An Apparatus and Protocol to Measure Shoulder Girdle Strength

Abstract

Muscles actuating the shoulder girdle are important for stabilizing the scapula and coordinating phased kinematics of the shoulder complex. If these muscles become weak or imbalanced, joint instability and injury may result. Reliable measurement of shoulder strength is thus important for prevention, diagnosis, and rehabilitation of shoulder problems. To date, studies quantifying the strength of the shoulder girdle are limited. The purpose of this work was to design and evaluate a custom apparatus and corresponding protocol for measuring maximal, voluntary, isometric strength of the shoulder girdle during various forms of shrugging exercise. A custom apparatus was constructed as a rigid frame with a vertical post supporting a seat, seat back, and horizontal beam. The beam extends laterally on either side beyond and around the shoulders of a seated subject. A pair of arm extension members pivots on the beam about an axis aligned with the shoulder flexion-extension axis. These members can be locked in place at any angle. Between them is mounted a force-sensing grip assembly, which can be adjusted proximally or distally to accommodate varying shoulder girdle positions. Subjects grasp the grip assembly handles with extended elbows and push or pull as forcefully as possible. Nine female and ten male subjects participated in a protocol using the apparatus to measure maximum isometric force generated at three positions each for elevation, depression, protraction, and retraction of the shoulder girdle (3positions×4modes=12tests). A video motion capture system was used to measure shoulder girdle angles. The reliability of the approach was evaluated based on the repeatability of measured shoulder elevation angle, protraction angle, and total force over three days of testing. The apparatus performed well during the tests, providing a stable, rigid, yet adjustable platform for measuring shoulder girdle strength. Repeatability of force measurements was interpreted as very good to excellent, with intraclass correlation coefficient (ICC) (2,1) values ranging from 0.83 to 0.95 for all tests except one (ICC=0.79). Repeatability of angle measurements was interpreted as good to excellent. For tests measuring elevation and depression strength, the ICC of elevation angle ranged from 0.85 to 0.89. For tests measuring protraction and retraction strength, the ICC of protraction angle ranged from 0.68 to 0.88. This type of apparatus could be an effective clinical tool for measuring strength in the shoulder girdle muscles. Use of the video motion capture system is optional.