The baseline position is a position where the arm is alongside the torso with the thumb pointed ventrally. Range of movement is assessed using this position as a reference [Figure 17]. The active movement of both shoulders should be carried out by the patient as simultaneously and symmetrically as possible, to avoid movement of the torso and to allow comparison of the side that is being examined with the contralateral side. If necessary, demonstrate the movements.
Figure 17
Procedure
- The patient should stand or sit comfortably with their arms hanging down, and face the examiner.
- Inspect the movements and assess:
- The course of the movement.
- The maximum range of motion.
- Occurrence of pain.
- Occurrence of crepitations.
- Occurrence of any contractures and/or compensatory movements.
- Movements in the acromioclavicular and sternoclavicular joint.
- Allow six composite movements to be carried out:
- Anteflexion (from the starting position) [Figures 18a, 18b].
Figure 18a
Figure 18b
- Retroflexion (from the starting position) [Figure 19].
Figure 19
- Abduction (have the patient rotate their arm outwards; the thumb should point backwards slightly so that the greater tubercle turns dorsally from underneath the shoulder blade so the glenohumeral ligaments are slightly more relaxed) [Figures 20a, 20b].
Figure 20a
Figure 20b
- Horizontal adduction (from the starting position) [Figure 21].
Figure 21
- Outward rotation (starting position: the 90° flexed elbows are positioned at the flanks) [Figure 22].
Figure 22
- Inward rotation (starting position: the 90° flexed elbows are positioned at the flanks) [Figure 23].
Be aware that these composite movements are achieved by movements of the whole shoulder girdle, not only the humeral joint.
Figure 23
- Abduction [Figures 24] and anteflexion [Figures 25a, 25b] at the posterior side, to assess the scapulohumeral rhythm.
Figure 24
Figure 25a
Figure 25b
- Should there be any suspicion of a disorder of the acromioclavicular or sternoclavicular joint, it is also useful to ask the patient to carry out the following movements:
- Elevation (raising the shoulders) [Figure 26].
Figure 26
- Depression (pushing the shoulders down) [Figure 27].
Figure 27
- Protraction (moving shoulders forwards) [Figure 28].
Figure 28
- Retraction (moving shoulders backwards) [Figure 29].
Figure 29