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  2. Closed Kinetic Chain Upper Extremity Stability Test

Closed Kinetic Chain Upper Extremity Stability Test

Last Updated

Purpose

The Closed Kinetic Chain Upper Extremity Stability Test is a low-cost performance test that provides quantitative data (scores) for an upper extremity task in closed kinetic chain with no need for high technology to be realized in sportive or clinical settings. It can help to determine deficits in closed kinetic chain upper extremity functional performance.

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Instrument Details

Acronym CKCUEST

Area of Assessment

Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Sports & Musculoskeletal Injuries

Populations

Healthy Adults
Non-Specific Patient Population
Mixed Populations

Key Descriptions

  • Patients assume the push-up position, with hands set 36 inches apart, and are scored based on the number of times the patient is able to pick one hand up and swing it across their hand stance and touch the supporting hand in a 15 second period.
  • Females can perform the test in a modified (kneeling) push up position.

Number of Items

1

Equipment Required

  • Tape
  • Stopwatch

Time to Administer

4 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Reviewed 10/29/2015 by Monica Austin, SPT; Aaron Rygiel, SPT; Purvi Vayas, SPT MacKenzie Eldridge, SPT; Ashlee Kim, SPT; Jamie Grainger, SPT;Ashlee Price, SPT; Maddie Nagy, SPT; Alexis Meister, ATC, SPT; Sarah Foley, ATC, SPT; Scott Peters, ATC, SPT.

Updated 10/31/2024 by Brooke Bishop Student, P.T.; Kristen Lee, Student P.T.; Christopher Slootmaker, Student P.T.; William Steele, Student P.T.; Tyler Toth, Student P.T.; and Nicholas Valencia, Student P.T. under the direction of Irene Ward, P.T., D.P.T., NCS

 

 

Body Part

Upper Extremity

ICF Domain

Body Function

Measurement Domain

Motor

Considerations

  • Goldbeck & Davies, 2000
    • Contraindications to perform the test include elderly age and patients with wrist/ elbow pathologies or posterior instabilities of the shoulder.
  • Hegedus, 2014
    • Reproducibility, validity, and responsiveness are not established. Caution should be exercised in the clinical interpretation of CKCUEST in relationship to risk assessment or as a stand-alone diagnostic tool for upper extremity sports-related injury.
  • Roush, 2007
    • Patients with comorbidities of the upper extremities may have difficulty performing the task. The older geriatric population may be unable to perform the test, and patients who are at risk of fracture may have an increased risk due to the force of impact.
  • Tucci, 2014
    • Some healthy subjects reported pain after the test even with no pain reported before the test, thus clinicians should have care when the test is considered in the initial evaluation of a subject with shoulder injury.

Mixed Populations

back to Populations

Standard Error of Measurement (SEM)

Active Females (Tucci, 2014; n=20; mean age= 21.75 (1.37) years)

  • Number of touches: SEM= 2.76
  • Power: SEM= 12.94
  • Normalized Score: SEM= 0.04

Active Males (Tucci, 2014; n=20; mean age= 23.15 (2.48) years):

  • Number of touches: SEM= 2.0
  • Power: SEM= 20.03
  • Normalized score: SEM= 0.03

Females with Subacromial Impingement Syndrome (Tucci (2014; n=15; mean age 49.87 (5.87) years):

  • Number of touches: SEM=1.89
  • Power: SEM= 6.02
  • Normalized Score: SEM= 0.03

Male with Subacromial impingement syndrome (Tucci, 2014; n=13; mean age= 45.15 (12.59) years):

  • Number of touches: SEM=1.95
  • Power: SEM= 7.50
  • Normalized score: SEM= 0.03

Male College Students (Goldbeck & Davies, 2000; n= 24; mean age 20.3 years)

  • Number of touches: SEM= 0.49 (calculated from SD listed on p. 41)

Sedentary Female (Tucci, 2014; n=20; mean age= 22.65 (3.00) years)

  • Number of touches: SEM= 2.43
  • Power: SEM= 12.94
  • Normalized score: SEM= 0.04

Sedentary Male (Tucci, 2014; n=20; mean age=24.95 (2.45) years)

  • Number of touches: SEM= 1.45
  • Power: SEM= 12.58
  • Normalized score: SEM= 0.02

Adults With and Without Shoulder Symptoms: (Sciascia & Uhl, 2015; n = 36 (18 asymptomatic, 18 symptomatic); mean age = 29.5 (7.5) years) 

