The Journal of Bone and Joint Surgery (American). 2007;89:1710-1715.
doi:10.2106/JBJS.F.01263
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Intraobserver and Interobserver Reliability of Two Ultrasound Measures of Humeral Head Position in Infants with Neonatal Brachial Plexus Palsy

Torpon Vathana, MD1, Stace' Rust, MD2, Janith Mills, PA-C3, David Wilkes, MD3, Richard Browne, PhD3, Peter R. Carter, MD3 and Marybeth Ezaki, MD3

1 Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bankoknoi, Bangkok 10700, Thailand
2 9150 Huebner Road, Suite 290, San Antonio, TX 78240
3 Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for M. Ezaki: Marybeth.Ezaki{at}tsrh.org

Investigation performed at Texas Scottish Rite Hospital for Children, Dallas, Texas

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Ultrasonographic evaluation of the hip in infants is considered both reliable and reproducible in the diagnosis of developmental dysplasia of the hip. Ultrasonographic evaluation of the shoulder in infants has been reported as a valuable diagnostic aid in dysplastic development following neonatal brachial plexus palsy. To our knowledge, there has been no study of the intraobserver reproducibility and interobserver reliability of sonography of the shoulder in infants with and without suspected posterior shoulder dislocation.

Methods: Two identical but randomly ordered sets of the same deidentified sonographic images of shoulders in infants were given to radiologists, pediatric orthopaedists and orthopaedic residents, and fellows with varying degrees of experience in the evaluation of shoulder pathology in infants, who measured the position of the humeral head relative to the axis of the scapula. Intraobserver reproducibility and interobserver reliability of the measurements were assessed.

Results: For the position of the humeral head with respect to the glenoid in both normal and abnormal conditions, the Pearson correlation coefficient for intraobserver reproducibility was 0.91 and the intraclass correlation coefficient for interobserver reliability was 0.875. For estimating the percentage of the humeral head posterior to the axis of the scapula, the Pearson correlation was 0.85 and the intraclass correlation coefficient was 0.77.

Conclusions: Ultrasonographic examination of the shoulder in infants to assess for the position of the humeral head with respect to the scapula showed high intraobserver reproducibility and interobserver reliability. It is recommended as a reliable technique for evaluating shoulder position in infants with neonatal brachial plexus palsy.


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