The Reliability and Validity of a Clinical Measurement Proposed to Quantify Humeral Torsion

BACKGROUND: Range of motion (ROM) impairments of the overhead athletes’ shoulder are commonly addressed through mobility-based treatments, however, adaptations from humeral torsion (HT) are not amenable to such interventions. A clinical measurement to quantify HT has been proposed, however, the validity is not conclusive. PURPOSE: The primary aim of this study is to determine the intrarater reliability and standard error of measurement (SEM) of the biceps forearm angle (BFA) measurement. The secondary aim of this study is to investigate the convergent validity of the BFA compared to diagnostic ultrasound. STUDY DESIGN: Cross Sectional Reliability and Validity Study METHODS: HT measurements, utilizing diagnostic ultrasound, were compared to BFA in 74 shoulders (37 subjects) over two sessions. Each measurement was performed three times and a third investigator recorded measures to ensure blinding. Reliability was investigated using utilizing an intraclass correlation coefficient (ICC 3,k) RESULTS: Intrarater reliability values were 0.923 and 0.849 for diagnostic ultrasound and BFA methods respectively. Convergent validity was r = 0.566. The standard error of measurement for diagnostic ultrasound and BFA was 3° and 5°, respectively. The 95% limits of agreement between the two measurement methods were -24.80° and 19.80° with a mean difference of -2.50° indicating that on average the diagnostic ultrasound measurement was lower than that of the BFA method. CONCLUSION: The BFA is a reliable clinical method for quantifying HT, however, demonstrates moderate to poor convergent validity when compared to diagnostic ultrasound. LEVEL OF EVIDENCE: 2b