  • SEM for Asymptomatic Group: 2 touches
  • SEM for Symptomatic Group: 2 touches 

 

Minimal Detectable Change (MDC)

Active Females (Tucci, 2014)

  • Number of touches: MDC= 3.91
  • Power: MDC= 18.30
  • Normalized Score: MDC= 0.06

Active Males (Tucci, 2014)

  • Number of touches: MDC= 2.82
  • Power: MDC= 28.32
  • Normalized score: MDC= 0.04

Female with Subacromial Impingement Syndrome (Tucci, 2014)

  • Number of touches: MDC= 2.67
  • Power: MDC= 8.52
  • Normalized Score: MDC= 0.04

Males with Subacromial Impingement Syndrome (Tucci, 2014)

  • Number of touches: MDC= 2.76
  • Power: MDC= 10.61
  • Normalized score: MDC= 0.04

Males College Students (Goldbeck &Davies, 2000)

  • Number of touches: MDC= 1.35 (calculated from SD on p. 41)

Sedentary Females (Tucci, 2014)

  • Number of touches: MDC= 3.43
  • Power: MDC= 18.30
  • Normalized score: MDC= 0.05

Sedentary Males (Tucci, 2014)

  • Number of touches: MDC= 2.05
  • Power: MDC= 17.79
  • Normalized score: MDC= 0.03

Adults With and Without Shoulder Symptoms: (Sciascia & Uhl., 2015) 

  • MDC90 for asymptomatic group (n = 18) = 4 touches
  • MDC90 for symptomatic group (n = 18) = 4 touches

Cut-Off Scores

Athletes (Hegedus, 2014) 

  • In a small, single-center trial, a cut score of <=24 discriminated between non-injured and injured collegiate baseball players with upper extremity sport-related injury. However, this cut score has poor diagnostic utility (sensitivity=0.72, specificity=0.69, positive likelihood ratio=2.3, negative likelihood ratio=0.39).

Normative Data

College-aged Males (Hegedus, 2014)

  • Number of touches: 27.8 ± 1.8

Collegiate Male Baseball Players (Roush (2007; n=77, mean age 19.03 (1.22) years)

  • Number of touches: 30.41 ± 3.87

Female Reference Values (Tucci, 2014)

  • Number of touches: 20.5
  • Power: 135
  • Normalized score: 0.31

Male Reference Values (Tucci, 2014)

  • Number of touches: 18.5
  • Power: 150
  • Normalized score: 0.26

Test/Retest Reliability

Active Female (Tucci, 2014)

  • Number of touches: Excellent test-retest reliability (ICC= 0.85)
  • Power: Excellent test-retest reliability (ICC= 0.82)
  • Normalized Score: Excellent test-retest reliability (ICC= 0.87)

Active Male (Tucci, 2014)

  • Number of touches: Excellent test-retest reliability (ICC=0.89)
  • Power: Excellent test-retest reliability (ICC= 0.84)
  • Normalized score: Excellent test-retest reliability (ICC= 0.90)

Female with subacromial impingement syndrome (Tucci, 2014)

  • Number of touches: Excellent test-retest reliability (ICC= 0.93)
  • Power: Excellent test-retest reliability (ICC= 0.94)
  • Normalized Score: Excellent test-retest reliability (ICC= 0.94)

Male with subacromial impingement syndrome (Tucci, 2014)

  • Number of touches: Excellent test-retest reliability (ICC= 0.91)
  • Power: Excellent test-retest reliability (ICC= 0.93)
  • Normalized score: Excellent test-retest reliability (ICC= 0.92)

Male College Students (Goldbeck &Davies, 2000)

  • Excellent test-retest reliability (ICC=0.922)

Sedentary Female (Tucci, 2014)

  • Number of touches: Excellent test-retest reliability (ICC= 0.92)
  • Power: Excellent test-retest reliability (ICC= 0.96)
  • Normalized score: Excellent test-retest reliability (ICC= 0.92)

Sedentary Male (Tucci, 2014)

  • Number of touches: Excellent test-retest reliability (ICC= 0.96)
  • Power: Excellent test-retest reliability (ICC= 0.96)
  • Normalized score: Excellent test-retest reliability (ICC=0.96)

Adults with and without upper limb pain: Lee & Kim, 2015; n = 40 (20 males, 20 females); mean age = 28.96 (3.15) years; Korean sample)

  • Excellent test-retest reliability: (ICC = 0.97, 95%CI: 0.93-0.99)

Adults With and Without Shoulder Symptoms: (Sciascia & Uhl, 2015) 

