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Validez Regla Kalterborn en Glenohumeral PDF
Validez Regla Kalterborn en Glenohumeral PDF
Review
Abstract
Kaltenborn’s convex–concave rule is a familiar concept in joint treatment techniques and arthrokinematics. Recent investigations
on the glenohumeral joint appear to question this rule and thus accepted practice guidelines. An evidence-based systematic review
was conducted to summarize and interpret the evidence on the direction of the accessory gliding movement of the head of the
humerus (HOH) on the glenoid during physiological shoulder movement. Five hundred and eighty-one citations were screened.
Data from 30 studies were summarized in five evidence tables with good inter-extracter agreement. The quality of the clinical trials
rated a mean score of 51.27% according to the Physiotherapy Evidence Database scale (inter-rater agreement: k ¼ 0:6111).
Heterogeneity among studies precluded a quantitative meta-analysis. Weighting of the evidence according to Elwood‘s classification
and the Agency for Health Care Policy and Research classification guidelines indicated that evidence was weak and limited. Poor
methodological quality, weak evidence, heterogeneity and inconsistent findings among the reviewed studies regarding the direction
of translation of the HOH on the glenoid, precluded the drawing of any firm conclusions from this review. Evidence, however,
indicated that not only the passive, but also the active and control subsystems of the shoulder may need to be considered when
determining the direction of the translational gliding of the HOH. The indirect method, using Kaltenborn’s convex–concave rule as
applied to the glenohumeral joint, may therefore need to be reconsidered.
r 2006 Elsevier Ltd. All rights reserved.
Contents
1. Introduction/background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
2. Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
2.1. The search strategy and data selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
2.2. Quality assessment of the clinical trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
2.3. Meta-analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
2.4. Weighting of the evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
3.1. Study characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
3.2. Methodological quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
3.3. Meta-analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
3.4. Level of the evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Corresponding author. P.O. Box 339 (G30), Bloemfontein 9300, South Africa. Tel: +51 4013297; fax: +51 4013290.
E-mail address: gnftcb.md@mail.uovs.ac.za (C. Brandt).
1356-689X/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.math.2006.02.011
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4 C. Brandt et al. / Manual Therapy 12 (2007) 3–11
4. Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
4.1. Methodological quality of the clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
4.2. The evidence on the arthrokinematics of the glenohumeral joint. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
4.3. Relating the findings to Kaltenborn‘s rule and theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
4.4. Implications and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
4.5. Limitations of this review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
review to increase its clinical value (Mays and Pope, 1999; calculated. A study was considered as high quality if it
Elwood, 2002; Hoepfl, 2002; Fritz and Cleland, 2003). In satisfied at least 50% of the criteria (X5.5 points)
vivo and in vitro studies were assessed. The investigated (Maher et al., 2003; Scholten-Peeters et al., 2003). The k
population had to be human (male and/or female), a mean statistic and the 95% confidence level provided for
age of 15 years or older, with or without shoulder measurement of interobserver agreement (Maher et al.,
pathology. The study had to investigate a variable factor 2003; Scholten-Peeters et al., 2003).
regarding glenohumeral joint translation and had to
measure the direction of translation of the humeral head 2.3. Meta-analysis
on the glenoid fossa during normal or simulated, active or
passive physiological shoulder movement. The reviewers Clinical trials were considered for meta-analysis regard-
decided upon inclusion by means of consensus (Oxman et less of their quality score in order to reduce bias (Guyatt et
al., 1994; Jadad et al., 1996). al., 1995; Woolf, 2000). The following study characteristics
Data were extracted from the included reports and were compared by two independent reviewers in order to
summarized on a standardized data collection form by identify the possibility of statistical pooling of results: (i)
two independent, masked reviewers. The form provided the study populations, (ii) the interventions, (iii) the sample
for the gathering of information on the study design, sizes, (iv) the availability and format of the results, (v) the
subgroups, exposure or intervention, study population, statistical methodology used for analysis, and (vi) the
research methodology, data analysis, main results, hypotheses tested (Dickersin and Berline, 1997).
