Background. Evaluation of scapular posture is a fundamental component in the clinical evaluation of the upper quadrant. This study examined the intrarater reliability of scapular posture ratings. Methods. A test-retest reliability investigation was undertaken with one week between assessment sessions. At each session physical therapists conducted visual assessments of scapula posture (relative to the thorax) in five different scapula postural planes (plane of scapula, sagittal plane, transverse plane, horizontal plane, and vertical plane). These five plane ratings were performed for four different scapular posture perturbating conditions (rest, isometric shoulder; flexion, abduction, and external rotation). Results. A total of 100 complete scapular posture ratings (50 left, 50 right) were undertaken at each assessment. The observed agreement between the test and retest postural plane ratings ranged from 59% to 87%; 16 of the 20 plane-condition combinations exceeded 75% observed agreement. Kappa (and prevalence adjusted bias adjusted kappa) values were inconsistent across the postural planes and perturbating conditions. Conclusions. This investigation generally revealed fair to moderate intrarater reliability in the rating of scapular posture by visual inspection. However, enough disagreement between assessments was present to warrant caution when interpreting perceived changes in scapula position between longitudinal assessments using visual inspection alone. 1. Background Painful disorders of the upper quadrant are among the most commonly reported musculoskeletal complaints [1, 2]. The scapulae are an important consideration in upper quadrant disorders on the basis of their integral role in the function of the upper limb and cervico-thoracic spine. Changes in scapular posture and motion (often referred to as scapular dyskinesis) [3] are proposed to detrimentally alter the distribution of mechanical forces within the upper quadrant during upper limb activities due to their extensive muscle attachments to the axial skeleton [4, 5] and impact on glenohumeral joint biomechanics [6]. In support of this are studies showing scapular dyskinesis in upper quadrant disorders such as subacromial impingement [6–8] and chronic neck pain [9, 10] that may also be associated with altered axio-scapular muscle function [6, 7, 11, 12]. However, as highlighted in a review paper, there are inconsistencies between studies as to the most common pattern of scapular dyskinesis present in painful shoulder girdle disorders [13]. Irrespective of which scapular dyskinesis is most
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