Glenohumeral eklemin anteriora translasyonunun ultrasonografik değerlendirmesi: Değerlendirici içi ve değerlendiriciler arası güvenilirlik çalışması

Year 2014, Volume: 48 Issue: 2, 169 - 174, 21.04.2014

Leonard H. Joseph Rizuana İ. Hussain Ubon Pirunsan Amaramalar S. Naicker Ohnmar Htwe Aatit Paungmali

https://doi.org/10.3944/AOTT.2014.3184

Abstract

 

Amaç: Bu çalışmanın amacı, sağlıklı ve sakroiliak eklem disfonksiyonu olan olgularda humerus başının anteriora translasyonunun ultrasonografi (US) ile ölçümünde değerlendirici içi ve değerlendiriciler arası güvenilirliğini incelemekti.

 

Çalışma planı: Çalışmaya 11 olgunun 22 omuz eklemi dahil edildi. Altı olgu sağlıklı iken, 5 olguda sakroiliak eklem disfonksiyonu vardı. Humerus başının anteriora yer değiştirmesini saptamak amacıyla iki farklı araştırmacı tarafından US ile ikişer ölçüm yapıldı. Sınıf içi korelasyon katsayısı (SKK3,1), ölçmenin standart hatası (ÖSH), değişim katsayısı (DK) ve Bland-Altman yöntemi kullanılarak araştırmacılar arasında değerlendirici içi ve değerlendiriciler arası güvenilirlik, hata miktarı ve ölçümlerin tutarlılığı analitik olarak incelendi.

 

Bulgular: Sınıf içi korelasyon katsayısı 0.94 idi ve humerus başının anteriora translasyonunun ölçümünde ÖSH (0.01 cm) ve DK (%5.1) değerleri ile ilk araştırmacının yüksek seviyede değerlendirici içi güvenilirliğe sahip olduğu görüldü. İkinci araştırmacının değerlendirici içi güvenilirliği ise 0.84 SKK ile ÖSH’ler için (0.03 cm), DK için (%9.6) değeri vermekteydi ki bu da yüksek derecede güvenilirliğe işaret etmekteydi. Değerlendiriciler arası güvenilirlik de, 0.92 SKK ile ÖSH’ler için (0.02 cm), DK için (%5.9) değerleriyle yine yüksek olarak saptandı.

 

Çıkarımlar: Humerus başının anteriora translasyonunun ölçümünde US kullanımı, klinik uygulamada değerlendirici içi ve değerlendiriciler arası güvenilirlik açısından tatminkar sonuçlar vermektedir.

 

Keywords

Güvenilirlik; humerus başı; muayene; omuz; translasyon; ultrason.

Clinical evaluation of the anterior translation of glenohumeral joint using ultrasonography: an intra- and inter-rater reliability study

Abstract

Objective: The aim of this study was to investigate the intra- and inter-rater reliability of ultrasonography (US) to measure anterior translation of the humeral head (ATHH) among healthy subjects and patients with sacroiliac joint dysfunction.

Methods: The study included a total of 22 shoulder joints from 11 subjects. Six subjects were healthy and 5 had sacroiliac joint dysfunction. Anterior translation of the humeral head was measured twice using US by two different investigators. Intraclass correlation coefficient (ICC3,1), standard error of measurements (SEMs), coefficient of variations (CVs) and Bland-Altman plot were used as analytical tests to investigate intra- and inter-rater reliability, amount of error and agreeability of the measurements between investigators.

Results: Intraclass correlation coefficient was 0.94, showing a high level of intra-rater reliability of the first investigator with SEMs (0.01 cm) and CV (5.1%) in measuring ATHH. Intra-rater reliability of the second investigator was 0.84 with SEMs (0.03 cms) and CV (9.6%), indicating a high level of reliability. Inter-rater reliability was high, with an ICC value of 0.92 with SEMs (0.02 cms) and CV (5.9%).

Conclusion: The use of US as a measurement of ATHH has good levels of intra- and inter-rater reliability in clinical practice.