hypotheses, and any other relevant data (Oxman et al.,
1994; Elwood, 2002; Scholten-Peeters et al., 2003; 2.4. Weighting of the evidence
Tugwell et al., 2003). The data were recorded (by means
of consensus) as stated in the report. Where data were The strength of the scientific evidence was rated by two
unclear and biased recording a possibility, it was clearly analysts according to two classification systems (Moher
indicated (Scholten-Peeters et al., 2003). et al., 1996; Elwood, 2002; Mays and Pope, 2002) namely,
(i) a hierarchy of evidence (Table 1) relevant to human
2.2. Quality assessment of the clinical trials health studies (Elwood, 2002) and (ii) the modified
classification of the Agency for Health Care Policy and
The quality of the clinical trials were assessed by means Research (AHCPR) guidelines (Table 2) on acute low
of the 11-item Physiotherapy Evidence Database (PEDro) back problems in adults (Ejnisman et al., 2002).
scale which was developed by the Centre for evidence-
based Physiotherapy, University of Sydney. The PEDro 3. Results
scale measures the internal validity and the sufficiency of
the statistical information provided by a clinical trial. The 3.1. Study characteristics
scale assesses criteria such as random allocation, conceal-
ment of allocation, comparibility of groups at baseline, Fig. 1 depicts the results yielded by the search and
blinding of patients, therapists and assessors, analysis by selection process. Eighteen clinical trials, seven compara-
intention to treat, adequacy of follow-up, between group tive, and five descriptive studies were included in the
statistical comparisons, report of point estimates, and review. Summary of the data indicated major methodolo-
measures of variability. Though the PEDro scale does not gical heterogeneity. Researchers used various protocols
usually assess the external validity of a trial, this item from and measuring instruments such as magnetic tracking
the Delphi list (upon which the PEDro scale is based), was devices or position sensors (n ¼ 11), three-dimensional
included in the assessment. Verhagen et al. (1998) magnetic resonance imaging (n ¼ 4), computertomogra-
reported that external validity should form part of any phy (n ¼ 3), ultrasonic devices (n ¼ 2), potentiometers
concept of quality (Verhagen et al., 1998; Woolf, 2000; (n ¼ 3), radiographs (n ¼ 6), and arthroscopy (n ¼ 1) for
‘‘PEDro: frequently asked questions’’, 2003). investigation. Eleven studies were conducted in vivo and
Two masked reviewers independently scored the quality 19 in vitro. Movements were either done passively (n ¼ 15)
of the studies (Jadad et al., 1996; Moher et al., 1996; or actively (n ¼ 14); simulated, static or continuous, while
Dickersin & Berline, 1997). Criteria were rated as yes when the plane of motion also varied. Data were gathered on
they were clearly satisfied on reading of the report, as no eight different physiological movements performed
when an unbiased decision could be made that the criteria through a variety of ranges of motion. The movements
were not satisfied, and as don’t know when the information of active flexion, active extension, and passive horizontal
was insufficient or unclear and a biased decision possible. extension were not included in any investigation.
Points were allocated for all the clearly satisfied items The literature indicated six main factors to explain
(Verhagen et al., 1998; ‘‘PEDro: the PEDro scale’’, 2003). the translational behaviour of the humeral head namely,
The mean quality score, the total frequency results, as the influence of (i) the capsulo-ligamentous structu-
well as the frequency results on each item were res (n ¼ 17), (ii) neuromuscular control (n ¼ 17),
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6 C. Brandt et al. / Manual Therapy 12 (2007) 3–11
Table 1
Elwood’s hierarchy of evidence
1 Randomized intervention trials, properly performed on an adequate number of subjects, in a human situation.
1m Results from a meta-analysis of trials.
1s One or more individual trials.
2 Observational studies, namely cohort and case–control designs, of appropriately selected groups of subjects.
2m Results from a meta-analysis of such studies.
2s One or more individual studies.
3 Comparative studies that compares groups of subjects representative of different populations or subject groups. For example:
correlation studies of populations in which data on each individual are not assessed separately and informal comparisons between
patients.
