Philip W Mcclure

Arcadia University · Department of Physical Therapy

BACKGROUND: Neck pain and headaches are common conditions in physical therapy practice. Clinical practice guidelines (CPG’s) are forms of evidence designed to decrease practice variability and guide care. CPG recommendations are general, with few specific tactics recommended, which could be a factor in their limited adoption and poor application. T...

Background The rotator cuff (RC) plays a pivotal role in the performance and health of the shoulder and upper extremity. Blood flow restriction training (BFRT) is a modality to improve strength and muscle hypertrophy with even low-load training in healthy and injured individuals. There is minimal evidence examining its effect proximal to the occlud...

Objective The Staged Approach for Rehabilitation Classification for the Shoulder (STAR-Shoulder) has been proposed as a model to guide management and improve outcomes for patients with shoulder pain, however, the effect of its utilization on patient outcomes has not been established. Therefore, the primary purpose of this study was to determine whe...

OBJECTIVE: Guidelines include manual therapy and exercise for subacromial shoulder pain, but there is low certainty for these recommendations. Here, we evaluated if adding manual therapy to a resistance exercise program improved patient outcomes. DESIGN: Randomized parallel controlled clinical trial. METHODS: Individuals with subacromial pain syndr...

Objective: The purpose of this study was to determine the feasibility, reliability, validity, and responsiveness of the Timed Functional Arm and Shoulder Test (TFAST) in patients with shoulder problems. Methods: This study was a repeated-measures clinical measurement observational cohort study. A total of 104 individuals who were symptomatic par...

Background The use of blood flow restriction training (BFRT) to treat patients with lower extremity conditions has been found to be relatively safe, but there is minimal evidence and no reports on BFRT in patients with shoulder dysfunction. Case Presentation This case report describes the safe application of BFRT as part of a conventional multimod...

The movement system has been adopted as the key identity for the physical therapy profession and recognition of physical therapists’ primary expertise as managing movement dysfunction is an important achievement. However, existing movement system models seem inadequate for guiding education, practice, or research. Lack of a clear, broadly applicabl...

Objective Rating tissue irritability has been recommended to aid decision making in several recent clinical practice guidelines. An explicit method for rating tissue irritability was proposed as part of the Staged Algorithm for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder), but the reliability and validity of this classification...

Background Shoulder muscle force is commonly assessed during clinical examination using both an isometric “make” test against a fixed resistance or a “break” test where the examiner exerts enough force to break the isometric contraction. The purpose of this study was to explain the difference in force produced during these two forms of testing. Me...

Background: Pitching velocity is a critical measure of performance, but it may also play a role in the development of injury. It has been proposed that increased humeral retrotorsion (HRT) may be an advantageous adaptation among throwers, resulting in increased throwing velocity. However, there is limited published data directly investigating this...

Background: Forward head and round shoulder posture (FHRSP) is believed to be related to scapular dyskinesis (SD), placing increased stress on the neck and shoulder, leading to pain and dysfunction. Therefore, a clinical method with sufficient reliability to distinguish normal and abnormal scapular position and motion among people with FHRSP is cal...

PURPOSE/HYPOTHESIS: No widely used performance test of arm and shoulder function currently exists, and functional measures rely on patient self-report. We have developed the Timed Functional Arm and Shoulder Test (TFAST), which has demonstrated good psychometric properties in healthy, asymptomatic individuals in varied age groups. The purpose of th...

Inhibition of rotator cuff activation and force after local experimental pain has been previously shown. Clinically, strength is often indexed to the uninvolved side in order to quantify deficits during injury and recovery. This study assessed the effect of experimental subacromial pain on contralateral shoulder external rotation (ER) force and act...

Background: Forward head and round shoulder posture (FHRSP) is believed to be related to scapular dyskinesis (SD), placing increased stress on the neck and shoulder, leading to pain and dysfunction. Therefore, a clinical method with sufficient reliability to distinguish normal and abnormal scapular position and motion among people with FHRSP is cal...

