INTER AND INTRA-RATER RELIABILITY OF THE DROP VERTICAL JUMP (DVJ) ASSESSMENT.

BACKGROUND: Non-contact injuries are common in sports as abnormal lower extremity joint mechanics can place athletes at risk for injury. It is important to have reliable, feasible, cost-effective assessment tools to determine lower limb control and injury risk. HYPOTHESIS/PURPOSE: The purpose of the study was to assess the intra- and inter-rater reliability of a three-tiered anterior cruciate ligament (ACL) injury risk rating assessment of the drop vertical jump using frontal plane, two-dimensional (2-D) motion capture. STUDY DESIGN: Repeated measures. METHODS: Twenty male elite basketball athletes performed the drop vertical jump during a 2-D video assessment at Mayo Clinic Sports Medicine Center in Minneapolis, Minnesota. DVJ scores indicated the following: 1 no visible knee valgus, 2 slight wobble, inward motion of the knees, and 3 knee collision or large frontal plane knee excursion. Score assessment from video of the drop vertical jump was obtained by four independent investigators. The four raters then re-examined the same videos 1 month later, blinded to their original scores. RESULTS: Intra-rater reliability Fleiss Kappa measure of agreement was substantial amongst all four raters at all scoring time points: initial contact (0.672), first landing (0.728), second landing (0.670), and peak valgus (0.662) (p < 0.001). The intra-rater ICC values were good at initial contact (0.809), second landing (0.874), and max valgus (0.885), however were excellent at first landing (0.914) (p < 0.001). Inter-rater reliability Fleiss Kappa measurement scores were slight at initial contact (0.173), fair at max valgus (0.343), and moderate at first landing (0.532) and second landing (0.514; p < 0.001). Inter-rater ICC values were moderate at initial contact (0.588), excellent at first landing (0.919), and good at second landing (0.883) and max valgus (0.882; p<0.001). CONCLUSION: When comparing scores of the drop vertical jump between four independent raters across two sessions, the study demonstrated substantial Kappa and good to excellent ICC intra-rater reliability. Inter-rater reliability demonstrated slight to moderate Kappa measurements of agreement and moderate to excellent ICC's. Thus, for excellent reliability using this assessment, patients should be scored by one individual. For moderate reliability between multiple raters, the first landing of the DVJ should be scored. Findings indicate that the proposed drop vertical jump assessment may be used for reliable identification of abnormal landing mechanics. LEVEL OF EVIDENCE: Level 3.

Refractory Ulnar Nerve Symptoms in an Adolescent Pitcher With Medial Apophysitis.

A 16-year-old high school baseball pitcher with a 3-week history of acute-onset pain in his medial elbow during throwing presented to physical therapy. Following examination, physical therapy was initiated and the patient was referred for imaging, with suspicion of ulnar collateral ligament (UCL) injury. Radiographs were noncontributory. Ultrasound imaging, however, was performed by a physiatrist and was suggestive of a partial-thickness tear of the UCL and ulnar nerve enlargement. The physiatrist ordered magnetic resonance imaging, which confirmed a medial apophyseal stress reaction, a mild UCL sprain, and reactive ulnar nerve edema. J Orthop Sports Phys Ther 2018;48(5):419. doi:10.2519/jospt.2018.7359.

Ultrasound Evaluation of the Lower Trapezius in Adolescent Baseball Pitchers.

BACKGROUND: Biomechanical studies have demonstrated that the lower trapezius (LT) facilitates normal shoulder function, and given its potential role in causing and/or perpetuating dysfunction, clinicians have begun to evaluate and rehabilitate the LT in the context of comprehensive shoulder rehabilitation programs. Although some studies have compared side-to-side differences in LT thickness among nonthrowers, no studies have been performed to examine the normal ultrasound appearance of the LT in the adolescent throwing population. OBJECTIVES: To examine whether LT thickness and cross-sectional area (CSA) differ between dominant and nondominant sides in adolescent baseball pitchers and to determine the inter-rater and intrarater reliability of the sonographically measured parameters. STUDY DESIGN: Observational, repeated measures study. SETTING: Hospital-based outpatient practice. PARTICIPANTS: Thirty asymptomatic male baseball pitchers aged 13-18 years with at least 3 years of pitching experience from a convenience sample in the Rochester, Minnesota, area. METHODS: LT thickness and CSA were measured at the T8 and T5 vertebral levels at rest, and thickness was measured again in active prone T- and Y-pose positions by multiple investigators. Side-to-side differences in thickness and CSA were examined, and inter-rater and intrarater measurement reliability coefficients were estimated. MAIN OUTCOME MEASUREMENTS: Thickness and cross-sectional area were measured. For reliability, we calculated intraclass correlation coefficients along with the standard error of measurement and the minimal detectable change. RESULTS: Resting LT thickness was 0.064 cm greater on the dominant side than on the nondominant side (P = .001). During contraction, LT thickness was 0.084 and 0.097 cm greater on the dominant side in the T and Y poses (P = .036 and P = .001, respectively). The CSA at the T5 level was 0.36 cm(2) greater on the dominant side than on the nondominant side (P < .001). Inter-rater and intrarater reliability coefficients exceeded 0.898 across all levels of measurement. CONCLUSION: Asymptomatic adolescent pitchers have greater resting and contracted LT thickness and resting CSA on the dominant versus the nondominant side, although the quantitative differences are small. These differences suggest that structural changes and asymmetry can manifest at young ages; however, clinically, the nondominant arm can be used as a control in the adolescent pitching population. Ultrasound provides a noninvasive way to reliably evaluate LT thickness and CSA in adolescent pitchers.