4 Case series, descriptive studies, professional experience. The evidence is largely anecdotal, unsystematically recollected (for example
‘‘clinical judgement’’ and ‘‘experience’’), conclusions based on traditional practice, information derived from other species, in vitro
testing, basic physiological principles and indirect assessments.
Table 2
The modified classification of the AHCPR guidelines on acute low back problems in adults
A Strong research-based evidence provided by generally consistent findings in multiple (more than one) high-quality randomized
clinical trial (RCT).
B Moderate research-based evidence provided by generally consistent findings in one high-quality RCT and one or more low-quality
RCT, or generally consistent findings in multiple low quality RCTs.
C Limited research-based evidence provided by one RCT (either high or low quality) or inconsistent or contradictory evidence
findings in multiple RCTs.
D No research-based evidence: no RCTs.
(iii) articular geometry/congruency/conformity (n ¼ 8), According to Elwood’s classification (Table 1), one
(iv) negative intra-articular pressure (n ¼ 4), (v) rigidi- study fulfilled the criteria for level 2 s evidence, five
fication of musculature (n ¼ 1), and (vi) gravity (n ¼ 1). for level 3 and 19 studies for level 4 evidence. The
Agreement between the reviewers were 100% for the level 2 s evidence found (i) translation to be in the
data extracted on the sample and methodological opposite direction during active physiological move-
characteristics. Disagreement occurred only on the ment in pathological joints and (ii) the humeral
study design in two of the studies which was resolved head to remain centered during active physiologi-
by means of consensus. cal movement in normal joints (Paletta et al., 1997).
For all other stratified movement planes, only levels
3.2. Methodological quality 3 and 4 evidence were found. Table 4 summar-
izes the amount and level of evidence found on the
The mean PEDro score of the clinical trials equalled
direction of the translational movement of the humeral
51.27%. Table 3 summarizes the individual results. The
head.
inter-rater agreement for quality assessment was poor
According to the AHCPR rating system (Table 2),
(k ¼ 0:611). This was confirmed by the 95% con-
level C evidence is contradictory on the direction of
fidence level of [0.8661;0.3562].
translation during active and passive lateral rotation in
3.3. Meta-analysis 901 of elevation in normal and reconstructed joints
(Karduna et al., 1997; Williams et al., 2001). Only
Heterogeneity among studies, insufficient reported inconsistent, level D evidence could be found on the
data, and poor study quality precluded statistical translation occurring during physiological movements
pooling of results. in other planes.
Inclusion of only higher quality clinical trials (quality
3.4. Level of the evidence score X54.5%) in the weighting of the evidence indu-
ced the following changes: according to Elwood‘s
Twenty-five of the reviewed studies were analysed classification, only level 4 evidence was now available,
qualitatively. Five studies were excluded due insufficient while the level of evidence according to the AHCPR
information provided for classification purposes. rating system, remained unchanged.
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C. Brandt et al. / Manual Therapy 12 (2007) 3–11 7
COMPUTER-BASED SEARCH
of databases: 555 citations
REFERENCE CHECKING: 26
articles identified, 21 retrieved
and screened
Fig. 1.
randomized, which may raise some concern regarding A quality score of 50–60% have been suggested as a
the appropriateness of the PEDro scale for assessing cut-off to distinguish between good and poor quality
these trials (Verhagen et al., 1998). It should be noted, studies (Maher et al., 2003; Scholten-Peeters et al.,
though, that poor reporting does not necessarily imply 2003). The mean quality score of 51.27% together with
that the criteria were not satisfied during the execution the poor inter-rater agreement (k ¼ 0:611) necessitated
of the trial (Elwood, 2002). careful consideration regarding the methodological
quality of the included clinical trials (Oxman et al.,
Table 3 1994; Elwood, 2002; Scholten-Peeters et al., 2003).
