Arm dominance is another limitation of the study. While the uninjured arm is a natural and readily available control, strength may not be truly symmetric. The literature on this is mixed but tends to indicate that the contralateral arm may be used as a reliable control as was done in the seminal study by McKee et al.5,29-31. Moreover, since thirteen of the sixteen frac- tures in our study occurred on the nondominant side, one could argue that the moderate deficit found in external rotation strength and abduction endurance strength may be exagger- ated. There are no good data on the difference in shoulder strength between the dominant and nondominant sides of adolescents, but in healthy adults shoulder strength tends to be equal between the sides, with both dominant and nondomi- nant arms being stronger in different planes of motion de- pending on the study31-36. Finally, the clinical examination and radiographic measurements were not performed by a blinded reviewer, as blinding could not be reasonably achieved given the clinical and radiographic deformities.