Reliability and validity of a 1-person technique to measure humeral torsion using ultrasound

Context: Knowledge of the bilateral difference in humeral torsion (HT) enables clinicians to implement appropriate interventions for soft tissue restrictions of the shoulder to restore rotational motion and reduce injury risk. Whereas the current ultrasound method for measuring HT requires 2 assessors, a more efficient 1-person technique (1PT) may be of value. Objective: To determine if a 1PT is a reliable and valid alternative to the established 2-person technique (2PT) for indirectly measuring HT using ultrasound. Design: Descriptive laboratory study. Setting: Biomechanics laboratory. Patients or Other Participants: A convenience sample of 16 volunteers (7 men, 9 women; age ¼ 26.9 6 6.8 years, height ¼ 172.2 6 10.7 cm, mass ¼ 80.0 6 13.3 kg). Main Outcome Measure(s): We collected the HT data using both the 1PT and 2PT from a total of 30 upper extremities (16 left, 14 right). Within-session intrarater reliability (intraclass correlation coefficient; ICC [3,1]) and standard error of measurement (SEM) were assessed for both techniques. Simple linear regression and Bland-Altman analysis were used to examine the validity of the 1PT when compared with the established 2PT. Results: The 1PT (ICC [3,1] ¼ 0.992, SEM ¼ 0.88) and 2PT (ICC [3,1] ¼ 0.979, SEM ¼ 1.18) demonstrated excellent within-session intrarater reliability. A strong linear relationship was demonstrated between the HT measurements collected with both techniques (r ¼ 0.963, r ² ¼ 0.928, F_1,28 ¼ 361.753, P, .001). A bias of 1.28 6 2.68 was revealed, and the 95% limits of agreement indicated the 2 techniques can be expected to vary from 6.38 to 3.88. Conclusions: The 1PT for measuring HT using ultrasound was a reliable and valid alternative to the 2PT. By reducing the number of testers involved, the 1PT may provide clinicians with a more efficient and practical means of obtaining these valuable clinical data.^a