Summary of the quality scores of clinical trials The best approach when comparing the agreement
between two raters is to calculate the k statistic. Similar
Study Mean quality scores to other methods, such as McNemar’s test which was
(out of 11)
also calculated (0.3103), small frequency tables (in this
Level 2s evidence study n ¼ 30) present difficulties associated with the use
Paletta et al. 1997 5 and interpretation of kappa (Altman, 1996; Elwood,
Level 4 evidence 2002). The problem most cited is that the value of k
Karduna et al. (1997) 7
depends upon the proportion of subjects in each
Harryman et al. (1992) 6
Harryman et al. (1990) 6 category. Landis and Koch (1977), as well as Elwood
McMahon et al. (1995) 4.5 (2002), have characterized ranges of values for kappa
Gohlke et al. (1994) 6 with respect to the degree of agreement they suggest.
Vaesel et al. (1997) 5 Values greater than 0.75 may be taken to represent
Novotny et al. (1998) 4.5
excellent agreement beyond chance, values below 0.40
Williams et al. (2001) 6.5
Apreleva et al. (1998) 6 may be taken to represent poor agreement beyond
Wuelker et al. (1994) 6 chance, and values between 0.40 and 0.75 may be taken
Loehr et al. (1994) 5 to represent fair to good agreement beyond chance.
Karduna et al. (1996) 6
Thompson et al. (1996) 5
Helmig et al. (1993) 6
4.2. The evidence on the arthrokinematics of the
Wuelker et al. (1998) 6 glenohumeral joint
Debski et al. (1995) 5
Total mean score 5.64 The best evidence (level 2 s), as well as many of the
selected studies (n ¼ 17), supported the hypotheses of
Table 4
Levels of evidence
Levels of evidence are indicated according to Elwood’s classification system (normal print) and according to the AHCPR’s guidelines (in italics).
—, No evidence; n ¼ amount of studies.
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C. Brandt et al. / Manual Therapy 12 (2007) 3–11 9
capsulo-ligamentous structures and neuromuscular con- 450%) were contradicting regarding the translational
trol influencing the translation of the head of the direction during active and passive lateral rotation in 901
humerus (HOH). The capsulo-ligamentous structures of elevation in normal and reconstructed joints (Karduna
may be responsible for an obligatory translation of the et al., 1997; Williams et al., 2001).
humeral head at the end range of motion when the Considering Table 4, interpretations with regards to the
capsule and/or ligaments are tensioned. This was convex–concave rule need to be made with caution due to
especially observed during passive motion in the absence the following limitations: (i) the table is not representative
of rotator cuff activity (Howell et al., 1988; Harryman of all physiological movements since certain motion planes
et al., 1990, 1992; Gohlke et al., 1994; Debski et al., were not investigated by any of the studies; (ii) findings
1995; Karduna et al., 1996, 1997; Paletta et al., 1997; regarding the direction of translation were inconsistent for
Novotny et al., 1998; Rhoad et al., 1998; Baeyens et al., different physiological motion planes, and (iii) hetero-
2000; Williams et al., 2001). During active movement the geneous shoulder pathologies were grouped together,
stabilizing effect of the rotator cuff on the humeral head although these may affect translation in different manners
causes a centring motion (Poppen and Walker, 1976; (Burkhart, 1994; Meister, 2000).
Howell et al., 1988; Gohlke et al., 1994; Wuelker et al.,
1994, 1998; Debski et al., 1995; Karduna et al., 1996; 4.3. Relating the findings to Kaltenborn‘s rule and theory
Thompson et al., 1996; Karduna et al., 1997; Paletta
et al., 1997; Apreleva et al., 1998; Rhoad et al., 1998; Kaltenborn and MacConaill based their hypotheses
Graichen et al., 2000; Williams et al., 2001; Von of normal and abnormal intra-articular dynamics on the
Eisenhart-Rothe et al., 2002). Any loss of or defect in geometry of the articulating surfaces and location of the
the stabilizing mechanism of the shoulder joint may movement axis alone (MacConaill, 1953; Kaltenborn
increase or disrupt normal translational patterns, and Evjenth, 1989). The evidence indicates (i) different
depending on the involved structure and its role in the arthrokinematic behaviour for normal and dysfunc-
gliding of the humeral head (Poppen and Walker, 1976, tional joints and (ii) that not only the passive subsystem,
1978; McGlynn and Caspari, 1984; Howell et al., 1988; but also the active and control subsystems may
Ozaki, 1989; Harryman et al., 1990; Helmig et al., 1993; determine intra-articular gliding motion.
