During AROM you are assessing, how many degrees of freedom the patient has in the shoulder complex. Additionally, you are looking for compensation and movement quality. If your patient is in a lot of pain or comes to your practice directly post-op, you rather want to choose for the supine position instead of sitting. So what kind of pathologies could we use AROM assessment in the shoulder for? Let’s look at the most prominent ones:
1) Frozen Shoulder: In Frozen Shoulder you’d expect a severe decrease in AROM as well as PROM (tomorrow) with minimal pain, especially in external rotation in 0° of abduction and elevation.
2) Rotator cuff pathology: In this case, you might for example observe a painful arc between 60-120° of abduction, as well as scapular dyskinesia – although evidence for scapula dyskinesia and its contribution to shoulder pain is conflicting.
During active range of motion assessment, you’re going to evaluate the following movements: First, there is elevation through abduction. Ask your patient to place the arms in the anatomic position, meaning the palms face forward with the thumbs pointing towards the side. Then ask your patient to slowly abduct the arms as far as possible. Ask your patient to perform the same movement, but now you’re looking at him from the back.
To evaluate the movement, make use of the scapulohumeral rhythm. You’re going to examine the movements of the humerus, scapula, and clavicle. The second movement is elevation through forward flexion. Ask your patient to stand upright and the thumbs point forward and then your patient is going to slowly forward flex both arms.
For extension, ask your patient to stand upright and then instruct him to bring the arms as far back as possible. Make sure that the movement is in the shoulder and that the patient does not compensate from the spine by leaning forward or by scapular retraction.
For lateral or external rotation, ask your patient to flex the elbow to 90° and have the upper arms rest against the thorax. The patient is then asked to bring the wrist outward as far as possible without abducting the arm. This movement should be performed carefully in patients who suffered shoulder dislocations.
For medial or internal rotation, there are two ways to assess this movement. First, there is the hitchhiking thumb. Ask your patient to extend the thumb and reach as far up the back as possible with it. The spinous processes T5 and T10 represent normal internal rotation degrees. The second way to assess medial or internal rotation is to ask your patient to abduct the arms to 90° and then perform internal rotation.
Next up is adduction. Instruct your patient to bring the arms as far as possible in front of the body. Next up is horizontal adduction or crossed flexion. Ask your patient to abduct the arms to 90° and then bring the arms as far as possible in front of the body.
For scapular protraction, ask your patient to bring the shoulders as far as possible together anteriorly. For scapular retraction, ask your patient to squeeze the shoulder blades together and thus perform retraction.
For shoulder elevation, instruct your patient to shrug the shoulders. For shoulder depression, instruct your patient to bring the shoulders towards the floor as far as possible.
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