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The Reliability of Rehabilitative Ultrasound Imaging in the Measurement of Infraspinatus Muscle Function in the Symptomatic and Asymptomatic Shoulders of Patients with Unilateral Shoulder Impingement Syndrome.

Authors:   Koppenhaver S, Harris D, Harris A, O’Connor E, Dummar M, Croy T, Walker M, Flynn T

Rehabilitative ultrasound Imaging (RUSI) is increasingly used in the management of musculoskeletal conditions as it provides an objective measure of muscle function while being less invasive than needle electromyography.  While research has documented the ability to reliably measure trunk muscles in patients with back pain, no study to date has used RUSI to quantify infraspinatus muscle function in patients with shoulder impingement syndrome (SIS).  The purpose of this study was to examine the intra-rater and inter-rater reliability of measuring infraspinatus muscle thickness with RUSI and to compare such measures during resting versus contracted muscle states and in the symptomatic versus asymptomatic shoulders in patients with SIS.  Estimates (ICCs) for thickness measurements ranged between 0.96 and 0.98 for intra-rater reliability and between 0.87 and 0.92 for inter-rater reliability. Reliability was substantially lower (ICC = 0.43 to 0.79) for calculations of percent thickness change. The infraspinatus muscle was significantly thicker when contracted (19.1mm) than during rest (16.2mm) in both shoulders (p < 0.001).  There was also a statistically significant interaction between contraction state and shoulder (p = 0.026), indicating that the change in thickness that occurred during contraction was significantly smaller in the symptomatic shoulder than in the asymptomatic shoulder.  Therefore, the authors concluded that RUSI measurements of infraspinatus muscle thickness appear to be highly reliable, both within the same examiner and between different examiners, in patients with SIS.  Moreover, such measurements were different in rested and contracted states of the infraspinatus as well as between the symptomatic and asymptomatic shoulders of patients with unilateral SIS.

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