Loehr et al., 1994; Debski et al., 1995; McMahon et al., It appears that Kaltenborn’s rule for the treatment of
1995; Deutsch et al., 1996; Thompson et al., 1996; restricted joint motion may be valid if the intention of
Karduna et al., 1997; Paletta et al., 1997; Apreleva et al., the treatment is to stretch a tight capsulo-ligamentous
1998; Novotny et al., 1998; Wuelker et al., 1998; structure causing limitation of the physiological joint
Baeyens et al., 2000, 2001; Graichen et al., 2000; Von motion. By gliding the humeral head in the opposite
Eisenhart-Rothe et al., 2002). Pain, muscle spasm, and direction of the restricted physiological bone movement,
loss of proprioception associated with shoulder dysfunc- the restricting capsulo-ligamentous structure may be
tion may lead to neurophysiological responses. Imbal- stretched. According to the evidence, however, this
ance/incoordination of the shoulder musculature may motion performed by the therapist may not necessarily
influence the translation of the humeral head (Poppen mimic the true gliding taking place due to the tight
and Walker, 1976; Wuelker et al., 1994, 1998; Bertoft, structure.
1999; Graichen et al., 2000; Von Eisenhart-Rothe et al.,
2002). 4.4. Implications and recommendations
In correllation with the original theory of MacConaill
and Kaltenborn, some studies did report that geome- Clinically authors postulate that the validity of the
trical factors, such as the size of the humeral head, may Kaltenborn rule might not be accepted dogmatically.
determine translation. Increased head size seems to The arthrokinematics of each patient might need to be
distension the capsule and thus reduce translation considered in the context of existing neuro-musculoske-
(Vaesel et al., 1997; Rhoad et al., 1998). letal and biopsychosocial dysfunction which requires the
To relate the findings of this review on the translational process of clinical reasoning. Scientifically such a
direction of the humeral head to the Kaltenborn rule, the recommendation still lacks evidence.
best evidence will be considered (Elwood, 2002). The level Methodologically sound, randomized, clinically con-
2 s evidence (quality score o50%) found translation to be trolled, in vivo, and homogeneous primary studies are
in the opposite direction during active horizontal needed on this subject. As such studies emerge, this
extension with lateral rotation and in the same direction review should be updated and reproduced. To ensure a
during active abduction in anterior unstable joints and meta-analysis in future reviews, the following criteria
joints with rotator cuff tears. The humeral head remained need to be considered: (i) movement should be classified
centred during active abduction in normal shoulder joints as active or passive, (ii) the plane and the range of
(Paletta et al., 1997). According to the AHCPR motion investigated should be similar, (iii) homogeneous
classification, level C evidence (n ¼ 2, quality scores pathologies should be grouped, and (iv) measuring
ARTICLE IN PRESS
10 C. Brandt et al. / Manual Therapy 12 (2007) 3–11
instruments, exposures or interventions, as well as the of the shoulder at the end of the late preparatory phase of
hypotheses tested, should be similar. throwing. Clinical Biomechanics 2001;16:752–7.
Bertoft ES. Painful shoulder disorders from a physiotherapeutic view:
a review of literature. Physical and Rehabilitation Medicine
4.5. Limitations of this review 1999;11:229–77.
Burkhart SS. Reconciling the paradox of rotator cuff repair versus
Bias needs to be considered. Only one reviewer was debridement: a unified biomechanical rationale for the treatment of
involved in the initial screening of the 555 citations. A rotator cuff tears. Arthroscopy 1994;10:4–19.
Debski RE, McMahon PJ, Thompson WO, Woo SLY, Warner JJP,
few articles could not be retrieved internationally and
Fu FH. A new dynamic testing apparatus to study glenohumeral
attempts to retrieve unpublished literature yielded no joint motion. Journal of Biomechanics 1995;28(7):869–74.
results. Deutsch A, Altchek DW, Schwartz E, Otis JC, Warren RF. Radiologic
Working with such considerable amounts of evidence measurement of superior displacement of the humeral head in the
could not exclude the possibility of including multiple impingement syndrome. Journal of Shoulder and Elbow Surgery
publications from the same large trial. Careful inspec- 1996;5(3):186–493.
