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Closed Kinetic Chain Upper Extremity Stability Test

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In another post, I discussed why we would consider testing an athlete in an open-kinetic chain sport with closed-kinetic chain tests. It is important to remember that there is a hierarchy of testing and begins with ROM, strength, plank, and progresses to the Functional Movement Screen Trunk Stability Push Up and  Upper Quarter Y Balance test as basic tests of movement competency, motor control competency, and motor control capacity. Now we will examine another test that looks at capacity – the Closed Kinetic Chain Upper Extremity Stability Test. 

The Closed Kinetic Chain Upper Extremity Stability Test is reliable and has some discriminant and predictive validity.1-3,5,6 The test is performed in a pushup position with the hands placed 36 inches apart on strips of athletic tape. The person reaches with alternating hands across the body to touch the piece of tape under the opposing hand. The number of cross-body touches performed in 15 seconds is recorded. The test can be modified by performing the test in the kneeling position.

It has also been suggested that the number of touches can also be divided by height to normalize the number of touches to each person. While this does give some normalization, the test is still not body relative since everyone has hands placed 36 inches apart (think about how hard that position would be for 5 foot tall gymnast compared to a 7 foot tall basketball player).

In addition, a power score can be calculated by “multiplying the average number of touches with 68% of the patient’s body weight in kilograms, which is the weight of the arms, head, and trunk. That score is then divided by 15, which is the duration of the test in seconds. The power score reflects the amount of work performed in a unit of time.”

Validity

It appears that the CKCUEST does have some discriminant validity. In a recent study, researchers found that those with shoulder impingement performed substantially worse on the test compared to activity level matched controls.3 They also found the MDC to range between 2 and 4. What is interesting is that 15-25% of the “healthy” subjects reported shoulder pain after performing the test. This again speaks to the importance of having a hierarchy of testing (and maybe the number of people that consider having shoulder pain as normal).3 There is one prospective study that examines the predictive validity of the CKCUEST in collegiate football players.4 Researchers did a battery of strength, ROM, shoulder endurance, and CKCUEST at the beginning of the season on 26 players. The authors found that scoring less than 21 touches increased the likelihood of a shoulder injury during the season (5/6 of the injured players scored below 20 touches).4 While this test requires upper quarter stability, it is more of a speed/agility/power test as its measurement is touches per unit of time/height/bodyweight. I think the real value of the test lies in what one of the original authors describes as its ability to identify patients who were

“unwilling or unable to perform or developed pain during the test were not able to participate in their sport pain-free in the glenohumeral complex.”1

Take Home Message

Given the number of healthy people that have pain with the test and its potential predictive validity, it may have a place in the testing continuum to identify those with unreported pain/problems once lower level testing is complete (shoulder mobility, impingement clearing test, trunk stability push up, etc.). In addition, it can be used as one factor to determine that a person has the capacity to accept weight through one limb which is an important demonstration of stability and strength particularly after rehabilitation. Remember, this assumes all lower level testing has been passed including shoulder mobility, trunk stability push up, grip strength, and side bridge.  

 

 References:  

1.  Goldbeck TG, Davies J. Test-Retest Reliability of the Closed Kinetic Chain Upper Extremity Stability Test: A Clinical Field Test. J of Sport Rehabil. 2000;9(1):35-46.

2.  Roush JR, Kitamura J, Waits MC. Reference Values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball PlayersNAJSPT. Aug 2007;2(3):159-163.

3.  Tucci HT, Martins J, Sposito Gde C, Camarini PM, de Oliveira AS. Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome. BMC musculoskeletal disorders. 2014;15:1.

4.  Pontillo M. Spinelli BA SB. Prediction of In-Season Shoulder Injury From Preseason Testing in Division I Collegiate Football Players. Sports Health. 2014.

5. de Oliveira VM, Pitangui AC, Nascimento VY, da Silva HA, Dos Passos MH, de Araújo RC. TEST-RETEST RELIABILITY OF THE CLOSED KINETIC CHAIN UPPER EXTREMITY STABILITY TEST (CKCUEST) IN ADOLESCENTS: RELIABILITY OF CKCUEST IN ADOLESCENTS. Int J Sports Phys Ther. 2017 Feb;12(1):125-132. PMID: 28217423; PMCID: PMC5294939.

6. Hollstadt K, Boland M, Mulligan I. Test-Retest Reliability of the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) in a Modified Test Position in Division I Collegiate Basketball Players. Int J Sports Phys Ther. 2020 Apr;15(2):203-209. PMID: 32269853; PMCID: PMC7134354.

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