Intra- and interobserver reproducibility of the shoulder laxity examination

The present study evaluates the inter- and intraobserver reproducibility of clinical examination of glenohumeral laxity in the unanesthetized shoulder . Forty-three asymptomatic Division I collegiate athletes underwent bilater al shoulder laxity examination initially and again after 3 months. Translat ion of the humeral head on the glenoid fossa in the anterior, posterior, an d inferior directions was graded by four physicians who were blinded to the ir own previous grading and that of the other examiners. Overall intraobser ver reproducibility of examination was 46%. When grades 0 and 1 were equali zed, overall intraobserver reproducibility improved to 74%. For both the eq ualized and non-equalized reproducibility values reported by all examiners, the kappa values for intraobserver correlation were less than 0.5, which s uggests that correlations were not better than those achieved by chance alo ne. Overall interobserver reproducibility was 47%. When grades 0 and 1 were equalized, interobserver reproducibility improved to 78%. Kappa values wer e greater than 0.5 only in equalized posterior and inferior laxity. The dat a demonstrate that the laxity examination of the unanesthetized shoulder is not easily reproducible in either intra- or interobserver comparison. Equa lization of grade 0 and grade 1 laxity improves both intra- and interobserv er reproducibility. We recommend caution when determining diagnosis and tre atment based on this examination.