Bari Shoulder Telemedicine Examination Protocol (B-STEP): A Standard Protocol for Personalized Remote Shoulder Examination
Abstract
:1. Introduction
Manuscript Organization
2. Materials and Methods
- Glenoid, humeral, and scapular fractures: a patient with proximal humerus fracture treated with plate and screws
- Tendinitis and long head of the biceps tendon (LHB) injuries: a patient with LHB tendonitis was treated with mesotherapy
- Rotator cuff injuries: a patient with supraspinatus (SSP) tendon lesion treated arthroscopically.
- Acromioclavicular locations: an acromioclavicular dislocation surgically treated with a tight-rope technique
- Glenohumeral osteoarthritis (GHO): a patient with glenohumeral osteoarthritis, not eligible for surgery, in conservative treatment
- Shoulder instability and/or superior labrum anterior-posterior (SLAP) lesion: a patient with recurrent shoulder dislocation treated with remplissage
2.1. Outpatient Clinical Examination
2.2. The Bari Shoulder Telemedicine Exam Protocol (B-STEP)
2.2.1. Preliminary Phase:
2.2.2. Phase I: Anamnesis
2.2.3. Phase II: Visual Examination
2.2.4. Phase III: Palpatory Examination
2.2.5. Phase IV: ROM (Constant Score Application) [19]
- -
- 0 pounds (0 kg)
- -
- 1–3 pounds (0.45–1.3 kg); example: 1 to 3 packages of pasta in a bag
- -
- 4–6 pounds (1.8–2.7 kg); example: a 2 L bottle up to 2 1.5 L bottles
- -
- […]
- -
- >24 pounds (>10 kg) example: a bale of water with 2 L bottles
2.2.6. Phase V: Specific Tests
3. Results
Telemedicine Reproducibility of Specific Tests in the Objective Examination of the Shoulder
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Inclusion Criteria |
---|
Over 18 years of age |
Capable of expressing informed agreement |
A known diagnosis |
At least 6 months follow up |
Availability of electronic devices with webcam (cell phones, tablets, pc) |
Exclusion Criteria |
The concomitance of more than shoulder pathology |
Presence of other rheumatological, orthopedic, or neurological ipsilateral upper limb pathologies |
Inability/unwillingness to be remotely monitored. |
Specific Test | Tested Pathology | Test Description | Criteria for Positivity | Sens/Spec in Literature |
---|---|---|---|---|
Rotator cuff integrity | ||||
Intra-rotation against resistance [8] | Subscapularis | Upper limb along the trunk, forearm flexed 90° in a neutral position. Intrarotation is forced against a door jamb | Test positive if evoking pain or strength deficit relative to contralateral is reported | Sens: 0.56 Spec: 0.87 |
Hand behind the back [9] | Subscapularis | Shoulder intrarotation bringing the hand behind the back (“bra lacing movement”) | Range of motion assessment (hand at lumbar level, hand at thoracolumbar level, …) | Reliability: Weighted k 0.73 |
Belly-press [10] | Subscapularis | The upper limb was slightly abducted and intrarotated by bringing the palm up to the navel level. The patient is asked to intrarotate the limb by pressing the hand against the abdomen | Positive test if the patient fails to keep the elbow in the frontal plane during the intrarotation movement | Sens: 0.40 Spec: 0.98 |
Extra-rotation against resistance [11] | Infraspinatus/teres minor | Upper limb along the trunk, forearm flexed 90° in a neutral position. The patient is asked to force extrotation against a door jamb | Test positive if evoking pain or strength deficit relative to contralateral is reported | Sens: 0.46 Spec: 0.94 |
Extrotation with abducted arm [11] | Infraspinatus/teres minor | Abduction of the shoulder to 90° and simultaneous external rotation. | The feeling of apprehension or pain at maximum degrees of extrotation | Sens: 0.40–0.62 Spec: 0.42–0.87 |
Hand behind neck [9,12] | Infraspinatus/teres minor | The patient brings the hand behind the neck | ROM amplitude is assessed: hand on the neck, hand on the ipsilateral scapula, and hand on the opposite scapula. The test is positive if it evokes pain | Reliability: Weighted k Intra-examinator: 0.80 Inter-examinator: 0.90 |
Jobe test [13] | SSP | Shoulder abducted to 90°, anterior flexion to approximately 45°; a supra-rotated limb. The patient is asked to further elevate the limb against known resistance | Test positive if evoking pain or strength deficit relative to contralateral is reported | Sens: 0.50–0.69 Spec: 0.62–0.87 |
SLAP lesions/LHB | ||||
Speed test [14] | SLAP lesion/long head bicep integrity | Anterior humerus flexion at 90°, upper extremity fully extended and supinated. The patient is asked to flex the elbow against resistance using a known weight | Test considered positive if it evokes pain at the level of the groove of the long head of the biceps | Sens: 0.20–0.60 Spec: 0.38–0.78 |
Impingement Syndrome | ||||
Painful ROM arch in abduction [14] | Impingement syndrome/subacromial bursitis | Abduction of the upper limb up to about 90°; possible extrotation of the limb to complete the ROM | Positive test if evokes pain | Sens: 0.56 Spec: 0.76 |
Shoulder instability | ||||
Anterior apprehension test [15,16] | Abduction of the shoulder to 90° and simultaneous external rotation. | The feeling of apprehension or pain at maximum degrees of extrotation | Sens: 0.40–0.62 Spec: 0.42–0.87 | |
