title: Assessment of glenohumeral subluxation in poststroke hemiplegia: comparison between ultrasound and fingerbreadth palpation methods.
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.
  
  
  METHODS
  A prospective study was conducted.
  
  
  METHODS
  The study was conducted in local hospitals and day centers in the southwest of England.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: 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. Praveen.Kumar@uwe.ac.uk.
authors: Praveen
authors: P
authors: Kumar
authors: M. Mardon, BSc, Department of Physiotherapy, University Hospital Bristol, Bristol, United Kingdom.
authors: Marianne
authors: M
authors: Mardon
authors: M. Bradley, MD, Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors: Michael
authors: M
authors: Bradley
authors: S. Gray, MBChB, MD, Centre for Clinical and Health Services Research, University of the West of England.
authors: Selena
authors: S
authors: Gray
authors: A. Swinkels, PhD, Department of Physiotherapy, University of the West of England.
authors: Annette
authors: A
authors: Swinkels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006429:Hemiplegia / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009129:Muscle Tonus; D010173:Palpation / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging* / Q000209:etiology; D020521:Stroke / Q000150:complications*; D014463:Ultrasonography