Scientific/Clinical Article| Volume 30, ISSUE 4, P420-431, October 2017

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What is the reliability of clinical measurement tests for humeral head position? A systematic review

Published:August 09, 2017DOI:


      Study Design

      Systematic review.


      Physiotherapists routinely assess the position of the humeral head (HH) in patients with shoulder pain.

      Purpose of the Study

      To conduct a systematic review to determine the quality and content of studies that evaluated the reliability of clinical measurement methods for assessing the HH position.


      Five databases and gray literature were searched for studies fitting the eligibility criteria. After abstract and full-text review, the included studies were appraised using the Quality Appraisal of Reliability Studies checklist. Articles were considered of high quality if 8 was achieved on the checklist, and the overall quality of evidence was classified using prespecified criteria. Multiple raters extracted and performed quality ratings; a consensus process was used to finalize the reliability data that were synthesized and presented in a narrative synthesis. Reliability was classified as excellent if the intracorrelation coefficients or intercorrelation coefficients (ICCs) reported exceeded 0.75.


      Fifteen studies on the reliability of ultrasound (US) and 3 studies on palpation were included. The methodologic quality was moderate in 17 of 18 studies. The intrarater reliability for all studies was excellent (ICC, 0.76-0.99) with the exception of the 90° abduction in internal rotation position (ICC, 0.48) for palpation. The inter-rater reliability tended to be lower (ICC, 0.48-0.68) for palpation and higher (ICC, 0.66-0.99) for US. Physiotherapists demonstrated excellent intrarater reliability across different levels of training in ultrasonography.


      Our study found a moderate overall level of evidence to support the use of US for assessing HH position in symptomatic or asymptomatic subjects.


      A moderate overall level of evidence exists for the use of US to reliably assess the HH position. Limited research supports the methods used for palpation within a clinical setting.

      Level of Evidence



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      JHT Read for Credit

      Quiz: #503

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The study design is
        • a.
          a prospective cohort
        • b.
        • c.
        • d.
          a systematic review
      • #2.
        The purpose of the investigation was to determine the _______________of clinical tests for humeral head position
        • a.
          most common application
        • b.
          correlation to X-ray findings
        • c.
        • d.
      • #3.
        The palpation method was based on comparing the distance between the _________________________ in the involved limb to that same measure in the uninvolved limb
        • a.
          anterior acromion and the anterior humeral head
        • b.
          anterior acromion and the bicipital groove
        • c.
          anterior humeral head and the scapular notch
        • d.
          anterior humeral head and the A/C joint
      • #4.
        The reliability was
        • a.
          greater for inter-rater than intra-rater
        • b.
          greater for intra-rater than inter-rater
        • c.
          the same for intra-rater and inter-rater
        • d.
          none of the above
      • #5.
        Conclusive evidence was found for the use of both methods, ultra sound and palpation
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.