Changing our Diagnostic Paradigm Part II: Movement System Diagnostic Classification.

Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.

Development of three-dimensional shoulder kinematic and electromyographic exposure variation analysis methodology in violin musicians.

A total of 11 male and 19 female violinists performed 30-second random-ordered slow and fast musical repertoire while right shoulder three-dimensional kinematic, and upper trapezius and serratus anterior surface electromyography (EMG) data were summarised using exposure variation analysis (EVA), a bivariate distribution of work time spent at categories of signal amplitude, and duration spent at a fixed category of amplitude. Sixty-two per cent of intraclass correlation coefficients [1,1] for all kinematic and EMG variables exceeded 0.75, and 40% of standard error of the measurement results were below 5%, confirming EVA reliability. When fast repertoire was played, increases in odds ratios in short duration cells were seen in 23 of 24 possible instances, and decreases in longer duration cells were seen in 17 instances in all EVA arrays using multinomial logistic regression with random effects, confirming a shift towards shorter duration. A reliable technique to assess right shoulder kinematic and EMG exposure in violinists was identified. PRACTITIONER SUMMARY: A reliable method of measuring right shoulder motion and muscle activity exposure variation in violinists was developed which can be used to assess ergonomic risk in other occupations. Recently developed statistical methods enabled differentiation between fast and slow musical performance of standardised musical repertoire.