Athletic Shoulder Test

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (23/04/2023)

Original Editor - Carina Therese Magtibay
Top Contributors - Rasha Moghanam, Carina Therese Magtibay and Ewa Jaraczewska

Background

Upper extremity injuries are common in overhead sports, however objective criteria to support back to sport decisions remains limited.In overhead, the shoulder and elbow are at higher risk of injury due to the high forces required to perform sport specific tasks.(Cain et al., 2003; Wright et al., 2018) cited in advances and Orthopedics and Sports Medicine). Overhead sports include but are not limited to basketball, water-polo, Javelin and volleyball. Additionally, the majority of shoulder injuries occur in the latter stages of training and matches as a consequence of repeated exposure to tackling, fatigue may contribute to risk. Since scapular muscles are highly activated to protract, upwardly rotate and stabilize scapula in early pull through of freestyle swimming or at ball impact in volleyball and tennis, their activity will be explored during the Modified- Athletic test. (Miura et al., 2020), (Pink et al., 1991), (Ryu et al., 1988) cited in Cited in (Physical Therapy in Sport, November 2022.

Purpose

The athletic shoulder (ASH) test is used to assess and monitor the shoulder isometric strength of athletes during recovery. It is a novel test developed by Ashworth et al. (2018) that focuses on rugby players at risk of shoulder injuries when performing long lever arm tackles.

Technique

Both upper extremities were tested to ensure accurate data between dominant and non dominant limbs.

Starting Position : Prone on the floor with the forehead resting on a 4cm foam block and the hand placed on a vertical axis platform.

Procedure:

The subject will push down from the shoulder in three consecutive test positions maximally for 3 seconds:

1. I-test: Shoulder positioned in full abduction (180°), forearm in pronation and elbow in full extension. Contralateral arm at the side.
2. Y-test: Shoulder positioned at 135°, forearm in pronation and elbow in full extension. The contralateral arm placed behind the back
3. T-test: Shoulder positioned at 90°, forearm in pronation and elbow in full extension. The contralateral arm is placed behind the back.

Evidence

1-The test demonstrates excellent reliability, but further studies are needed to assess its sensitivity

• Interday reliability in all test positions (ICC 0.94–0.98)
• Absolute reliability (SEM 4.8–10.8)
• Interday measurement error was below 10% in all test positions (CV 5.0–9.9) except for non-dominant arm I-position (CV 11.3%)"

2-Some data supports the isometric-based strength training device Active5™ as a reliable and valid tool for ASH test performance.

There was limited research specifically investigating the use of the Athletic Shoulder Test (AST) for monitoring shoulder strength in athletes during recovery. However, there is some evidence to suggest that certain components of the AST can be useful in assessing and monitoring changes in shoulder strength. For example, a study by Reinold et al. (2010) evaluated the relationship between the AST and shoulder strength in 31 patients with shoulder pathology. The results showed a moderate correlation between AST scores and shoulder strength as measured by manual muscle testing (MMT) and isokinetic testing.

3-On the other note, another recent study by Struyf et al. (2021) evaluated the validity of the AST compared to other shoulder assessment tools in 151 overhead athletes with and without shoulder pain. The results showed that the AST had good to excellent validity compared to other shoulder assessment tools, suggesting that it can be a valid tool for assessing shoulder function in athletes. While these studies did not specifically investigate the use of the AST for monitoring shoulder strength during recovery, they do provide support for the validity and reliability of the AST as a tool for assessing shoulder function in athletes.

Functional Shoulder Test

Karlen-Jobe Functional Shoulder Test:

It's clinically relevant to aid in clearance of an athlete for return to overhead sports.

Hypothesis: Ashworth et al. (2018) tested the reliability of a series of tests on portable force plates in various positions (I, Y, T) made to mimic motions in rugby and found excellent reliability, However, these tests were made as a return to tackling test in rugby, which has different demands in comparison to overhead sports.

Shoulder testing positions included: I, Y, Internal rotation (IR), & External Rotation (ER) of the shoulder. It consists of 4 positions, 3 prone and 1 supine position.

Testing protocol: Subject performs 3 trials in each position. In the prone testing positions (I, Y, IR), subjects were directed to maintain their scapula in a neutral position relative to the upper extremity being tested (no winging, anterior tilt, or excessive upward rotation).

Each subject has to press down with maximal effort and verbal encouragement is provided at the start of the test. Each attempt consisted of 3 seconds of exertion, alternating with 5 seconds of rest. A 20 second recovery was used between test positions.

The entire testing protocol took less than 10 minutes per subject, including warm-up and recovery periods.

Result: The high reliability of this test shows a positive trend that the 4 testing positions may have clinical utility when making a return to sport decision with overhead athletes.

Modified - Athletic Shoulder Test

Using a force platform is considered the gold standard in assessing isometric force. However, due to their cost and impracticality, other devices are studied as potential alternatives.

The Modified-Athletic Shoulder Test (M-AST) is a promising alternative, utilizing a handheld dynamometer for the easier test implementation. The use of a handheld dynamometer to appreciate muscle function has become more popular in the last years for its accessibility and its cost (Cools et al., 2016), (Cools et al., 2015). Cited in Physical Therapy in Sport, November 2022

Hypothesis: Since scapular muscles are highly activated to protract, upwardly rotate and stabilize scapula in early pull through of freestyle swimming or at ball impact in volleyball and tennis, their activity will be explored during the test (Miura et al., 2020), (Pink et al., 1991), (Ryu et al., 1988) cited in Cited in (Physical Therapy in Sport, November 2022.

A strong concordance was found between ASH Test and M-AST values (ICC = 0.86–0.97; p > 0.05) in all the positions.Therefore, the Modified-Athletic Shoulder Test (M-AST) constitutes a reliable, quick and easy to implement test to measure performance and return to play capacity in a non-rotational plane of movements in overhead athletes. The recovery status after training sessions/matches could also be monitored with this test.

Summary

Existing upper limb strength assessments are typically short lever tests that do not mimic sports specific actions or adequately assess higher shear forces experienced during competition.

The M-AST can be a useful tool for sports medicine professionals, coaches, and athletes to evaluate shoulder joint function and to monitor progress during rehabilitation.

Resources

1. ForceDecks Test: Athletic Shoulder (ASH) Test Protocol