  • Acceptable test-retest reliability ICC (95% CI)
    • Asymptomatic group = 0.85 (0.42, 0.95)
    • Symptomatic group = 0.86 (0.11, 0.96) 

Construct Validity

Adults with and without upper limb pain: (Lee & Kim, 2015)  

  • Excellent convergent validity between the CKCUES test and maximum grip strength (r = 0.78–0.79, p < 0.01)   
  • Excellent convergent validity between the CKCUES test and peak torque of internal/external shoulder rotation (r = 0.82–0.94, p < 0.01)  

Responsiveness

College-aged Men and Women (Schulte-Edelmann et al., 2005; n=30)

  • Moderate Responsiveness (ES= 0.58463, calculated from Table 4 on p. 132)

Healthy Adults

back to Populations

Standard Error of Measurement (SEM)

Asymptomatic Adult Males: (Callaway et al., 2020; n = 34; male = 100%)

SEM by hand placement distance and variation: 

  • 36”
    • Mean touches: 1.72
    • Normalized to height: 0.009
    • Power scores: 7.74
  • Shoulder Breadth
    • Mean touches: 2.85
    • Normalized to height: 0.015
    • Power scores: 10
  • Shoulder Breadth to 36”
    • Mean touches: 2.06
    • Normalized to height: 0.011
    • Power scores: 7.48
  • 50% Height
    • Mean touches: 1.49
    • Normalized to height: 0.009
    • Power scores: 5.54

Non-Overhead Athletes: (Riemann & Davies, 2023; n = 40 (20 males, 20 females); mean age = 27.25 (2.6) years; no injury) 

  • SEM for females: 1.0
  • SEM for males: 1.4 

Female Overhead Athletes: (Kardor et al., 2023; n = 29; mean age = 26.6 (5.29) years; no injury) 

  • SEM: 1.72

 

Minimal Detectable Change (MDC)

Asymptomatic Adult Males: (Callaway et al., 2020)

MDC by hand placement distance and variation:  

  • 36”
    • Mean touches: 4.76
    • Normalized to height: 0.026
    • Power scores: 21.44
  • Shoulder Breadth
    • Mean touches: 7.78
    • Normalized to height: 0.043
    • Power scores: 27.72
  • Shoulder Breadth to 36”
    • Mean touches: 5.72
    • Normalized to height: 0.03
    • Power scores: 20.72
  • 50% Height
    • Mean touches: 4.14
    • Normalized to height: 0.024
    • Power scores: 15.35

Non-Overhead Athletes: (Riemann & Davies, 2023) 

  • MDD 90% for males = 3.3
  • MDD 90% for females = 2.3
  • MDC95 for males = 4.08 (calculated)
  • MDC95 for females = 2.85 (calculated) 

Female Overhead athletes: (Kardor et al., 2023)

  • MDC (MDC%) = 4.75 (20.35)

 

 

Normative Data

Elite canoe/kayak slalom athletes: (Powell et al., 2020; n = 13 (5 male, 8 female); mean age = 19.7 (5.15) years (3 Senior, 7 U23, 3 Junior); no injury) 

  • CKCUEST (Mean (SD); 95% CI; Minimum; Maximum)
    • Male: 29.1 (4.55); 23.5 - 34.8; 21.3; 32.3
    • Female: 22.3 (2.47); 20.2 - 24.4; 19.0; 25.3
    • All: 24.9 (4.73); 22.1 - 27.8; 19.0; 32.3
  • Modified-CKCUEST (Mean (SD); 95% CI; Minimum; Maximum)
    • Male: 25.1 (2.95); 21.5 - 28.6; 20.3; 27.7
    • Female: 24.7 (1.41); 23.5 - 25.9; 22.7; 26.7
    • All: 24.9 (1.97); 23.7 - 26.0; 20.3; 27.7
  • Normalized-CKCUEST (Mean (SD); 95% CI; Minimum; Maximum)
    • Male: 0.30 (0.043); 0.25 - 0.36; 0.23; 0.34
    • Female: 0.26 (0.024); 0.24 - 0.28; 0.23; 0.29
    • All: 0.28 (0.039); 0.25 - 0.30; 0.23; 0.34
  • Narrow Hand Position (Mean (SD); 95% CI; Minimum; Maximum)
    • Male: 29.1 (4.55); 23.4 - 34.8; 21.3; 32.3
    • Female: 24.8 (1.33); 23.7 - 25.9; 22.7; 26.7
    • All: 26.5 (3.57); 24.3 - 28.6; 21.3; 32.3
  • Wide Hand Position (Mean (SD); 95% CI; Minimum; Maximum)
    • Male: 25.1 (2.85); 21.5 - 28.6; 20.3; 27.7
    • Female: 22.2 (2.41); 20.2 - 24.2; 19.0; 25.3
    • All: 23.3 (2.86); 21.6 - 25.0; 19.0; 27.7

