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Variability of shoulder girdle proprioception in 44 healthy volunteers - 06/04/19

Doi : 10.1016/j.otsr.2019.01.019 
Camille Echalier a, , Julien Uhring b, Julie Ritter a, Pierre-Bastien Rey c, Emmanuelle Jardin d, Séverin Rochet a, Laurent Obert a, François Loisel a
a Service de chirurgie orthopédique, département universitaire, CHU de Besançon, boulevard Alexandre-Fleming, 25000 Besançon, France 
b Hôpital-Clinique Claude Bernard, 97, rue Claude-Bernard, BP 45050, 57072 Metz, France 
c Hôpital Privé de la Miotte, 15, avenue de la Miotte, CS 30109, 90002 Belfort, France 
d Clinique du Diaconat-Roosevelt, 14, boulevard Roosevelt, 68067 Mulhouse, France 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 06 avril 2019
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Abstract

Background

Improved knowledge of normal shoulder girdle proprioception should benefit the treatment and rehabilitation of shoulder disorders. Whereas many of the available methods for assessing joint position sense (JPS) are costly and complex, Balke et al. have described a simple test. The primary objective of this study was to use this test to identify factors that influence shoulder-girdle JPS evaluation in healthy individuals. The secondary objective was to determine reference values based on the values obtained and on the factors associated with their variability.

Hypothesis

Age and dominant limb influence the results of shoulder girdle JPS evaluation, creating a need for reference values that take these factors in account.

Patients and methods

A single-centre prospective study of healthy volunteers was performed between September 2012 and January 2013. In each volunteer, shoulder repositioning accuracy was assessed bilaterally as described by Balke et al. A line was drawn on the floor parallel to and 1 metre away from a wall. A target on the wall showed marks corresponding to three angles of arm elevation: 55°, 90°, and 125°. The volunteer was asked to raise the arm to the three positions, in abduction and in flexion, while memorising the joint positions, then to replicate the same positions with the eyes closed. The absolute differences between the replicated positions and the reference positions, designated angle deviations, were measured in degrees. Age, sex, and dominant upper limb were recorded.

Results

The 88 shoulders of 44 healthy volunteers were studied. No significant difference was found between males and females (p>0.05). The only significant difference between sides was better replication by the dominant arm of flexion at 55° (p=0.03). By univariate analysis, age was the only factor significantly associated with repositioning errors (p=0.003); neither dominant limb nor sex were significant (p=0.29 and p=0.59, respectively). In flexion, the angle deviation increased significantly with movement amplitude. The measurements were used to create a chart of expected angle deviations in healthy individuals according to age and to plane and amplitude of movement.

Discussion

The test described by Balke et al. is simple and feasible in everyday practice. Age, dominance, and plane of movement should be considered when evaluating abnormal shoulders. Further studies in larger numbers of individuals are needed to better define normal angle deviations related to these factors.

Level of evidence

IV.

Le texte complet de cet article est disponible en PDF.

Keywords : Shoulder, Proprioception, Proprioception test, Joint position sense, Instability


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