The scapula backward tipping test: An inter-rater reliability study.

BACKGROUND & PURPOSE: The purpose of this study was to determine the reliability of the scapula backward tipping test (SBTT) in detecting the presence of pectoralis minor (PM) tightness and subsequently scapula forward tipping, in a symptomatic population. PM tightness with scapula forward tipping has been described to cause pain and dysfunction in the shoulder region. METHODS: 30 patients with a diagnosis of shoulder pain were randomly assigned and examined by 2 musculoskeletal physical therapists at a time. The procedure consisted of having the individual lay on the stomach in a neutral head position with palms in the anatomical position. The examiner firmly stabilized the inferior angle of the scapula with one hand and the fingers of the other hand hooked the under surface of the coracoid process. A gentle yet firm pull was imparted in an upward direction to sense tightness and to observe movement of the acromion up to the tragus of the ear. A comparison was made with the other side to sense restriction. Inter-rater reliability was determined using the kappa statistic. RESULTS: The SBTT was found to be reproducible between examiners (Kappa = 0.735, SE of kappa = 0.123, 95% confidence interval), with a percentage agreement of 86.67%. CONCLUSION: The SBTT may be incorporated as a simple yet effective test to determine the presence of PM tightness and subsequently scapula forward tipping.

Cervical extensor endurance test: a reliability study.

BACKGROUND & PURPOSE: The purpose of this study was to determine the inter-rater reliability in detecting the presence of weakness of the neck extensors and differentiate the presence of weakness of the superficial versus the deep neck extensors in a symptomatic population. The presence of weakness of the neck extensors has been described to cause pain and dysfunction in the cervical region. METHODS: 30 patients with a diagnosis of neck pain were randomly assigned and examined by two musculoskeletal physical therapists at a time, in order to determine the presence of weakness of the superficial versus the deep neck extensors. With the patient lying prone and head and neck past the edge of the table and the cervico-thoracic junction stabilized, the ability of the individual to sustain a chin tuck position in neutral for 20 s was evaluated. A positive finding for weakness of the deep neck extensors is the 'chin length' increasing with neck extension, as observed on the inclinometer, indicating a dominance of the superficial extensors of the neck. Weakness of both deep and superficial neck extensors was identified by the presence of neck flexion indicating an inability to hold the head up. Inter-rater reliability was determined using the Cohen's un-weighted kappa statistic. RESULTS: For the cervical extensor endurance test, the inter-rater reliability was 'very good' (k = 0.800, SE of kappa = 0.109, 95% CI). CONCLUSION: The cervical extensor endurance test may be incorporated as a simple yet effective test to determine the presence of weakness of the neck extensors and differentiate the presence of weakness of the superficial versus the deep neck extensors in a symptomatic population. The accuracy of the CEET as a test is still debatable, as it has not been compared to a diagnostic gold standard. Based on the results of this study, we speculate the CEET may still offer an initial sense of direction for clinicians treating neck dysfunction.

The sitting active and prone passive lag test: an inter-rater reliability study.

BACKGROUND & PURPOSE: To determine inter-rater reliability in identifying a knee extension lag using the sitting active and prone passive lag test (SAPLT). METHODS: 56 patients with a diagnosis of knee pain were randomly assigned and independently examined by two physical therapists at a time, to determine the presence of an active or a passive extension lag at the knee. An active lag was determined by the inability of the erectly seated subject to actively extend the involved knee in maximal dorsiflexion of the ankle to the same level as the normal knee held in maximal extension and ankle in maximal dorsiflexion, as seen by the levels of the toes. A passive lag was determined by placing the subject prone with the knees just past the edge of the table and determining the high position of the heel in a fully resting extension position compared to the heel on the normal side. RESULTS: For the sitting active lag test, the inter-rater reliability was 'good' (Kappa 0.792, SE of kappa 0.115, 95% confidence interval). For the prone passive lag test, the inter-rater reliability was 'good' (Kappa 0.636, SE of kappa 0.136, 95% confidence interval). CONCLUSION: The SAPLT may be incorporated as a simple yet effective test to determine the presence of a knee extension lag. It identifies the type of restraint, active, passive or both, and is suggestive of the most appropriate management.