An evidence-based review on the validity of the Kaltenborn rule as applied to the glenohumeral joint.

Kaltenborn's convex-concave rule is a familiar concept in joint treatment techniques and arthrokinematics. Recent investigations on the glenohumeral joint appear to question this rule and thus accepted practice guidelines. An evidence-based systematic review was conducted to summarize and interpret the evidence on the direction of the accessory gliding movement of the head of the humerus (HOH) on the glenoid during physiological shoulder movement. Five hundred and eighty-one citations were screened. Data from 30 studies were summarized in five evidence tables with good inter-extracter agreement. The quality of the clinical trials rated a mean score of 51.27% according to the Physiotherapy Evidence Database scale (inter-rater agreement: kappa=-0.6111). Heterogeneity among studies precluded a quantitative meta-analysis. Weighting of the evidence according to Elwood;s classification and the Agency for Health Care Policy and Research classification guidelines indicated that evidence was weak and limited. Poor methodological quality, weak evidence, heterogeneity and inconsistent findings among the reviewed studies regarding the direction of translation of the HOH on the glenoid, precluded the drawing of any firm conclusions from this review. Evidence, however, indicated that not only the passive, but also the active and control subsystems of the shoulder may need to be considered when determining the direction of the translational gliding of the HOH. The indirect method, using Kaltenborn's convex-concave rule as applied to the glenohumeral joint, may therefore need to be reconsidered.