to assess the reliability, error, and validity of data obtained with an HHD for 4 scapular muscle tests in subjects with
shoulder pain and functional loss.
SUBJECTS AND METHODS:
Subjects (N=40) with shoulder pain and functional loss were tested by measuring the kilograms applied with an HHD during 3 trials for muscle tests for the lower trapezius, upper
trapezius, middle trapezius, and serratus anterior muscles. Concurrently, surface electromyography (sEMG) data were collected for the 4 muscles. The same procedures were performed
24 to 72 hours after the initial testing by the same tester. Muscle tests were performed 3 times, and the results were averaged for data analysis.
RESULTS:
Intraclass correlation coefficients for intratester reliability of measurements of isometric force obtained using an HHD ranged from .89 to .96. The standard error of the measure (90%
confidence interval [CI]) ranged from 1.3 to 2.7 kg; the minimal detectable change (90% CI) ranged from 1.8 to 3.6 kg. Construct validity assessment, done by comparing the amounts of
isometric muscle activity (sEMG) for each muscle across the 4 muscle tests, revealed that the muscle activity of the upper trapezius and lower trapezius muscles was highest during their
respective tests. Conversely, the isometric muscle activity of the middle trapezius and serratus anterior muscles was not highest during their respective tests.
DISCUSSION AND CONCLUSION:
In people with shoulder pain and functional loss, the intrarater reliability and error over 1 to 3 days were established using an HHD for measurement of isometric force for the assessment
of scapular muscle performance. Error values can be used to make decisions regarding individual patients. Construct validity was established for the lower and upper trapezius muscle
tests; therefore, these tests are advocated for use. However, construct validity was not demonstrated for the serratus anterior and middle trapezius muscle tests as performed in this
study. Further investigation of these muscle tests is warranted.
PMID:

16253043

[PubMed - indexed for MEDLINE]
Free full










Phys Ther. 2001 Feb;81(2):799-809.
Measurement of scapular asymetry and assessment of
shoulder dysfunction using the Lateral Scapular Slide
Test: a reliability and validity study.
Odom CJ, Taylor AB, Hurd CE, Denegar CR.
Source
Department of Community and Family Medicine, Division of Physical Therapy, Duke
University Medical Center, Durham, NC 27710, USA.
Abstract
BACKGROUND AND PURPOSE:
The Lateral Scapular Slide Test (LSST) is used to determine scapular position with the arm abducted 0, 45, and 90 degrees in the coronal plane. Assessment of scapular position is
based on the derived difference measurement of bilateral scapular distances. The purpose of this study was to assess the reliabilit y of measurements obtained using the LSST and
whether they could be used to identify people with and without shoulder impairments. Subjects. Forty-six subjects ranging in age from 18 to 65 years (X=30.0, SD=11.1) participated in
this study. One group consisted of 20 subjects being treated for shoulder impairments, and one group consisted of 26 subjects without shoulder impairments.
METHODS:
Two measurements in each test position were obtained bilaterally. From the bilateral measurements, we derived the difference measurement. Intraclass correlation coefficients (ICC
[1,1]) and the standard error of measurement (SEM) were calculated for intrarater and interrater reliability of the difference in side-to-side measures of scapular distance. Sensitivity and
specificity of the LSST for classifying subjects with and without shoulder impairments were also determined.
RESULTS:
The ICCs for intrarater reliability were .75, .77, and .80 and .52, .66, and .62, respectively, for subjects without and with shoulder impairments in 0, 45, and 90 degrees of abduction. The
ICCs for interrater reliability were .67, .43, and .74 and .79, .45, and .57, respectively, for subjects without and with shoulder impairments in 0,45 and 90 degrees of abduction. The SEMs
ranged from 0.57 to 0.86 cm for intrarater reliability and from 0.79 to 1.20 cm for interrater reliability. Using the criteri on of greater than 1.0 cm difference, sensitivity and specificity were
35% and 48%, 41% and 54%, and 43% and 56%, respectively, for 0, 45, and 90 degrees of abduction. Sensitivity and specificity based on the criterion of greater than 1.5 cm difference
were 28% and 53%, 50% and 58%, and 34% and 52%, respectively, for the 3 scapular positions.
CONCLUSION AND DISCUSSION:
Our results suggest that measurements of scapular positioning based on the difference in side-to-side scapular distance measures are not reliable. Furthermore, the results suggest that
sensitivity and specificity of the LSST measurements are poor and that the LSST should not be used to identify people with and without shoulder dysfunction.
PMID:

11235656

[PubMed - indexed for MEDLINE]
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Br J Sports Med. 2010 Mar;44(4):289-93. Epub 2008 Sep 23.
The reliability measurements of lateral scapular slide test
at three different degrees of shoulder joint abduction.
Shadmehr A, Bagheri H, Ansari NN, Sarafraz H.
Source
Department of Physiotherapy, Faculty of Rehabilitation, University of Tehran (Medical
Sciences), Piche-Shemiran, Enghelab Ave, Tehran 11489-65141, Iran.
Abstract
BACKGROUND:
Lateral scapular slide test (LSST) quantitatively measures the distance between thoracic spine (T7) and inferior angle of scapula.
OBJECTIVE:
In this study, the intra-rater reliability, inter-rater reliability and diagnostic accuracy of LSST were measured using a caliper.
METHODS:
Three measurements of each test position were obtained bilaterally. Intraclass correlation coefficient (ICC) (2.1), 95% CI and 2 SEMs were calculated for intra-rater and inter-rater
reliability of the absolute scapular distance. Sensitivity, specificity, positive and negative likelihood ratios were determi ned.
RESULTS:
27 people with and 30 people without shoulder pain participated. The mean age (SD) for the participant was 47.7 (11.6) years and 33.5 (11.7) years, respectively. The ICCs for intra-rater
reliability were high. A range of poor to good ICCs was found for inter-rater reliability. The 2 SEMs ranged from 4.6 to 7.9 mm for intra-rater reliability and from 6.8 to 13.4 mm for inter-
rater reliability for people with shoulder pain. Positive and negative likelihood ratios from 0.94 to 1.22 and from 0.21 to 2.5, respectively, were demonstrated.
CONCLUSION:
SST did not show a consistent high reliability. The diagnostic accuracy of the LSST was low, which questions the clinical importance of the tests outcomes.
PMID:

18812417

[PubMed - indexed for MEDLINE]












BMC Musculoskelet Disord. 2007 Jul 9;8:64.
The pectoralis minor length test: a study of the intra-rater
reliability and diagnostic accuracy in subjects with and
without shoulder symptoms.
Lewis JS, Valentine RE.
Source
Therapy Department, Chelsea and Westminster Hospital NHS Foundation Trust, London,
UK. jeremy.lewis@chelwest.nhs.uk
Abstract
BACKGROUND:
Postural abnormality and muscle imbalance are thought to contribute to pain and a loss of normal function in the upper body. A shortened pectoralis minor muscle is commonly identified
as part of this imbalance. Clinical tests have been recommended to test for shortening of this muscle. The aim of this study was to evaluate the intra-rater reliability and diagnostic
accuracy of the pectoralis minor length test.
METHODS:
Measurements were made in 45 subjects with and 45 subjects without shoulder symptoms. Measurements were made with the subject s lying in supine. In this position the linear distance
from the treatment table to the posterior aspect of the acromion was measured on two occasions (separated by a minimum of 30 minutes and additional data collection on other subjects
to reduce bias) by one rater. The reliability of the measurements was analyzed using intraclass correlation coefficients (ICC), 95% confidence intervals (CI) and standard error of
measurement (SEM). The diagnostic accuracy of the test was investigated by determining the sensitivity, specificity, positive and negative likelihood ratios of the test against a 'gold
standard' reference. The assessor remained 'blinded' to data input and the measurements were staggered to reduce examiner bias.
RESULTS:
The pectoralis minor length test was found to have excellent intra-rater reliability for dominant and non-dominant side of the subjects without symptoms, and for the painfree and painful
side of the subjects with symptoms. The values calculated for the sensitivity, specificity, positive and negative likelihood ratios suggest this test performed in the manner investigated in
this study and recommended in the literature, lacks diagnostic accuracy.
CONCLUSION:
The findings of this study suggest that although the pectoralis minor length test demonstrates acceptable clinical reliabilit y, its lack of specificity suggests that clinicians using this test to
inform the clinical reasoning process with regard treatment planning must do so with caution.
TRIAL REGISTRATION:
National Research Register: N0060148286.
PMID:

17620136

[PubMed - indexed for MEDLINE]
PMCID: PMC1934353
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