PURPOSE/HYPOTHESIS: No widely used performance test of arm and shoulder function currently exists, and functional measures rely on patient self-report. We have developed the Timed Functional Arm and Shoulder Test (TFAST), which has demonstrated good psychometric properties in healthy, asymptomatic individuals in varied age groups. The purpose of th...

Objective: To present the case of a 15 year-old baseball player with Little League Shoulder (LLS) and describe how developmental changes in the angle of humeral retrotorsion (HRT) may contribute to the underlying pathology of this condition. Design: Case report. Setting: Two years earlier, the patient had participated in a healthy player scree...

Background: Physical therapists regularly make decisions regarding intervention intensity based upon pathoanatomy and symptom irritability, but the reliability and validity of classifying patients by symptom irritability are unknown. Purpose: Examine the reliability and construct validity of the shoulder symptom irritability classification (SSIC) s...

Background Identifying risk factors that contribute to shoulder and elbow pain within youth baseball players is important for improving injury prevention and rehabilitation strategies. Hypothesis Differences will exist between youth baseball players with and without a history of upper extremity pain on measures related to growth, shoulder performa...

Background Loss of voluntary activation of musculature can result in muscle weakness. External neuromuscular stimulation can be utilized to improve voluntary activation but is often poorly tolerated because of pain associated with required stimulus level. Intramuscular electrical stimulation requires much lower voltage and may be better tolerated,...

The scapular examination is an important component when examining the patient with shoulder pain. Several factors must be considered to determine if scapula dysfunction is contributing to the patient’s symptoms. The focus on this chapter is to guide the clinician in how to logically examine the scapula using his or her eyes and hands primarily. The...

Study Design Repeated-measures clinical measurement reliability study. Background While there are some shoulder functional tests for athletes, no widely used performance test of arm and shoulder function currently exists to assess lower-level upper extremity functional demands in, for example, a nonathlete population or elderly individuals. In the...

Background: Baseball players exhibit a more posteriorly oriented humeral head in their throwing arm. This is termed humeral retrotorsion (HRT) and likely represents a response to the stress of throwing. This adaptation is thought to occur while the athlete is skeletally immature, however currently there is limited research detailing how throwing a...

PURPOSE/HYPOTHESIS: Previous work in our lab has established sufficient clinical feasibility, and between session reliability of the Functional Arm and Shoulder Test (FAST) in asymptomatic young adults. The purpose of this study is to establish the reliability and age-related norms of the FAST in asymptomatic, older adults (over 65). NUMBER OF SUB...

Context: Several investigations have noted that throwing athletes exhibit a more posteriorly oriented humeral head (humeral retrotorsion) in the dominant arm. This asymmetry is believed to represent an adaptive response to the stress of throwing that occurs during childhood. The significance of this alteration and factors that affect its developme...

Shoulder disorders are a common musculoskeletal problem causing pain and functional loss. Traditionally, diagnostic categories are based on a pathoanatomic medical model aimed at identifying the pathologic tissue(s). However, the pathoanatomic model may not provide diagnostic categories that effectively guide treatment decision-making in rehabilita...

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF)...

The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. The areas c...

Objective: To define for 2 shoulder outcomes scales the substantial clinical benefit (SCB)-a metric that defines the change amount associated with patient perception of a large meaningful improvement and that can be used to interpret change over time in the outcome score. Design: Cohort. Setting: Clinic. Participants: Patients (N=74) with sh...

Background: The effect of pain on muscle activation is poorly understood. This study examined the effects of acute experimental pain on rotator cuff muscle force and voluntary activation (VA). We hypothesized that acute subacromial pain would cause inhibition of infraspinatus VA with a corresponding decrease in external rotation force. Materials...

Study design: Controlled laboratory study. Objectives: To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed. Background: There are va...

The scapula plays an important role in shoulder function and requires both significant mobility and stability. Normal motion is 3-dimensional, and during arm elevation consists of upward rotation, posterior tilting, and external rotation as well as clavicular elevation and retraction. Examination should include visual observation, symptom alteratio...

Controlled laboratory study. To determine the effect of the modified scapular assistance test (SAT) on 3-dimensional shoulder kinematics, strength, and linear measures of subacromial space in patients with subacromial impingement syndrome (SAIS). Abnormal scapular kinematics have been identified in patients with SAIS. Increased scapular upward rota...

Dental hygienists suffer a high incidence of shoulder pathology that seems to increase with job longevity. It has been hypothesized that occupational injuries could be due to local muscle fatigue caused by repetitive low level work and awkward and constrained working postures. In the laboratory, scapular kinematics can be temporarily altered using...

Scapular dyskinesis is an abnormal scapular motion or position during active arm elevation. Dyskinesis is theorized to contribute to impingement syndrome by decreasing the subacromial space. A corrective maneuver of the scapular assistance test (SAT) proposes to increase scapular upward rotation and posterior tilt to increase the subacromial space....

The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics,...

Case series. Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. Ten patients (age rang...

This was the third research meeting focused on scapular function and dysfunction, following similar meetings in 2003 and 2006. The purpose of this meeting, hosted by the Shoulder Center of Kentucky, was to continue to examine the biomechanical and clinical factors thought to be associated with the role of the scapula in shoulder function and dysfun...

Failure of voluntary activation is an important source of weakness in several different muscles after injury or surgery. Despite the high prevalence of shoulder rotator cuff disorders and associated weakness, no test currently exists to identify voluntary activation deficits for the rotator cuff. The purpose of this study was to develop a test to q...

Unlabelled: Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is descri...

Shoulder injuries are common in athletes involved in overhead sports, and scapular dyskinesis is believed to be one causative factor in these injuries. Many authors assert that abnormal scapular motion, so-called dyskinesis, is related to shoulder injury, but evidence from 3-dimensional measurement studies regarding this relationship is mixed. Reli...

Although clinical methods for detecting scapular dyskinesis have been described, evidence supporting the validity of these methods is lacking. To determine the validity of the scapular dyskinesis test, a visually based method of identifying abnormal scapular motion. A secondary purpose was to explore the relationship between scapular dyskinesis and...

Two group, repeated measures design. To determine whether manually repositioning the scapula using the Scapula Reposition Test (SRT) reduces pain and increases shoulder elevation strength in athletes with and without positive signs of shoulder impingement. Symptom alteration tests may be useful in determining a subset of those with shoulder patholo...

Het doel van dit onderzoek was te bepalen of stretching invloed heeft op lengteverandering van de hamstrings, zoals blijkt bij ‘straight leg raising’ — slr — (heffen van het gestrekte been), de lumbosacrale stand en de relatieve mate van lumbale en heupbeweging tijdens het naar voren buigen. hamstrings–lage-rugpijn

Randomized controlled trial, To compare changes in shoulder internal rotation range of motion (ROM), for 2 stretching exercises, the "cross-body stretch" and the "sleeper stretch," in individuals with posterior shoulder tightness. Recently, some authors have expressed the belief that the sleeper stretch is better than the cross-body stretch to addr...

Repeated-measures experimental design. To determine the effects of shoulder external rotator muscle fatigue on 3-dimensional scapulothoracic and glenohumeral kinematics. The external rotator muscles of the shoulder are important for normal shoulder function. Impaired performance of these muscles has been observed in subjects with impingement syndro...

Several factors such as posture, muscle force, range of motion, and scapular dysfunction are commonly believed to contribute to shoulder impingement. The purpose of this study was to compare 3-dimensional scapular kinematics, shoulder range of motion, shoulder muscle force, and posture in subjects with and without primary shoulder impingement syndr...

The purpose of this study was to determine the effects of shoulder muscle fatigue on three dimensional scapulothoracic and glenohumeral kinematics. Twenty healthy subjects participated in this study. Three-dimensional scapulothoracic and glenohumeral kinematics were determined from electromagnetic sensors attached to the scapula, humerus, and thora...

Scapulothoracic muscle activity is believed to be important for normal scapulothoracic motion. In particular, the trapezius and serratus anterior muscles are believed to play an important role in the production and control of scapulothoracic motion. The aim of this study was to determine the effects of different levels of muscle activity (active ve...

Shoulder impingement syndrome is a common condition and is often managed with an exercise program. The purpose of this study was to examine an exercise program in patients with shoulder impingement syndrome. Specifically, the purpose was to identify changes that might occur in 3-dimensional scapular kinematics, physical impairments, and functional...

To determine the effects of fatigue during an external rotation task on 3-dimensional scapular kinematics. A single-group, pretest-posttest measurement design. Research laboratory. Thirty healthy subjects. Not applicable.Main Outcome Measures: Three-dimensional scapular kinematics were recorded with a Polhemus magnetic tracking device during arm el...

The purpose of this article was to illustrate a limited search for evidence and its application in the context of a patient with CTS. The search was by no means exhaustive, as it was performed and interpreted in less than an hour. My conclusions are not definitive because my evidence was based almost exclusively on abstracts, and many key details a...

Subacromial impingement syndrome is the most common disorder of the shoulder, resulting in functional loss and disability in the patients that it affects. This musculoskeletal disorder affects the structures of the subacromial space, which are the tendons of the rotator cuff and the subacromial bursa. Subacromial impingement syndrome appears to res...

Tsai N-T, McClure PW, Karduna AR. Effects of muscle fatigue on 3-dimensional scapular kinematics. Arch Phys Med Rehabil 2003;84:1000-5.

The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), patient self-report section. Patients with shoulder dysfunction (n = 63) completed the ASES, The University of Pennsylvania Shoulder Score, and the Short Form-36 during the initial evaluation...

The purpose of this study was to describe 3-dimensional scapular motion patterns during dynamic shoulder movements with the use of a direct technique. Direct measurement of active scapular motion was accomplished by insertion of 2 1.6-mm bone pins into the spine of the scapula in 8 healthy volunteers (5 men, 3 women). A small, 3-dimensional motion...

The validation of two noninvasive methods for measuring the dynamic three-dimensional kinematics of the human scapula with a magnetic tracking device is presented. One method consists of simply fixing a sensor directly to the acromion and the other consists of mounting a sensor to an adjustable plastic jig that fits over the scapular spine and acro...

Test-retest repeated measures and correlational design. To examine the reliability and validity of a "modified" digital inclinometer to assess scapular upward rotation during humeral elevation in the scapular plane Evidence exists that scapular motion is related to shoulder pathology; however, evaluation and treatment planning for shoulder rehabili...

Alterations in scapular movement patterns are believed to be associated with muscle weakness, fatigue, and paralysis. Due to the control that muscles exert on scapular position, it is important to understand their mechanical efficiency. Previous researchers have used the principle of virtual work to assess shoulder muscle moment arms, but these stu...

An analysis of Euler angle sequences is presented for the scapula. In vivo kinematics were collected with a magnetic tracking device on eight healthy volunteers. To ensure accurate representation of scapular motion, pins were rigidly drilled into the scapular spine. Three rotations of the scapula with respect to the thorax were recorded during hume...

The degenerative process associated with spondylosis in the cervical spine has been reviewed. The two compressive syndromes commonly associated with spondylosis, radiculopathy and myelopathy, are briefly reviewed. Except for more severe, multilevel degenerative changes producing neurologic compromise, correlation between degenerative changes and pa...

Nonrandomized 2 group post-test only. To compare scapular position and orientation between subjects with and without impingement syndrome. Abnormal scapular motion is commonly believed to be a contributing factor to shoulder impingement syndrome. Twenty nonimpaired subjects with a mean age of 34.3 (+/- 7.5 years) and 17 patients with impingement sy...

To quantitatively evaluate the effects of commonly used shoulder exercises on shoulder kinematics and resting posture. A repeated-measures design was used with measurements performed before and after a 6-week exercise program. Twenty asymptomatic subjects with forward shoulder posture were recruited. Stretching exercises for the pectoral muscles an...

To determine the effect of thoracic posture on scapular movement patterns, active range of motion (ROM) in scapular plane abduction, and isometric scapular plane abduction muscle force. Repeated measures design. There were 34 healthy subjects (mean age, 30.2 yrs). Each subject was positioned and stabilized while sitting in both erect and slouched t...

When a researcher concludes that “no difference between groups was present,” there is the potential of the Type II error, which is indicative of low statistical power. Low power increases the chance of missing a difference between groups when, in fact, a difference really exists. The two primary reasons for low power are small sample size and small...

The purpose of this study was to determine the effect of change in video display terminal (VDT) height from desktop height (96.5 cm [38 in]) to an elevated position (109.2 cm [43 in]) on postural angles of the head and neck and the effect on cervical spine flexion moments. Twenty-seven persons (3 male, 24 female) who spent at least 3 hours per day...

A test-retest design to establish the reliability of a new system capable of quantifying the load-displacement characteristics of the cervical spine. The study was primarily descriptive, but the design allowed comparisons between men and women as well as within-group comparisons among different cervical motions. To determine the flexibility of the...

This study analyzed two groups of individuals during return to an upright position (extension) from a forward, bent position. Group 1 (n = 12) included individuals with no history of low back pain who were currently asymptomatic, and group 2 (n = 12) included individuals with no history of low back pain. To determine the amount and pattern of lumba...

The purpose of this study was to determine whether stretching the hamstring muscles affects extensibility, as indicated by straight leg raising (SLR), lumbopelvic posture, and the relative amounts of lumbar and hip motion during forward bending. Thirty-nine subjects without known musculoskeletal impairments of their spine or lower extremities and w...

A six-degree of freedom spatial linkage which permits measurement of cervical spine stiffness and range of motion (ROM) is described. Using the apparatus, the ROM restriction capabilities and passive stiffness characteristics of cervical orthoses in flexion, extension, axial rotation and lateral bending may be directly evaluated and compared. Expon...

This study used a repeated measures design to assess the effects of multiple sitting postures on various spinal angles. All subjects were tested in slouched, erect, forward inclined, and comfortable postures. The purposes of this study were to evaluate the changes in head, cervical, lumbar, and pelvic postures in different sitting positions and als...

The purpose of this report is to describe the management of a 30-year-old male truck driver following a zone-VI (metacarpal level) laceration of the tendons of the extensor digitorum and extensor indicis muscles to the index finger. Surgical repair was performed 6 days after the injury and was followed by a 32-day period of short-arm cast immobiliz...

This study analyzed two groups of subjects during forward bending. Group 1 (n = 20) contained subjects with a history of low back pain and Group 2 (n = 21) included subjects without a history of low back pain. The purposes of this study were to establish the amount and pattern of lumbar spine and hip motion during forward bending, and determine dif...

A series of patellofemoral (PF) alignment tests have been described that are used to determine when and how PF taping techniques should be applied. The reliability of measurements obtained with these tests has not been reported. The purpose of this study was to determine the intertester reliability of measurements obtained with four PF alignment te...

The purpose of this article are (1) to discuss the rationale for using splints to increase range of motion (ROM) and (2) to describe an algorithm that can guide therapists' clinical decisions when splints are used to treat patients who have limited ROM. The primary rationale for using splints is to apply relatively long periods of tensile stress to...

The purpose of this article is to examine issues pertinent to the study of the clinical effectiveness of manual therapy. The need for complete operational definitions of treatment procedures, criteria for altering treatment, and criteria for subject selection is discussed. The need for studies that examine the relationship among impairment, functio...

This article describes the management of a 57-year-old female patient following a fracture and dislocation of the right humeral head. The treatment of the patient involved the use of thermal agents, manual therapy, continuous passive motion, and splinting of the arm in an elevated position. We describe an approach to treatment of limited shoulder m...

This article describes the management of a patient with limited shoulder range of motion (ROM) by use of an elevation splint. The limited ROM was believed to be due to structural changes in the tissues surrounding the glenohumeral joint following a Magnuson-Stack repair for anterior glenohumeral instability. The patient's ROM plateaued approximatel...

The purpose of this study was to determine the intertester reliability of judgments based on tibiofemoral joint abduction (TFJA) tests of the medial collateral ligament (MCL). The TFJA tests were performed by three physical therapists on 50 patients with unilateral knee problems. The therapists used the techniques they normally use in clinical prac...