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Force Production Measurement Between Dominant and Non-Dominant Arm Using the Empty-Can and Full-Can Tests

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Force Production Measurement Between Dominant and Non-Dominant Arm Using the Empty-Can and Full-Can Tests Force Production Measurement between Dominant and Non-Dominant Arm using the Empty-can and Full-can Tests A THESIS Submitted to the Faculty of the School of Graduate Studies and Research of California University of Pennsylvania in partial fulfillment of the requirements for the degree of Master of Science by Timothy Richard Olsen Research Adviser, Dr. Thomas Kinsey California, Pennsylvania 2008 ii CALIFORNIA UNIVERSITY OF PENNSYLVANIA CALIFORNIA, PA THESIS APPROVAL Graduate Athletic Training Education We hereby approve the thesis of Timothy Richard Olsen Candidate for the degree of Master of Science Date Faculty Thomas Kinsey, PhD Edwin Zuchelkowski, PhD Michael Meyer, MS, ATC iii ACKNOWLEDGEMENTS I would first like to thank God who was watched over me for the first 23 years of life and blessed me with all the riches in the world. Next I would like to thank my Mom, Dad, Pat, and Kristina. Mom, thanks for all the care packages through the years and the constant stream of never-ending love and affection. Dad, thanks for being a great role model and always there to lend me advice whenever I needed it and teaching me the value of hard-work. Pat, for all the years of constant psychological warfare I say thanks and “Mother of God”. Tina thanks for always being a wonderful little sister and sharing all those little talks. To both of you I hope the future brings everything you wish for and remember your older brother is always here for you, and never keep forgetting to thank Mom and Dad for all they have done for us. Next, I would like to thank Grandma and Grandpa for all they have done for me. From all the summer days at the shore, presents, meals, money, and love you have given me throughout my journey through life. I would also like to thank Boop and Pop who are no longer with us. Their memories have driven me to make them proud in what I do in life everyday and not a day goes by without a thought of how special they are to me. To all my extended family, those living and no longer with us, thanks for being so loving and a positive influence in my life. In a world full of negatives and broken homes, it has been great to brag about what a wonderful family I do have. Thanks to each and every one of you. Next, thanks to my friends Fran and Nick. You two have truly been great friends and I look forward to life-long friendships with both you guys. Words cannot say what the both of your friendships have meant to me through the years. Thanks for everything you both have done for me. For all those brothers from Lynchburg, the memories will last me a life time. Thanks. Next, I want to thank all the people who have helped me in my pursuit of being an Athletic Trainer. From Carl and Mr. Christy in high school to Dr. Laurent, Tom, Pat, Emily, and Debbie at Lynchburg College. Thanks to all of you for being great role models to look up to and teaching me about this wonderful profession of ours. Also, I would like to thank my thesis committee with whose approval I get to graduate with my Master of Science degree, Dr. Kinsey, Dr. Z, and Mike. Special thanks goes to Dr. Kinsey for being my thesis advisor and reading my thesis more times then he probably wanted to. My graduate class, the time has finally come to leave beautiful California and embark on the rest of our lives. It has been a great year together and there have been a lot of memories I will take with me. I am glad to have met all of you and wish you all nothing but the best. Chris, thanks for introducing me to 10 cent wing night at the Foster House, Pittsburgh style sandwiches, and an endless amount of humor. You definitely made this year a lot more fun then it probably should have been. In case I have forgotten anyone, sorry and thank you. For all those who read this in the future, always follow your dreams and do what will make you happy in life. iv TABLE OF CONTENTS Page SIGNATURE PAGE . ii ACKNOWLEDGEMENTS . iii TABLE OF CONTENTS . iv LIST OF TABLES . vii LIST OF FIGURES . viii INTRODUCTION . 1 METHODS . 6 Research Design. 6 Subjects. 7 Preliminary Research. 7 Instruments . 8 Procedures . 9 Research Questions. 11 Hypotheses . 11 Null Hypotheses . 12 Data Analysis . 12 RESULTS . 13 Demographics . 13 v Hypotheses Testing . 15 Additional Findings . 17 DISCUSSION . 20 Discussion of Results . 20 Conclusions . 23 Recommendations . 24 REFERENCES . 26 APPENDICES . 29 A. Review of the Literature . 31 Functional Anatomy . 32 Bony Anatomy . 33 Joint Articulations . 35 Rotator Cuff Muscles . 38 Special Tests . 39 Dynamometer . 43 Effect of Dominance. 44 Test Relevance . 45 B. The Problem . 