Shoulder Passive Range of Motion | PROM Assessment
The goal of passive range of motion assessment is to assess the osteokinematic movements of a joint, evaluate the range of motion in degrees and if motion is limited, assess the end feel. A collection of different end-feels can be seen in this table. Often times you will see differences between the dominant and non-dominant sides, which is completely normal and does not have to correlate with symptoms.
According to a study done by Werner et al in 2014, shoulder passive range of motion assessment had substantial interrater reliability in healthy subjects and significant interrater reliability in symptomatic individuals, with an innovative approach using a smartphone inclinometer performing the best. (show values in the table):
Let’s first look at forward flexion in the glenohumeral joint.
With the patient sitting on the bench, place one hand on the scapula and clavicle to fixate both. Then grasp the patient’s humerus as distal as possible and move it into forward flexion, which should be limited at around 80-90° for pure glenohumeral flexion. If we let go of the fixation and thus allow the clavicle and scapula to move, we should be able to raise the arm above the head to round about 180 degrees.
For extension, the same principles apply but the arm is moved backward to around 60° as a norm.
Let’s now look at abduction and adduction. For abduction, the patient is again in sitting position and we will apply the same proximal fixation as with flexion. Then abduct the arm to around 90°. If we let go of the fixation we should be able to move the arm further but will eventually have to externally rotate it slightly to reach end-range.
Abduction and adduction can not only happen in the frontal plane but also in the transversal plane. We then refer to horizontal abduction and adduction. For horizontal adduction, start with the arm in 90° abduction. Fixate the scapula at the lateral border and bring the arm towards the midline of the body. With proper scapula fixation, you should reach end-range at around 110°. Letting go of the scapula will allow you to move further across. Horizontal abduction is minimal at around 15°. You can fixate the clavicle and scapula with your body and hand and then move into horizontal extension.
At last, let’s examine the rotations in the glenohumeral joint. For external rotation, have the patient in upright sitting position. To fixate the shoulder girdle and thus isolate movement in the glenohumeral joint, place your thigh on the scapula and the contralateral arm over the patient’s chest. The hand of that same arm cups the elbow of the patient to stabilize it in the anatomic position. Then use your other hand to induce external rotation by grabbing onto the wrist of the patient’s arm and moving it outwards approximately 60° For internal rotation, the patient can sit on the end of the bench. The fixation of the shoulder girdle is then going to be opposite to the one we’ve seen for external rotation. So your thigh fixates the shoulder girdle anteriorly against the clavicle and your arm rests against the scapula. Then the patient’s arm is brought behind the back and lifted off the thorax. Which is usually around 100° from the anatomic position. Both of the rotations can also be assessed in 90° of abduction.
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