Test/Retest Reliability

Non-Overhead Athletes: (Riemann & Davies, 2023) (ICC, 95% CI) 

  • Acceptable test-retest reliability for males: (ICC = 0.823, 0.606-0.926)
  • Excellent test-retest reliability for females: (ICC = 0.954, 0.888-0.982)   

Female Overhead athletes: (Kardor et al., 2023; 3-day interval between tests)  

  • Acceptable test-retest reliability (ICC, 95% CI) = (0.8, 0.58-0.9)

 

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Adolescents: (Oliveira et al., 2017; n = 25; female = 14; mean age = 16.92 (1.41) years) 

  • SEM for average touches: 2.17
  • SEM for normalized scores: 1.35
  • SEM for power scores: 6.49 

 

Minimal Detectable Change (MDC)

Adolescents: (Oliveira et al., 2017) 

  • MDC for average touches: 6.01
  • MDC for normalized scores: 3.74
  • MDC for power scores: 17.98 

 

Normative Data

Adolescents: (Oliveira et al., 2017) 

Mean (SD) for Test and Retest

  •  Average Touches (Mean (SD))
    • Test: 25.6 (3.8)
    • Retest: 28.0 (5.4)
  • Normalized Score (Mean (SD))
    • Test: 14.8 (2.4)
    • Retest: 16.2 (3.4)
  • Power Score (Mean (SD))
    • Test: 69.1 (17.99)
    • Retest: 75.9 (20.7)

 

Test/Retest Reliability

Adolescents: (Oliveira et al., 2017) 

  • Poor test-retest reliability for average touches and normalized score (ICC = 0.68 for each)
  • Acceptable test-retest reliability for power (ICC = 0.87) 

 

Bibliography

Callaway, A.; Peck, J.; Ellis, S.; et al. (2020). A randomised observational study of individualised variations in the start position of the closed-kinetic chain upper extremity stability test. Phys Ther Sport, 41:16-22.   

Goldbeck TG, Davies GJ. (2000). Test-retest reliability of the Closed Kinetic Chain Upper Extremity Stability Test: a clinical field test. J Sport Rehabil. 9:35-45.

Hegedus EJ, Vidt, ME & Tarara, DT. (2014). The best combination of physical performance and self-report measures to capture function in three patient groups. Physical Therapy Reviews, 19(3), 196-203.

Kardor, S.; Gorji, Z.; Ghotbi, N.; et al. (2023). Upper extremity physical performance tests in female overhead athletes: a test-retest reliability study. J Orthop Surg Res, 18(1):489.  

Lee, D.R. & Kim, L.J. (2015). Reliability and validity of the closed kinetic chain upper extremity stability test.  J Phys Ther Sci., 27(4):1071-1073.  

Oliveira, V.M.; Pitangui, A.C.; Nascimento V.Y.; et al. (2017). 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, 12(1):125-132.

Powell, A.; Williamson, S.; Heneghan, N.R.; et al. (2020) Investigation of the closed kinetic chain upper extremity stability test in elite canoe/kayak slalom athletes. Phys Ther Sport, 46:220-225.  

Riemann, B.L. & Davies, G.J. (2023). Reliability of upper extremity functional performance tests for the non-overhead athlete. Int J Sports Phys Ther, 18(5):1166-1175.

Roush, J. R., Kitamura, J., & Waits, M. C. (2007). Reference Values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball Players. North American Journal of Sports Physical Therapy?: NAJSPT, 2(3), 159–163.

Schulte-Edelman, J, Davies, GJ, Kernozek, TW, & Gerberding, ED. (2005). The Effects of Plyometric Training of the Posterior Shoulder and Elbow. Journal of Strength and Conditioning Research, 19(1), 129-134.

Sciascia, A. & Uhl, T. (2015). Reliability of strength and performance testing measures and their ability to differentiate persons with and without shoulder symptoms. Int J Sports Phys Ther, 10(5): 655-666.

Tucci, HT, Martins, J, Carvalho Sposito, G, Camarini, PM, Siriani de Oliveria, A. (2014). Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome. BMC Musculoskeletal Disorders. 15(1), 1-9.

 

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