Reliability of measuring pectoralis minor muscle resting length in subjects with and without signs of shoulder impingement

Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM) muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic) participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic), and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k) for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM) ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC) for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval.

The role of sensitization in musculoskeletal shoulder pain

Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization.Method:This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization.Results:All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studies. The chronicity of symptoms in subjects who were included in the studies is probably influencing this finding. The primary somatosensory test used to assess sensitization in these studies was Pressure Pain Threshold, a test for lowered nociceptive thresholds.Discussion:It appears that peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the manuscripts. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for its presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain.