Shoulder Flexion
The motion of shoulder flexion is a combined effort of many joints. Motion occurs at the glenohumeral, sternoclavicular, scapulothoracic, and acromioclavicular joints. Allowing motion to occur at all joints involved may assess the overall functional abilities of the shoulder complex.
Normal Values:
0° to 180° (180°)
Testing Position:
Client is positioned seated with the shoulder in 0° of abduction, adduction, and rotation. Cervical, thoracic, mid lumbar spine retain nom curvatures.
Stabilization:
Stabilize the upper thorax to prevent excessive extension of the lumbar spine.
Goniometer Placement:
A: Centre the goniometer at the lateral shoulder, 1” distal to the acromion process.
SA: Mid-axillary line of the upper thorax.
MA: Lateral midline of the humerus, referencing the lateral epicondyle of the humerus.
Assessment:
Maintain goniometric placement and passively flex the shoulder with the “thumb up” position until the first resistance bather is noted or the spine becomes extended. Hold range of motion and record measurement.
Possible Tight Structures:
Latissimus dorsi, pectoralis major (costal fibers), rhomboids, serratus anterior.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
Glenohumeral Joint Internal (Medial) Rotation
Motion occurs primarily at the glenohumeral joint in the transverse plane around a longitudinal axis with the Client’s arm in anatomical position.
Normal Values:
0° to 70° (70°)
Testing Position:
Client is positioned supine with the humerus abducted at 90°, and elbow flexed at 900. Elbow is also at 0° of supination and pronation so that the palmar surface of the hand faces the ground. Humerus is supported by a towel to maintain a level position aligned with the acromion.
Stabilization:
Stabilize the scapula to prevent elevation as a medial rotation force is applied.
Goniometer Placement:
A: Center the goniometer at olecranon process of the elbow.
SA: Align the arm to be perpendicular to the floor.
MA: Align arm with the lateral midline of the ulna, referencing the ulnar styloid and olecranon process.
Assessment:
Maintain goniometric placement and passively internally rotate the humerus by applying a downward pressure to the dorsal wrist until the first resistance barrier is noted. Hold range of motion and record measurement.
Possible Tight Structures:
Infraspinatus, teres glenohumeral joint minor, posterior capsule.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
Glenohumeral Joint External (Lateral) Rotation
Motion occurs primarily at the glenohumeral joint in the transverse plane around an anterior- posterior axis.
Normal Values:
0° to 90° (90°)
Testing Position:
Client is positioned supine with the humerus abducted at 90°, and elbow flexed at 90°. Elbow is also at 0° of supination and pronation so that the palmar surface of the hand faces the ceiling. Humerus is supported by a towel to maintain a level position aligned with the acromion process.
Stabilization:
Stabilize the scapula to prevent lateral tilting and rotation.
Goniometer Placement:
A: Center the goniometer at olecranon process of the elbow.
SA: Align the arm to be perpendicular to the floor.
MA: Align arm with the lateral midline of the ulna, referencing the ulnar styloid and olecranon process.
Assessment:
Maintain goniometric placement and passively externally rotate the humerus by applying a downward pressure to the wrist until first resistance barrier is noted. Hold range of motion and record measurement. Motions greater than 90° may be considered normal depending on the overhead activities the Client participates in.
Possible Tight Structures:
Subscapularis, latissimus dorsi, teres major, pectoralis major, anterior glenohumeral joint capsule.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.