Dickersin K, Berline T. Combining the results of several studies. In:
tion, though, did not reveal any such errors. Informa- Lang TA, Secic M, editors. How to report statistics in medicine.
tion from papers concerning the same variables or American College of Physicians; 1997. p. 171–84 [Chapter 11].
cohorts, may influence the quality rating of similar Ejnisman B, Carrera EF, Fallopa F, Peccin MS, Cohen M.
papers later on. Earlier papers can provide the reviewers Interventions for tears of the rotator cuff in adults (Protocol for
with additional information on validity. a Cochrane Review). In: The Cochrane Library, issue 4. Oxford:
Update Software; 2002.
This review lacks statistical strength due to the
Elwood JM. Critical appraisal of epidemiological studies and clinical
preclusion of a meta-analysis and the poor kappa value trials, 2nd edn. Oxford: Oxford University Press; 2002. p. 105–115,
calculated for inter-rater agreement. The findings should 198–244. [Chapters 5,8–9].
be interpreted with caution due to the limitations of a Fritz JM, Cleland J. Effectiveness versus efficacy: more than a debate
qualitative/categorical analysis. over language. Journal of Orthopaedic and Sports Physical
Therapy 2003;33(4):163–5.
Gohlke FE, Barthel T, Daum P. Influence of T-shift capsulography on
5. Conclusion rotation and translation of the glenohumeral joint: an experi-
mental study. Journal of Shoulder and Elbow Surgery 1994;3:
361–70.
Inconsistent evidence, poor methodological quality Graichen H, Stammberger T, Bonèl H, Englmeier K- H, Reiser M,
and heterogeneity among the reviewed studies precluded Eckstein F. Glenohumeral translation during active and passive
the drawing of any firm conclusions regarding the elevation of the shoulder–a 3D open-MRI study. Journal of
direction of translation of the humeral head on the Biomechanics 2000;33:609–13.
Green S, Buchbinder R, Glazier R, Forbes A. Interventions for
glenoid. The indirect method using Kaltenborn‘s con-
shoulder pain (Cochrane review). In: The Cochrane library, issue 2.
vex–concave rule, as applied to the glenohumeral joint, Oxford: Update Software; 2002.
need to be investigated appropriately by primary studies Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ.
to determine its validity. It can only be postulated that User’s guide to the medical literature: IX. A method for grading
not only the passive subsystem, as proposed by Kalten- health care recommendations. Journal of the American Medical
born, but also the active and control subsystems may Association 1995;274(22):1800–4.
Harryman DT, Sidles JA, Clark JM, Mcquade KJ, Gibb TD, Matsen
need to be considered when determining the direction of FA. Translation of the humeral head on the glenoid with passive
the translational gliding movement of the humeral head. glenohumeral motion. The Journal of Bone and Joint Surgery
It is suggested that clinical decisions of appropriate 1990;72A(9):1334–43.
gliding directions in the assessment and treatment of a Harryman DT, Sidles JA, Harris SL, Matsen FA. The role of the
patient with shoulder dysfunction should be considered rotator interval capsule in passive motion and stability of the
shoulder. The Journal of Bone and Joint Surgery 1992;74A(1):
carefully at this stage.
53–66.
Helmig P, Søjbjerg JO, Sneppen O, Lohr + JF, Østgaard SE, Suder P.
References Glenohumeral movement patterns after puncture of the joint
capsule: an experimental study. Journal of Shoulder and Elbow
Altman DG. Practical statistics for medical research. London: Chap- Surgery 1993;2:209–15.
man and Hall; 1996. p. 403–409. Hess SA. Functional stability of the glenohumeral joint. Manual
Apreleva M, Hasselman CT, Debski RE, Fu FH, Woo SLY, Warner Therapy 2000;5(2):63–71.
