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Assessment of Glenohumeral Subluxation in Poststroke Hemiplegia: Comparison Between Ultrasound and Fingerbreadth Palpation Methods

Praveen Kumar, Marianne Mardon, Michael Bradley, Selena Gray, Annette Swinkels
DOI: 10.2522/ptj.20130303 Published 1 November 2014
Praveen Kumar
P. Kumar, PhD, MCSP, MIAP, MSPA, Department of Allied Health Professions, Faculty of Health and Life Sciences, University of the West of England, Room 1K05, Glenside Campus, Blackberry Hill, Stapleton, Bristol, BS16 1DD, United Kingdom.
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Marianne Mardon
M. Mardon, BSc, Department of Physiotherapy, University Hospital Bristol, Bristol, United Kingdom.
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Michael Bradley
M. Bradley, MD, Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
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Selena Gray
S. Gray, MBChB, MD, Centre for Clinical and Health Services Research, University of the West of England.
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Annette Swinkels
A. Swinkels, PhD, Department of Physiotherapy, University of the West of England.
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Abstract

Background Glenohumeral subluxation (GHS) is a common poststroke complication. Treatment of GHS is hampered by the lack of objective, real-time clinical measurements.

Objective The aims of this study were: (1) to compare an ultrasound method of GHS measurement with the fingerbreadth palpation method using a receiver operating characteristic curve (ROC) and (2) to report the sensitivity and specificity of this method.

Design A prospective study was conducted.

Setting The study was conducted in local hospitals and day centers in the southwest of England.

Patients One hundred five patients who had one-sided weakness following a first-time stroke (51 men, 54 women; mean age=71 years, SD=11) and who gave informed consent were enrolled in the study.

Measurements Ultrasound measurements of acromion–greater tuberosity (AGT) distance were used for the assessment of GHS. Measurements were undertaken on both shoulders by a research physical therapist trained in shoulder ultrasound with the patient seated in a standardized position. Fingerbreadth palpation assessment of GHS was undertaken by a clinical physical therapist based at the hospital, who also visited the day centers.

Results The area under the ROC curve was 0.73 (95% confidence interval [95% CI]=0.63, 0.83), suggesting that the ultrasound method has good agreement compared with the fingerbreadth palpation method. A cutoff point of ≥0.2 cm AGT measurement difference between affected and unaffected shoulders generated a sensitivity of 68% (95% CI=51%, 75%), a specificity of 62% (95% CI=47%, 80%), a positive likelihood ratio of 1.79 (95% CI=1.1, 2.9), and a negative likelihood ratio of 0.55 (95% CI=0.4, 0.8).

Limitations Clinical therapists involved in the routine care of patients conducted the fingerbreadth palpation method. It is likely that they were aware of the patients' subluxation status.

Conclusion The ultrasound method can detect minor asymmetry (≤0.5 cm) and has the potential advantage over the fingerbreadth palpation method of identifying patients with minor subluxation.

Footnotes

  • All authors provided concept/idea/research design and consultation (including review of manuscript before submission). Dr Kumar provided writing and data analysis. Dr Kumar and Ms Mardon provided data collection, facilities/equipment, and institutional liaisons. Dr Kumar and Dr Swinkels provided project management. Ms Mardon provided study participants.

  • The authors thank all participants, Sonosite Limited, Hitchin, United Kingdom (loan of ultrasound equipment), the manager and support staff at the Bristol Area Stroke Foundation (help with recruitment), and Dr Paul White and Dr Jon Pollock (statistical help). Special thanks to the following physical therapists (clinical investigators) for help with recruitment and data collection: Carol Jenkins, Karen-Martyn Jones, Paul Cunningham (University Hospital Bristol), Fiona Henchie (Weston General Hospital), and Lucy Holl and Rebecca Wedeman (Chippenham Community Hospital).

  • This research was undertaken as part of Dr Kumar's doctoral thesis, which was funded by the University of the West of England, Bristol, United Kingdom.

  • Received July 15, 2013.
  • Accepted July 4, 2014.
  • © 2014 American Physical Therapy Association
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Vol 94 Issue 11 Table of Contents
Physical Therapy: 94 (11)

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Assessment of Glenohumeral Subluxation in Poststroke Hemiplegia: Comparison Between Ultrasound and Fingerbreadth Palpation Methods
Praveen Kumar, Marianne Mardon, Michael Bradley, Selena Gray, Annette Swinkels
Physical Therapy Nov 2014, 94 (11) 1622-1631; DOI: 10.2522/ptj.20130303

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Assessment of Glenohumeral Subluxation in Poststroke Hemiplegia: Comparison Between Ultrasound and Fingerbreadth Palpation Methods
Praveen Kumar, Marianne Mardon, Michael Bradley, Selena Gray, Annette Swinkels
Physical Therapy Nov 2014, 94 (11) 1622-1631; DOI: 10.2522/ptj.20130303
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