Original Communications
What do we know about the reliability and validity of physical examination tests used to examine the upper extremity?*,**,*,**,♢

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Abstract

The literature regarding the reliability and validity of commonly used clinical tests for disorders of the upper extremity was reviewed. Formal literature search, standard texts, and experts in the field of upper extremity were consulted to locate relevant articles. Range of motion and strength testing of the upper limb have been shown to be reliable, while various tests used for the diagnosis of conditions in the upper limb, such as carpal tunnel syndrome and rotator cuff tendinopathy, have been shown to have varying degrees of validity. Overall, however, we determined that there is little evidence regarding the reliability and validity of physical examination for the upper extremity and specifically less information available regarding the reliability of diagnostic physical examination tests and the validity of impairment measures used for the upper limb. Further studies in this area are warranted in view of the impact of these findings on the treatment of patients. (J Hand Surg 1999;24A:185–193. Copyright © 1999 by the American Society for Surgery of the Hand.)

Section snippets

Materials and methods

A formal literature search was performed to find studies evaluating the reliability and validity of physical examination for the upper extremity. Medline (1966 to 1996) was used as the database. Several specific searches were conducted. Arm (exploded) or shoulder (exploded) were crossed with anatomy (exploded), kinematics (text word), physiology (exploded), sensitivity and specificity (exploded), reliability (text word), validity (text word), physical exam (exploded), epidemiologic methods

Measures of impairment for the hand and wrist

Only one study that examined the reliability of the range of motion of the metacarpophalangeal and interphalangeal joints in the hand was located14 (Table 1).This study demonstrated that the intraobserver variations both for clinical observation and the use of a goniometer were not significant and that the inter-observer variation was greater. Three studies examined the reliability of the measurement of wrist range of motion and demonstrated similar findings 15, 16, 17 (see Table 1).

The two

Discussion

In virtually all patients with upper extremity disorders, the physical examination is used to grade the level of impairment and to make a diagnosis. This study has shown that not all aspects of the physical examination have been shown to be reliable and valid. The determination of the reliability and validity of physical examination tests is further complicated by the fact that there is no gold standard for many of the conditions that are routinely diagnosed by clinicians. In these cases, the

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    • Cited by (0)

    *

    Dr Marx is supported by the Arthritis Society, the Institute for Work and Health, and the Surgeon Scientist Program of the University of Toronto. Dr Wright is supported by an MRC scientist award.

    **

    Although the author or authors have not received or will not receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received but are directed solely to a research fund, foundation, educational institution, or other non-profit organization with which one or more of the authors are associated.

    *

    Reprint requests: James G. Wright, MD, The Hospital for Sick Children, 555 University Ave, S-107, Toronto, ON, Canada M5G 1X8.

    **

    J Hand Surg 1999;24A:185–193

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    Copyright © 1999 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.