JJP. A dynamic analysis of glenohumeral motion after simulated Hoepfl MC. Choosing qualitative research: A primer for technology
capsulolabral injury. A cadaver model. Journal of Bone and Joint education researchers. Acrobat reader: 1–15. Retrieved May 28,
Surgery 1998;80A:474–80. 2002 from the World Wide Web: http://www.curriculum.edu.au/
Baeyens JP, Van Roy P, Clarys JP. Intra-articular kinematics of the tech/articles/choose.htm, 2002.
normal glenohumeral joint in the late preparatory phase of Howell SM, Galinat BJ, Renzi AJ, Marone PJ. Normal and
throwing: Kaltenborn’s rule revisited. Ergonomics 2000;43(10): abnormal mechanics of the glenohumeral joint in the horizontal
1726–37. plane. The Journal of Bone and Joint Surgery 1988;70A(2):227–32.
Baeyens JP, Van Roy P, De Schepper A, Declercq G, Clarijs JP. Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds DJM,
Glenohumeral joint kinematics related to minor anterior instability Gavaghan DJ, McQuay HJ. Assessing the quality of reports of
ARTICLE IN PRESS
C. Brandt et al. / Manual Therapy 12 (2007) 3–11 11
randomized clinical trials: Is blinding necessary? Controlled with anterior instability or rotator cuff tearing. Journal of Shoulder
Clinical Trials 1996;17:1–12. and Elbow Surgery 1997;6(6):516–27.
Kaltenborn FM, Evjenth O. Manual mobilization of the extremity Panjabi MM. The stabilising system of the spine: part I–Function,
joints. Basic examination and treatment techniques (I), 4th edn. dysfunction, adaptation and enhancement. Journal of Spinal
Oslo: Olaf Norlin Bokhandel; 1989. p. 26–27. Disorders 1992;5:383–9.
Karduna AR, Williams GR, Williams JL, Iannotti JP. Kinematics of ‘‘PEDro: Frequently asked questions’’. PEDro 2003: 1–4. 5 March
the glenohumeral joint: influences of muscle forces, ligamentous 2003: http://www.pedro.fhs.usyd.edu.au/FAQs/faqs.htm
constraints, and articular geometry. Journal of Orthopaedic Poppen NK, Walker PS. Normal and abnormal motion of the shoulder.
Research 1996;14:986–93. The Journal of Bone and Joint Surgery 1976;58A(2):195–201.
Karduna AR, Williams GR, Williams JL, Iannotti JP. Glenohumeral Poppen NK, Walker PS. Forces at the glenohumeral joint in
joint translations before and after total shoulder arthroplasty. The abduction. Clinical Orthopaedics and Related Research 1978;135:
Journal of Bone and Joint Surgery 1997;79A(8):1166–74. 165–70.
Landis JR, Koch GG. The measurement of observer agreement for Rhoad RC, Klimkiewicz JJ, Williams GR, Kesmodel SB, Udupa JK,
categorical data. Biometrics 1977;33:159–74. Kneeland JB, et al. A new in vivo technique for three-dimensional
Loehr JF, Helmig P, Søjberg JO, Jung A. Shoulder instability caused shoulder kinematics analysis. Skeletal Radiology 1998;27:92–7.
by rotator cuff lesions: an in vitro study. Clinical Orthopaedics and Scholten-Peeters GGM, Verhagen AP, Bekkering GE, Van der Windt
Related Research 1994;304:84–90. DAWM, Barnsley L, Oostendorp RAB, et al. Prognostic factors of
MacConaill MA. The movements of bones and joints. The significance whiplash-associated disorders: a systematic review of prospective
of shape. The Journal of Bone and Joint surgery 1953;35B(2):290–7 cohort studies. Pain 2003;104:303–22.
[Chapter 5]. Thompson WO, Debski RE, Boardman III ND, Taskiran E, Warner
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. JJ, Fu FH, et al. A biomechanical analysis of rotator cuff deficiency
Reliability of the PEDro scale for rating quality of randomized in a cadaveric model. The American Journal of Sports Medicine
controlled trials. Physical Therapy 2003;83:713–21 Retrieved 1996;24(3):286–92.