Keywords

Examination, humeral head, reliability, shoulder, translation, ultrasound

References

• Ellenbecker TS, Mattalino AJ, Elam E, Caplinger R. Quantification of anterior translation of the humeral head in the throwing shoulder. Manual assessment versus stress radiography. Am J Sports Med 2000;28:161-7.
• Gerber C, Ganz R. Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. J Bone Joint Surg Br 1984;66:551-6. von Eisenhart-Rothe R, Müller-Gerbl M, Wiedemann E, Englmeier KH, Graichen H. Functional malcentering of the humeral head and asymmetric long-term stress on the glenoid: potential reasons for glenoid loosening in total shoulder arthroplasty. J Shoulder Elbow Surg 2008;17:695-702.
• Taylor JD, Bandy WD. Intrarater reliability of the KT1000 arthrometer in determining anterior translation of the glenohumeral joint. Arch Phys Med Rehabil 2005;86:826-9.
• Norris TR. C-arm fluoroscopic evaluation under anesthesia for gleno-humeral subluxation. In: Bateman JE, Welsh RP, editors. Surgery of the shoulder. Philadelphia, PA: BC Becker, Inc; 1984. p. 22-5.
• Lin HT, Hsu AT, Chang GL, Chang Chien JR, An KN, Su FC. Determining the resting position of the glenohumeral joint in subjects who are healthy. Phys Ther 2007;87:1669-82.
• Hawkins RJ, Schutte JP, Janda DH, Huckell GH. Translation of the glenohumeral joint with the patient under anesthesia. J Shoulder Elbow Surg 1996;5:286-92.
• Yeap JS, McGregor AH, Humphries K, Wallace AL. Ultrasonic evaluation of anterior shoulder translation in normal shoulders. J Musculoskeletal Res 2003;7:125-34.
• Krarup AL, Court-Payen M, Skjoldbye B, Lausten GS. Ultrasonic measurement of the anterior translation in the shoulder joint. J Shoulder Elbow Surg 1999;8:136-41.
• Court-Payen M, Krarup AL, Skjoldbye B, Lausten GS. Real-time sonography of anterior translation of the shoulder: An anterior approach. EJU 1995;2:283-7.
• Atkinson G, Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 1998;26:217-38.
• Kottner J, Audigé L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol 2011;64:96-106.
• Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. Man Ther 2009;14:213-21.
• Tong HC, Heyman OG, Lado DA, Isser MM. Interexaminer reliability of three methods of combining test results to determine side of sacral restriction, sacral base position, and innominate bone position. J Am Osteopath Assoc 2006;106:464-8.
• Cibulka MT, Koldehoff R. Clinical usefulness of a cluster of sacroiliac joint tests in patients with and without low back pain. J Orthop Sports Phys Ther 1999;29:83-92.
• Khamwong P, Nosaka K, Pirunsan U, Paungmali A. Reliability of muscle function and sensory perception measurements of the wrist extensors. Physiother Theory Pract 2010;26:408-15.
• Bruton A, Conway JH, Holgate ST. Reliability: what is it and how is it measured. Physiotherapy 2000;86:94-9.
• Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-10.
• Numanoğlu A, Günel MK. Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta Orthop Traumatol Turc 2012;46:196-200.
• Günel MK, Tarsuslu T, Mutlu A, Livanelioğlu A. Investigation of interobserver reliability of the Gillette Functional Assessment Questionnaire in children with spastic diparetic cerebral palsy. Acta Orthop Traumatol Turc 2010;44:63-9.
• Harryman DT 2nd, Sidles JA, Harris SL, Matsen FA 3rd. Laxity of the normal glenohumeral joint: A quantitative in vivo assessment. J Shoulder Elbow Surg 1992;1:66-76.
• Levy AS, Lintner S, Kenter K, Speer KP. Intra- and interobserver reproducibility of the shoulder laxity examination. Am J Sports Med 1999;27:460-3.
• Bahk M, Keyurapan E, Tasaki A, Sauers EL, McFarland EG. Laxity testing of the shoulder: a review. Am J Sports Med 2007;35:131-44.
• Sauers EL, Borsa PA, Herling DE, Stanley RD. Instrumented measurement of glenohumeral joint laxity: reliability and normative data. Knee Surg Sports Traumatol Arthrosc 2001;9:34-41.
• Borsa PA, Sauers EL, Herling DE, Manzour WF. In vivo quantification of capsular end-point in the nonimpaired glenohumeral joint using an instrumented measurement system. J Orthop Sports Phys Ther 2001;31:419-31.