• Jae-Young Hong, Seung-Woo Suh, Jae-Hyuk Yang, Si-Young Park, and Ji-Hoon Han.
• *Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea †Department of Orthopedics, Korea University Guro Hospital, Seoul, South Korea; and ‡Department of Orthopedics, Korea University Anam Hospital, Seoul, South Korea.
• Spine. 2013 Dec 15;38(26):E1684-90.

Study DesignObservational study with 3 examiners.ObjectiveTo compare the reliability of shoulder balance measurement methods.Summary Of Background DataThere are several measurement methods for shoulder balance. No reliability analysis has been performed despite the clinical importance of this measurement.MethodsWhole spine posteroanterior radiographs (n = 270) were collected to compare the reliability of the 4 shoulder balance measures in patients with adolescent idiopathic scoliosis. Each radiograph was measured twice by each of the 3 examiners using 4 measurement methods. The data were analyzed statistically to determine the inter- and intraobserver reliability.ResultsOverall, the 4 radiographical methods showed an excellent intraclass correlation coefficient regardless of severity in intraobserver comparisons (>0.904). In addition, the mean absolute difference values in all methods were low and were comparatively similar (<1.73°). However, in interobserver comparisons, reliabilities were significantly decreased in the less severe radiographs, firstly on radiographical shoulder height measures (intraclass correlation coefficients >0.445, mean absolute difference <3.91°). However, the intraclass correlation coefficients in the coracoid height difference and clavicular angle methods were in the excellent range (>0.810 and >0.787, respectively) regardless of severity. In addition, the mean absolute difference values in the clavicular angle method were lower (<0.62°) than others.ConclusionThe higher reliability of the clavicular angle and coracoid height difference methods indicate the clinical usefulness of these methods. Physicians should selectively use the shoulder balance measurement method clinically.Level Of Evidence3.

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