January 14, 2004 from the World Wide Web: http://www.ptjour- Tugwell P, Brooks P, Wells G, Davies J, Shea B, De Bie R, et al.
nal.org/includes/printit.cfm, p. 1–9. Cochrane Musculosceletal Group. In The Cochrane Library, issue
Maitland GD. Vertebral manipulation. Oxford: Butterworth-Heine- 2. Oxford: Update software; 2003.
mann; 1998. p. 3–13. [Chapter 1]. Vaesel MT, Olsen BS, Søjbjerg JO, Helmig P, Sneppen O. Humeral
Mays N, Pope C. Quality in qualitative health research. In: Pope C, head size in shoulder arthroplasty: a kinematic study. Journal of
Mays N, editors. Qualitative research in health care. London: Shoulder and Elbow Surgery 1997;6(6):549–55.
British Medical Journal publishing group; 1999 [Chapter 9]. Verhagen AP, De Vet HCW, De Bie RA, Kessels AGH, Boers M,
McGlynn FJ, Caspari RB. Arthroscopic findings in the subluxating Bouter LM, et al. The Delphi list: a criteria list for quality
shoulder. Clinical Orthopaedics and Related Research 1984;183: assessment of randomized clinical trials for conducting systematic
173–8. reviews developed by Delphi consensus. Journal of Clinical
McMahon PJ, Debski RE, Thompson WO, Warner JJP, Fu FH, Woo Epidemiology 1998;51(12):1235–41.
SLY. Shoulder muscle forces and tendon exursions during Von Eisenhart-Rothe RMO, Jager A, Englmeier K-H, Vogl TJ,
glenohumeral abduction in the scapular plane. Journal of Shoulder Graichen H. Relevance of arm position and muscle activity on
and Elbow Surgery 1995;4(3):199–208. three-dimensional glenohumeral translation in patients with trau-
Meister K. Injuries to the shoulder in the throwing athlete. Part one: matic and atraumatic shoulder instability. The American Journal
Biomechanics/pathophysiology/classification of injury. The Amer- of Sports Medicine 2002;30(4):514–22.
ican Journal of Sports Medicine 2000;28(2):265–75. Williams GR, Wong KL, Pepe MD, Tan V, Silverberg D, Ramsey
Moher D, Jadad AR, Tugwell P. Assessing the quality of randomized ML, et al. The effect of articular malposition after total shoulder
controlled trials. International Journal of Technology Assessment arthroplasty on glenohumeral translations, range of motion, and
in Health Care 1996;12(2):195–208. subacromial impingement. Journal of Shoulder and Elbow Surgery
Mulligan BR. Manual Therapy: ‘‘NAGS’’, ‘‘SNAGS’’, ‘‘MWMS’’, etc, 2001;10(5):399–409.
4th edn. Wellington: Plane View Services Limited; 1999. Winters JC, Jorritsma W, Groenier KH, Sobel JS, Meyboom-de Jong
Novotny JE, Nichols CE, Beynnon BD. Normal kinematics of the B, Arendzen HJ. Treatment of shoulder complaints in general
unconstrained glenohumeral joint under coupled moment loads. practice: long term results of a randomised, single blind study
Journal of Shoulder and Elbow Surgery 1998;7:629–39. comparing physiotherapy, manipulation and corticosteroid injec-
Oxman AD, Cook DJ, Guyatt GH. User‘s guides to the medical tion. British Medical Journal 1999;318(7195):1395–6.
literature: IV. How to use an overview. Journal of the American Woolf H. Evidence-based medicine and practice guidelines: an
Medical Association 1994;272(17):1367–71. overview. JMCC 2000;7(4):362–7.
Ozaki J. Glenohumeral movements of the involuntary inferior and Wuelker N, Korell M, Thren K. Dynamic glenohumeral joint stability.
multidirectional instability. Clinical Orthopaedics and Related Journal of Shoulder and Elbow Surgery 1998;7:43–52.
Research 1989;238:107–11. Wuelker N, Schmotzer H, Thren K, Korell M. Translation of the
Paletta GA, Warner JJP, Warren RF, Deutsch A, Altchek DW. glenohumeral joint with simulated active elevation. Clinical
Shoulder kinematics with two plane X-ray evaluation in patients Orthopaedics 1994;309:193–200.