In vivo measurements of humeral movement during posterior glenohumeral mobilizations

Abstract

Objectives: The purpose of this study was to quantify in vivo posterior translational movements occurring in the glenohumeral joint during posterior mobilizations and to determine the intratester reliability of those posterior translational movements.

Methods: Twenty-eight individuals (17 females, 11 males) participated in this study. One physical therapist utilized a Kaltenborn approach to apply three grades of posterior humeral mobilization. A hand held dynamometer was used to quantify the force used during each grade of mobilization. Ultrasound imaging was used to visualize and measure posterior humeral movement. Statistical analysis included descriptive statistics for force and posterior movement, intraclass correlation coefficient (ICC) for intrarater reliability of force and posterior movement during each grade of mobilization and paired t-tests to compare movement and force between grades of mobilization.

Results: Mean posterior movement (mm) measurements were 3.0, 8.2 and 10.7 for grade I, grade II and grade III mobilizations, respectively. Mean force (Newtons) measurements used during mobilization were 41.7, 121.5 and 209.4 for grade I, grade II and grade III mobilizations, respectively. The ICCs ranged from 0.849 to 0.905 for movement and from 0.717 to 0.889 for force. Force and measurement values were significantly different between grades of mobilization and between dominant and non-dominant arms. Gender was found to be significantly associated with force.

Discussion: Mean movements and mean forces occurring during posterior mobilization increased with increasing grades. Intratester reliability was high for all grades of manual mobilization supporting the use of subjective feedback to determine appropriate force application. Quantification of forces and movements helps to clarify parameters that can serve as a reference for clinical practice.

Keywords: Force; Manual therapy; Mobilization; Reliability; Shoulder joint; Ultrasound imaging.

Figures

Figure 1

(A) The mobilization test position. The shoulder is placed in 55°of abduction and 30° of horizontal adduction. The hand held dynamometer is position on the anterior humerus. The ultrasound transducer is placed horizontally over the anterior glenohumeral joint. (B) The transducer was moved medial and lateral until the biceps tendon, lesser tubercle and coracoid process were visualized in the ultrasound image.

Figure 2

Images taken during a grade 1 mobilization (A), a grade 2 mobilization (B) and a grade 3 mobilization (C). To determine the amount of movement, the distance between the superior aspect of the coracoid process (superior red line) and the lesser tubercle (inferior red line) was measured (green arrow).