Abstract
Background
10% of the points for the Constant–Murley score (CMS) are allocated for the capacity for internal rotation (IR), measured as unassisted active movement of the dorsum of the hand or the thumb to reach different anatomical landmarks. However, there is little information about the validity of this method and no three-dimensional measurement of the degree of IR that is necessary to reach these landmarks.
Methods
Sixteen volunteers with healthy shoulders were recruited. The degree of IR was defined using the following landmarks as described in the CMS: (1) lateral aspect of thigh, (2) buttock, (3) sacroiliac joint, (4) level of waist, (5) vertebra T12, (6) interscapular. The validity of IR measurement was assessed by simultaneous 3D motion analysis.
Results
Using the thumb as pointer, there were significant increases in IR from 39.3° at position 1 to 80.4° at position 2, followed by 105.1°, 108.6°, 110.1°, and 125.3° at position 3–6. Taking the dorsum of the hand as pointer, there were significant increases in IR between all positions, starting from 71.2° (position 1) and followed by 99.3°, 104.1°, 110.3°, 115.2°, and 119.7° at positions 2 to 6. Comparing the two measurement methods, a significant difference was found for the amount of IR between positions 1 and 2.
Conclusion
Measurement of IR as described in the CMS is a suitable method. However, there was an increase of only 10° in IR between positions 3 and 5, which may be hard to measure with a standard goniometer in clinical practice.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987(214):160–164
Constant CR et al (2008) A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17(2):355–361
Constant CR (1997) An evaluation of the Constant–Murley shoulder assessment. J Bone Joint Surg Br 79(4):695–696
Johansson KM, Adolfsson LE (2005) Intraobserver and interobserver reliability for the strength test in the Constant–Murley shoulder assessment. J Shoulder Elbow Surg 14(3):273–278
Hirschmann MT et al (2010) Reliability of shoulder abduction strength measure for the Constant–Murley score. Clin Orthop Relat Res 468(6):1565–1571
Blonna D et al (2012) Can we improve the reliability of the Constant–Murley score? J Shoulder Elbow Surg 21(1):4–12
Rettig O et al (2009) A new kinematic model of the upper extremity based on functional joint parameter determination for shoulder and elbow. Gait Posture 30(4):469–476
Kasten P et al (2010) Can shoulder arthroplasty restore the range of motion in activities of daily living? A prospective 3D video motion analysis study. J Shoulder Elbow Surg 19(2 Suppl):59–65
Maier MW et al (2014) 3D motion capture using the HUX model for monitoring functional changes with arthroplasty in patients with degenerative osteoarthritis. Gait Posture 39(1):7–11
Wu G et al (2005) ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—Part II: shoulder, elbow, wrist and hand. J Biomech 38(5):981–992
Katolik LI et al (2005) Normalization of the Constant score. J Shoulder Elbow Surg 14(3):279–285
Yian EH et al (2005) The Constant score in normal shoulders. J Shoulder Elbow Surg 14(2):128–133
Rocourt MH et al (2008) Evaluation of intratester and intertester reliability of the Constant–Murley shoulder assessment. J Shoulder Elbow Surg 17(2):364–369
Richards RR et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3(6):347–352
Mallon WJ et al (1996) Use of vertebral levels to measure presumed internal rotation at the shoulder: a radiographic analysis. J Shoulder Elbow Surg 5(4):299–306
Ginn KA, Cohen ML, Herbert RD (2006) Does hand-behind-back range of motion accurately reflect shoulder internal rotation? J Shoulder Elbow Surg 15(3):311–314
Edwards TB et al (2002) Interobserver and intraobserver reliability of the measurement of shoulder internal rotation by vertebral level. J Shoulder Elbow Surg 11(1):40–42
Hall JM et al (2014) Accuracy and reliability testing of two methods to measure internal rotation of the glenohumeral joint. J Shoulder Elbow Surg 23(9):1296–1300
Sraj SA, Internal Rotation Behind-the-Back Angle (2015) A reliable angular measurement for shoulder internal rotation behind the back. Sports Health (London) 7(4):299–302
Acknowledgements
We thank the research fund of the Department of Orthopaedic and Trauma Surgery of the University of Heidelberg for the financial support of the study. Furthermore, we would like to thank the motion analysis team of the University of Heidelberg, especially Dr. Stefan van Drongelen and Dr. Oliver Rettig, for their assistance.
Funding
Research fund of the Department of Orthopaedic and Trauma Surgery of the Hospital of the University of Heidelberg. The local ethics committee approved the study (S-342/2014) and all patients consented to the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
All authors, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Rights and permissions
About this article
Cite this article
Maier, M.W., Erhard, S., Niklasch, M. et al. Three-dimensional motion analysis for validation of shoulder internal rotation. Arch Orthop Trauma Surg 137, 735–741 (2017). https://doi.org/10.1007/s00402-017-2656-4
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-017-2656-4