Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols

J Shoulder Elbow Surg. 2014 Oct;23(10):1454-61. doi: 10.1016/j.jse.2014.01.006. Epub 2014 Apr 13.


Background: Shoulder range of motion (ROM) and strength measurements are imperative in the clinical assessment of the patient's status and progression over time. The method and type of assessment varies among clinicians and institutions. No comprehensive study to date has examined the reliability of a variety of procedures based on different testing equipment and specific patient or shoulder position. The purpose of this study was to establish absolute and relative reliability for several procedures measuring the rotational shoulder ROM and strength into internal (IR) and external (ER) rotation strength.

Methods: Thirty healthy individuals (15 male, 15 female), with a mean age of 22.1 ± 1.4 years, were examined by 2 examiners who measured ROM with a goniometer and inclinometer and isometric strength with a hand-held dynamometer (HHD) in different patient and shoulder positions. Relative reliability was determined by intraclass correlation coefficients (ICC). Absolute reliability was quantified by standard error of measurement (SEM) and minimal detectable change (MDC). Systematic differences across trials or between testers, as well as differences among similar measurements under different testing circumstances, were analyzed with dependent t tests or repeated-measures analysis of variance in case of 2 or more than 2 conditions, respectively.

Results: Reliability was good to excellent for IR and ER ROM and isometric strength measurements, regardless of patient or shoulder position or equipment used (ICC, 0.85-0.99). For some of the measurements, systematic differences were found across trials or between testers. The patient's position and the equipment used resulted in different outcome measures.

Conclusions: All procedures examined showed acceptable reliability for clinical use. However, patient position and equipment might influence the results.

Keywords: Shoulder rotation; goniometer; hand-held dynamometer; inclinometer; range of motion measurement; reliability; strength measurement.

MeSH terms

  • Arthrometry, Articular
  • Female
  • Humans
  • Male
  • Muscle Strength Dynamometer
  • Range of Motion, Articular
  • Reproducibility of Results
  • Rotation
  • Shoulder Joint / physiology*
  • Young Adult