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.
- Pain indicates subacromial bursitis or supraspinatus tendonitis.
- Stabilize the scapula. Take arm through passive abduction ROM.
- Palm faces inward on full abduction
- 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.
