Hara Test

Original Editor - Wataru Okuyama

Top Contributors - Wataru Okuyama, Kim Jackson and Wanda van Niekerk  

Introduction

Most baseball players don't know what's wrong with their bodies that prevents them from throwing. Therefore, the players needs to be aware of any abnormal physical findings. The 11 items of shoulder physical examination used by the author were used to help the players experience their own abnormalities. The next step is to improve the accuracy of the diagnosis by incorporating the findings of X-ray and ultrasound examinations, which are supplementary diagnostic methods.When an player comes to the hospital complaining of shoulder pain, it is important to evaluate the player's medical condition, including an imaging evaluation based on his or her physical findings, rather than an imaging evaluation itself. The Hara test is useful for assessing abnormalities in the kinetic chain of upper extremity leading to shoulder pain in patients with throwing disorder and provides a more effective basis to understand the clinical course for a return to pitching. The Hara test is useful for assessing abnormalities in the kinetic chain of upper extremity leading to shoulder pain in patients with throwing disorder. The Hara test consists of 11 physical examinations items that are associated with the scapular and humeral kinetic chain.

Scapula Spine Distance: SSD

Observe the degree of atrophy of the subspinous muscles and deviation of the scapula.

This phenomenon is also seen in subacromial impingement syndrome in addition to weakness of the periscapularis muscles such as the serratus anterior and rhomboids and decreased stability of the shoulder joint. Deviation of the scapula is assessed by measuring between the medial margin of the scapula and the spinous process of the spine.

Combined Abduction Aest: CAT

In this method, the abduction angle is taken as the angle of the scapulohumeral joint, and the angle is measured by abducting the upper limb with the scapula manually fixed.

Horizontal Flexion Test: HFT

The horizontal flexion angle is taken as the angle of the scapulohumeral joint as well, and the angle is measured with manual fixation of the scapula.

Muscle Testing of Infraspinatus(ISP), Supraspinatus(SSP) & Subscapularis(SSC)

Assessment of rotator muscle strength, including rotator cuff function, is necessary. The external rotation during descent is assessed as the strength of the muscles including the infraspinatus (ISP), and the internal rotation during descent is assessed as the strength of the muscles including the subscapularis (SSC). The strength to raise the upper limb to 30° diagonally anterior to the droop is assessed as the strength of the muscles including the supraspinatus (SSP).

Elbow Push Test: EPT

When a resistance test of the serratus propria muscle is performed against the olecranon in 90 degrees of elbow flexion, weakness or weakness may occur on the pitching side. From the examination of many athletes with throwing disorders, we noticed several interesting phenomena in the evaluation of the strength of compound movements and used them as functional assessment.

Elbow Extension Test: EET

Using the same technique as the manual strength test of the triceps muscle, auto-extension from 100° of elbow flexion in the evaluation of triceps muscle on the side of throwing disorder may cause weakness or weakness.

Capsular Laxity Test

Capsular laxity is evaluated by load-and shift testing in the anterior, posterior, and inferior directions; anterior apprehension and relocation tests are also done. When the dominant side shows increased laxity, or when the subject feels that the shoulder is unstable during any test, capsular laxity is considered abnormal.

Subacromial Impingement Test

To evaluate subacromial impingement, we perform the Neer, Hawkins, and Yocum tests. If the subject feels shoulder pain during any of these tests, subacromial impingement testing is graded as abnormal.

Hyper External Rotation Test: HERT

This test evaluates peel back of the superior labrum and pathologic internal impingement. The test performed in 90° of shoulder abduction with the elbow flexed at 90°. The test is considered to be abnormal when a subject feels pain as the examiner applies external rotation torque beyond the maximum external rotation position.

The number of "intact" results among the 11 physical examinations is recorded as the total Hara test score for each subject. The maximum total score (11 points) represents all "intact" results (i.e., no abnormality found) for all tests; subjects with lower scores are considered likely to have a problem in the upper-extremity kinetic chain. (Hara test does not have a section for psychometric property such as validity and reliability.)

References