Shoulder Assessment and Programming: Part 1 Shoulder Range of Movement and Strength Testing
When you sustain a shoulder injury there are a number of shoulder strength tests that exercise physiologists perform to assess the range of movement.
Forward Flexion
The straight arm is raised in front of the body, with the palm down, as high as possible.
Abduction
The straight arm is raised at the side, with the palm down, as high as possible.
External Rotation
The elbows are held by the sides of the body, bent at 90o with palms facing each other. Then, keeping the elbows in contact with the body, the hands are spread outwards as far as possible.
Internal Rotation (Hand Behind Back)
The arm is put behind the back with the elbow bent. The person reaches as far up the back as possible. This distance is measured from a specific point on the spine.
Supraspinatus Strength Test
Supraspinatus strength is tested with the arm held at 90o of scapular elevation. The patient resists a downward force applied by the examiner on the patient’s arm.
External Rotation Strength Test
Strength in external rotation is tested with the elbow held by the side and flexed at 90o, with the patient applying outward resistance against the examiner’s inward push on the hand.
Internal Rotation Strength Test
This movement is in the opposite direction to external rotation. To test strength in internal rotation, the patient resists inward pressure applied by the examiner’s hand.
Subscapularis Strength (Lift-off) Test
To test the strength of the subscapularis muscle, the hand of the affected shoulder is placed behind the back. The patient pushes outward, countering an inward push on the palm applied by the examiner. The examiner can measure the current strength of the subscapularis muscle by determining how much force is needed to resist the patient’s attempt to lift his/her hand from the back.
Range of Motion (ROM) Tests
The following ROM tests should be conducted both actively (patient’s own strength) and passively (performed by examiner), and the results should be considered separately. The reason for this is that if the patient is experiencing pain, he/she may restrict movement. Furthermore, the opposing limb should be examined in an identical fashion in order to evaluate bilateral symmetry.
External Rotation
The patient is positioned sitting and the elbow is flexed 90º. While the elbow is held against the patient’s side, the examiner externally rotates the arm as permitted.
Internal Rotation
The patient should be positioned sitting. With the elbows at the patient’s side, the examiner should raise the thumb up the spine, and record the position in relation to the spine (reaching T7 is normal, unless bilateral symmetry is observed).
Internal Rotation at 90º Degrees of Forward Flexion
The patient is positioned sitting with the elbow and shoulder supported to prevent muscle contraction. The arm is at 90º with the fingers pointing downward and palm facing posteriorly. The examiner attempts to rotate the forearm posteriorly as far as possible.
Forward Flexion Strength Tests
The arm is kept straightened and brought upward through the frontal plane, and moved as far as the patient can go above his head. Note: for recording purposes, 0º is defined as straight down at the patient’s side, and 180º is straight up.
External Rotator Cuff (RC) Strength
Position the patient sitting, with his arms at his sides and elbows at 90º. It is important to maintain the elbow positioning at the sides while the external rotation is attempted by the patient (the examiner applies internal resistance).
Internal Rotator Cuff (RC) Strength
Position the patient sitting, with his arms at his sides and elbows at 90º. It is important to maintain the elbow positioning at the sides while the internal rotation is attempted by the patient the examiner applies external resistance.
Supraspinatus Strength
The patient is positioned sitting with arms straight out, elbows locked, thumbs down, and arm at 30º (in scapular plane). The patient should attempt to abduct his arms against the resistance applied by the examiner.
Take a read of part II of this series where we look at corrective programming for shoulder injuries.