Date of Graduation

2008

Document Type

Thesis

Degree Type

MS

Committee Chair

Michelle A. Sandrey

Abstract

Context: Rotator cuff pathologies are common in baseball and softball. The diagnosis of rotator cuff injuries can be difficult to obtain due to the number of pathological conditions that affect the rotator cuff. While current rotator cuff evaluation techniques are used based on best clinical practice or evidence based research, no comprehensive evaluation tool exists that combines these two ideas. Objective: The purpose of this study is to create a concise, comprehensive rotator cuff evaluation tool for a throwing athlete, specifically a baseball or softball player, that includes evidence based research and best clinical practice. Design: The study is a descriptive prospective study based on the modified Delphi technique. Setting: The study took place at West Virginia University. Patients and Other Participants: Participants consisted of 19 participants for the first round and five for the second round. The experts were chosen based on their knowledge and expertise in evaluating rotator cuff injuries in baseball and softball. Other inclusion criteria were based on publications in the literature, their presentations at professional conferences, and by their clinical experiences with baseball and softball. Interventions: Three questionnaires were utilized in this study. The demographic questionnaire gathered information about the participants. The demographic questionnaire was emailed to the subjects following the first round questionnaire. The first round questionnaire that was sent to participants included the possible components of the rotator cuff evaluation tool. The participants were asked to rate each component on a 5-point Likert scale. The participants then returned the questionnaires. A second questionnaire with mean scores, frequencies, and additional write-in comments from the first round were mailed to the participants. Follow up cover letters for the first and second rounds were mailed one week before the due dates as reminders to complete the questionnaire. The responses from the second questionnaire will contribute to development of the evaluation tool. Main Outcome Measures: With a consensus of the participants (75%, and a mean score of 4), the entire evaluation process of the shoulder joint and shoulder girdle will be similar. There will also be an individual hypothesis for each component of the screening tool. These hypotheses include the following: with a consensus of the participants (75%, and a mean score of 4), the responses for the history, subjective complaints, observation and palpations, range of motion, manual muscle testing, functional testing, and special tests sections of the screening tool will be similar. Results: All of the components from the first round questionnaire remained on the second round. There were several additional comments from the first round that were placed on the second round questionnaire for participants to view. The final evaluation tool consisted of what should be included in a rotator cuff evaluation tool based on evidence based guidelines and best clinical practice. All components from the history, subjective complaints, manual muscle testing, and rotator cuff sections remained. Muscle symmetry and digital camera were eliminated from observations/palpations. Goniometer measurements, visual measurements, inclinometer, and tape measure were removed by the panel of experts in the range of motion/flexibility section; however goniometric measurements were returned based on the literature. The Rotator Cuff Functional Index was removed from functional testing. Sulcus sign was removed from the instability section. Neer’s Sign and Hawkins’ Test were removed from the impingement section, but were returned for the final tool based on the literature. All of the scapular special tests were removed. Most of the neurovascular components were removed. The only component that remained was the ulnar nerve. Conclusion: The responses from both rounds by the panel of experts led to the development of guidelines for a rotator cuff evaluation tool. Due to the lack of participation in the second round, this tool is not representative of NCAA Division I athletic trainers, physical therapists, and GH researchers. Since the remaining components are supported by evidence based research and current best clinical practice, this tool can serve as a guideline for an evaluation tool for the rotator cuff in overhead throwing athletes. Additional studies should continue for the development of a rotator cuff evaluation tool.

Download

Share

COinS