Relocation test [17] | Supine patient; glenohumeral joint at the edge of the table. Arm in 90° abduction and fully extrotated, with the elbow flexed 90°. A direct posterior force is applied to the humeral head | The test is positive if the force application reduces pain or apprehension | Sens: 0.81 Spec: 0.92 | |
Drawer test [17] | Supine patient; glenohumeral joint at the edge of the table. Arm at 60–80° of abduction and in neutral rotation. A force is applied to translate the humeral head anteriorly | Test positive if eliciting pain | Sens: 0.28–0.53 Spec: 0.71–0.85 | |
Crank test [14] | Patient supine; arm elevated to 160°. An axial force is applied to the humerus while the shoulder is intra- and extra-rotated. | Test positive if eliciting pain | Sens: 0.34 Spec: 0.75 | |
Fulcrum test [15] | Patient supine; arm abducted to 90° and elbow flexed to 90°; an axial force in compression is applied to the humerus and the shoulder is rotated. | Test positive if eliciting pain | Sens: 0.61 Spec: 0.54 | |
Jerk test [18] | Patient seated. The arm intrarotated and elevated to 90° of abduction. Then, an abduction movement is performed on the horizontal plane and an axial force is applied to the humerus. | Test positive if eliciting pain | Sens: 0.73 Spec: 0.98 |
Proximal Humeral Fracture | LHB Tendinitis | SSP Lesion, Surgically Treated | Acromion-Clavear Luxation | Hemarthrosis | Shoulder Instability | |
---|---|---|---|---|---|---|
Orthopedic physician 1 | Constant: 87.5% ASES: 100% | Constant: 100% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 100% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 75% ASES: 100% |
Orthopedic physician 2 | Constant: 100% ASES: 100% | Constant: 100% ASES: 100% | Constant: 100% ASES: 100% | Constant: 100% ASES: 100% | Constant: 100% ASES: 100% | Constant: 100% ASES: 100% |
Orthopedic physician 3 | Constant: 100% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% |
Orthopedic physician 4 | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 75% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% |
Orthopedic physician 5 | Constant: 100% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 100% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100%: |
Orthopedic physician 6 | Constant: 100% ASES: 100%: | Constant: 75% ASES: 100%: | Constant: 87.5% ASES: 100%: | Constant: 87.5% ASES: 100%: | Constant: 100% ASES: 100%: | Constant: 87.5% ASES: 100%: |
Orthopedic physician 7 | Constant: 87.5% ASES: 100%: | Constant: 87.5% ASES: 100%: | Constant: 87.5% ASES: 100%: | Constant: 87.5% ASES: 100%: | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% |
Orthopedic physician 8 | Constant: 100% ASES: 100%: | Constant: 87.5% ASES: 100% | Constant: 100% ASES: 100% | Constant: 75% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% |
Orthopedic physician 9 | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 100% ASES: 100% | Constant: 100% ASES: 100% |
Orthopedic physician 10 | Constant: 87.5% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 100% ASES: 100% | Constant: 87.5% ASES: 100% | Constant: 100% ASES: 100% | Constant: 87.5% ASES: 100% |
Tab 3 | ROM | Bellypress | Empty-Can Test | Speed Test | Yocum | Neer Sign | Relocation Test | Apprehension Test | Drawer Test | Crank Test | Fulcrum Test | Jerk Test |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Orthopedic physician 1 | Yes | Yes | Yes | Yes | No | Yes | No | Yes | No | No | No | No |
Orthopedic physician 2 | Yes | Yes | Yes | Yes | No | No | No | Yes | No | No | No | No |
Orthopedic physician 3 | Yes | No | Yes | No | Yes | No | No | Yes | No | No | No | No |
Orthopedic physician 4 | Yes | No | Yes | Yes | No | Yes | No | No | No | No | No | No |
Orthopedic physician 5 | Yes | Yes | No | Yes | No | Yes | No | Yes | No | No | No | No |
Orthopedic physician 6 | Yes | Yes | No | Yes | No | No | No | Yes | No | No | No | No |
Orthopedic physician 7 | Yes | Yes | Yes | Yes | Yes | No | No | Yes | No | No | No | No |
Orthopedic physician 8 | Yes | No | Yes | Yes | No | No | No | No | No | No | No | No |
Orthopedic physician 9 | Yes | Yes | Yes | Yes | No | No | No | Yes | No | No | No | No |
Orthopedic physician 10 | Yes | No | Yes | No | No | No | No | No | No | No | No | No |
Reprod.: | 10/10 | 6/10 | 8/10 | 8/10 | 3/10 | 3/10 | 0/10 | 7/10 | 0/10 | 0/10 | 0/10 | 0/10 |
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Share and Cite
Moretti, L.; Bizzoca, D.; Farì, G.; Caricato, A.; Angiulli, F.; Cassano, G.D.; Solarino, G.; Moretti, B. Bari Shoulder Telemedicine Examination Protocol (B-STEP): A Standard Protocol for Personalized Remote Shoulder Examination. J. Pers. Med. 2023, 13, 1159. https://doi.org/10.3390/jpm13071159
Moretti L, Bizzoca D, Farì G, Caricato A, Angiulli F, Cassano GD, Solarino G, Moretti B. Bari Shoulder Telemedicine Examination Protocol (B-STEP): A Standard Protocol for Personalized Remote Shoulder Examination. Journal of Personalized Medicine. 2023; 13(7):1159. https://doi.org/10.3390/jpm13071159
Chicago/Turabian StyleMoretti, Lorenzo, Davide Bizzoca, Giacomo Farì, Alessandro Caricato, Francesco Angiulli, Giuseppe Danilo Cassano, Giuseppe Solarino, and Biagio Moretti. 2023. "Bari Shoulder Telemedicine Examination Protocol (B-STEP): A Standard Protocol for Personalized Remote Shoulder Examination" Journal of Personalized Medicine 13, no. 7: 1159. https://doi.org/10.3390/jpm13071159