Range of Motion (ROM) Tests of the Shoulder

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. Note that all pictures shown here are performed passively, unless specifically noted as active.

External Rotation Test of Shoulder

The patient is positioned sitting and the elbow is flexed nienty(90) degrees. While the elbow is held against the patient's side, the examiner externally rotates the arm as far as posible.

Internal Rotation Test of Shoulder

The patient should be positioned sitting. Again 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 90 degrees of Forward flexion of Shoulder

The patient is positioned sitting with the elbow and shoulder supported to prevent muscle contraction. The arm is at 90 degrees with the fingers pointing downward and palm facing posteriorly. The examiner attempts to rotate the forearm posteriorly as far as possible.

Forward flexion Test of Shoulder

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, 0 degrees is defined as straight down at the patient's side, and 180 degrees is straight up.

Shoulder Abduction: Active Test

The arm is again kept straightened, while raised and abducted. Observe the twisting of hand -- facing outward, not forward, as in forward flexion. The ROM is measured in degrees as decribed for forward flexion. As pictured, this test is being done actively by the patient, but may be performed by the examiner as well.