47 Statement of the Problem . 48 Definition of Terms . 49 Basic Assumptions . 50 Limitations of the Study . 51 Delimitations of the Study . 52 vi Significance of the Study . 52 C. Additional Methods . 54 Informed Consent Forms (Appendix C1). 56 Demographic Information Sheet (Appendix C2). 62 Institutional Review Board (C3) . 64 REFERENCES . 73 ABSTRACT . 77 vii List of Tables Table 1. Frequency of Sport(s) Played and Percent Value . 14 Table 2. Average Force Production and Peak Times for Full- can and Empty-can Test Positions . 15 Table 3. Subjects Force, Peak Time, and Age Ranges from Table 4. Force Production 2x2 ANOVA Displaying Force Production Between Tests is not Significant . 16 Table 5. 2x2 ANOVA Displaying Peak Time Between Tests is not Significant . 18 Table 6. Male Means. 19 Table 7. Female Means . 19 viii List of Figures Figure 1. Demographic Information Sheet . 61 1 INTRODUCTION The shoulder complex is an extremely complicated region of the body. Due to the anatomical structure of the passive restraints surrounding the glenohumeral (GH) joint, the shoulder has a great deal of mobility. This large range of motion makes the shoulder inherently unstable; therefore, the shoulder complex relies on the surrounding musculature for stability. The rotator cuff muscles are the primary dynamic stabilizers of the GH joint and are highly susceptible to injury. 1,2 Many sport activities such as throwing, swimming, serving in tennis or volleyball, etc., place a great deal of stress on the supporting structures of the GH joint. Consequently, injuries involving the shoulder are commonplace in the athletic population. 2 Therefore it is important to have an extensive knowledge of shoulder anatomy as an athletic trainer. Rotator cuff muscles are a commonly injured muscle group in the shoulder. Injuries involving the rotator cuff typically involve the supraspinatus muscle, as it is the most commonly injured muscle in the rotator cuff group. 3-9 The diagnosis of a 2 rotator cuff injury is based on a history and physical examination. Two tests performed in determining the integrity of the supraspinatus muscle are the empty-can test and the full-can test. However, rotator cuff injuries are not the only injuries that occur in the shoulder. Other injuries involving the shoulder include dislocations, subluxations, acromioclavicular sprains, sternoclavicular sprains, tendonitis, muscle weakness, fractures, instability, and impingement. The complexity of the anatomy of the shoulder means an injury to any one of its structures can have an effect on the kinetic chain of the shoulder and the upper extremity. For instance, a weak serratus anterior can cause the scapula to track incorrectly. Therefore, the surrounding musculature such as the rhomboids and rotator cuff muscles, have an increased workload due to the serratus anterior weakness. This can cause problems such as impingement or tendonitis in the shoulder due to the overload of work put on these muscles. Another example could be laxity in the shoulder joint and capsule. With increased mobility of the head of the humerus, the rotator cuff muscles have an increased role in stabilizing this joint and this increased workload may result in chronic injury. 3 Understanding the functional anatomy and associated sources of injury of the shoulder allows the sports medicine professional to have a more structured approach to the care of an athletic shoulder injury. The diagnosis of a rotator cuff injury is based on a history and physical examination. Two tests performed in determining the integrity of the supraspinatus muscle are the empty-can test and the full-can test. 9 In a profession that relies heavily on tests being accurate in helping to determine pathologies, we need tests to be consistent as well. Several studies have looked at the similarities and differences between the empty can and full can tests, and these studies have suggested that these tests have high sensitivity and low specificity. 5,10,11 Specificity means the degree to which a negative clinical test represents the absence of a condition. Sensitivity indicates the degree to which a positive test represents the presence of a condition. The difference between the empty-can and full-can test is that the empty-can test is done with the athlete’s thumb facing downward perpendicular to the floor when pressure is applied downwards. The full-can test is performed with the athlete’s thumb pointing upward towards the sky, as if they 4 are giving a thumb’s up when pressure is applied. Other than this, the tests are performed in the same manner. Electromyography suggests that the supraspinatus muscle is important during all phases of glenohumeral motion as a humeral rotator and as a dynamic humeral stabilizer. 12,13 Some authors have reported that there is more pain with the empty-can test than with the full-can test.
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