Shoulder Assessment

Passive and active range of motion for the shoulder complex.

Shoulder Assesment

Passive ROM Tests

1. Passive Abduction (Normal 180°)

Tests the GH joint and scapular rotation.

  1. Pain indicates subacromial bursitis or supraspinatus tendonitis.
  2. Stabilize the scapula. Take arm through passive abduction ROM.
  3. Palm faces inward on full abduction
  4. If NO PAIN, test end feel.

2. Passive Abduction

  • Monitor scapular rotation.
  • Normal - 80° - 100° of abduction prior to scapular rotation.
  • Isolate the point at which the scapula begins to rotate.
  • Palpate the lateral border of the scapula, just above the inferior angle
  • Slowly abduct the arm to determine the point at which the scapula begins to rotate. Abduct/Adduct the arm through a short range of motion to confirm.
  • Scapular rotation prior to 80° indicates a restriction in the GH joint. This may be part of a capsular pattern, if lateral rotation is also limited.

3. Passive External Rotation

  • Normal 80°
  • Marked restriction indicates capsular adhesions or arthritis.
  • Also stretches internal rotators (subscapularis, pecs).
  • Arm at side, with elbow bent to 90 °.
  • Stabilize the elbow close to the body.
  • Passively rotate the shoulder to the end of pain free lateral rotation (True ROM).
  • If NO PAIN, test end feel.

4. Passive External Rotation at Shoulder Height

  • Normal ROM - 120°
  • Perform at shoulder height to test the length of the Subscapularis (medial rotators).
  • If NO PAIN,  test end feel.

5. Passive Internal Rotation - Normal 115°

  • Tests inner fascia of joint capsule.
  • Also Test the length of external rotators (infraspinatus and teres Minor).
  • Place clients hand behind the lower back with the elbow bent.
  • Stabilize the humerus in place, grasp the arm just above the wrist and pull slowly to the motion barrier. (True ROM).
  • If NO PAIN,  test end feel.
  • This test often reproduces symptoms in the posterior shoulder.

6. Passive Horizontal Adduction - AC Joint Test

  • Stand at the client’s side, opposite the shoulder to be tested.
  • Stabilize behind the scapula nearest nearest to you.
  • Support the shoulder at 90° of abduction, and pull the arm directly across the client’s body to an anatomical motion barrier.
  • If NO PAIN,  test end feel.
  • Positive sign is pain in the front of the shoulder joint.
  • A positive sign indicates a lesion in the acromioclavicular joint, that is created by the impingement of the acromion against the clavicle.

RESISTED ROM TESTS

1. Resisted Abduction

  • Tests for lesions along the entire length of the supraspinatus tendon.
  • Supraspinatus tendonitis often results from improper shoulder mechanics with overhead lifting, and can also be due to rounded shoulder posture.
  • Place patient’s elbow at side with elbow bent, and thumb up.
  • Resist abduction by applying pressure against the outside of the elbow.
  • Instruct client to match your resistance, and push against you.
  • Limit the abduction to 30°.
  • This can also be performed as a Fatigue Test - continue contractions until symptoms appear, or the client fatigues.
  • Thiswilldetermineifthereisanyweaknessoftheshoulderabductors(anterior, middle, posterior deltoids and supra).

2. Resisted Abduction; 30° Horizontal Adduction(empty can)

  • Test for lesions in the tenoperiostial junction (TPJ) of the supraspinatus.
  • Also tests for weakness of the supraspinatus.
  • Pinches the tendon against the acromion.
  • A Positive test with a specific pain at the site indicates scar tissue or disorganized collagen.
  • Abduct the client’s arm to 90°, with 30° of horizontal adduction.
  • Turn the thumb down.
  • Instruct the client to push the arm upwards, as you offer resistance downwards.

3. Resisted External Rotation -Tests for lesions in the infraspinauts and teres minor.

  • Weakness and adhesions in these tissues is common.
  • Stabilize the client’s bent arm (90°) with the elbow close to their body.
  • Provide resistance against the back of the forearm, just above the wrist.
  • Instruct the client to match your resistance to perform an isometric
  • contraction, pushing outwards.
  • Perform this at mid and end range of lateral rotation.

4. Resisted Internal Rotation

  • Tests for lesions in the subscapularis or pectoralis major.
  • Tightness and adhesions in these tissues is common.
  • Stabilize the client’s bent arm (90°) with the elbow close to their body, and
  • shoulder externally rotated to approximately 70° - 80°.
  • Provide resistance against the front of the forearm, just above the wrist.
  • Instruct the client to match your resistance to perform an isometric contraction, pulling inward

5. Resisted Flexion (Bicep Tendon)

  • Begin with the arm straightened.
  • Palpate the bicipital groove firmly with your thumb.
  • Hold above the wrist and instruct the client to flex their arm to contract thebiceps.
  • Positive test produces soreness to pressure over the bicipital tendon,restricted motion, and aching pain.
  • The long head of the biceps tendon travels through the capsule of theshoulder joint and the bicipital groove.
  • Referred pain is mostly over the front of the shoulder, with spill over painpattern in the suprascapular region.

6. Resisted Extension (Triceps)

• Lesions at the origin of the long head of the triceps are common.

• Tightness along the full length of the triceps is common.

  • When this muscle is short, it can cause the glenoid fossa to be pulled in a lateral and inferior direction.
  • This alters the normal biomechanical function of the GH joint.
  • Place client’s bent arm, with elbow pointing to ceiling and hand behind shoulder.
  • Place your opposite hand against the back of the scapula to stabilize.
  • Hold the arm just above the bent elbow, and induce shoulder flexion to an anatomical motion barrier to place the triceps on stretch.
  • Instruct client to pull down while you resist at the elbow.