Shoulder Flexion
Shoulder Extension
- Start Position: Seated with arm at side. Forearm in pronation.
- Stabilize: Over clavicle and scapula
- Instruction: “Life your arm straight in front of you. Do not let me push it down”
- Resistance: Pushing distal humerus downward
- Start Position: Seated with arm at side. Forearm in pronation.
- Stabilize: Over clavicle and scapula
- Instruction: “Move your arm straight back as far as it will go. Keep your palm facing away from you”
- Resistance: Pushing distal humerus forward
(Gett & Romaniw, 2021)
Shoulder flexion: Against gravity, November 4, 2021. Courtesy of Shelby Nigon.
Shoulder extension: Against gravity, November 4, 2021. Courtesy of Shelby Nigon.
Shoulder Flexion and Extension Gravity Eliminated (GE)
- Start Position: Lying on opposite side with arm resting at side of body. Therapist supports from beneath the elbow.
- Instruction: “Try to move your arm straight in front of you”
- Palpation: Anterior deltoid and pectoralis major
- Start Position: Lying on opposite side with arm resting at side of body. Therapist supports from beneath the elbow.
- Instruction: “Try to move your arm straight back”
- Palpation: Latissimus dorsi and teres major
(Gett & Romaniw, 2021)
Shoulder flexion: Gravity eliminated, November 5, 2021. Courtesy of Shelby Nigon.
Shoulder extension: Gravity eliminated November 5, 2021. Courtesy of Shelby Nigon.
Shoulder Abduction and Shoulder Abduction GE
- Start Position: Seated with arm at side
- Stabilize: Over clavicle and scapula
- Instruction: “Raise your arm straight out to the side. Don’t let me push it down”
- Resistance: Push distal end of humerus downward.
- Substitutions: Watch for trunk lateral flexion and biceps substitution in case of external rotation of humerus
- Start Position: Lying on back with arm at side. Therapist supports from beneath the elbow
- Instruction: “Try to move your arm straight out to the side”
- Palpation: Middle deltoid below the acromion
(Gett & Romaniw, 2021)
Shoulder abduction: Against gravity, November 4, 2021. Courtesy of Shelby Nigon.
Shoulder adduction: Against gravity, November 5, 2021. Courtesy of Shelby Nigon.
Shoulder Horizontal Abduction and Adduction
- Start Position: Lying on belly with shoulder abducted at 90 degrees and elbow bent at 90 degrees. Humerus supported by the mat.
- Stabilize: Pressure with palm on opposite scapula
- Instruction: “Raise your elbow upward against my hand”
- Resistance: Push downward on posterior distal humerus
- Start Position: Lying on back with shoulder flexed at 90 degrees with arm straight in the air
- Stabilize: If extensors are weak, support distal forearm
- Instruction: “Draw your arm across your chest”
- Resistance: Pull arm outward horizontally. May palpate pectoralis major with other hand.
(Gett & Romaniw, 2021)
Shoulder horizontal abduction: Against gravity, November 5, 2021. Courtesy of Shelby Nigon.
Shoulder horizontal adduction: Against gravity, November 5, 2021. Courtesy of Shelby Nigon.
Shoulder Horizontal Abduction and Adduction GE
- Start Position: Seated with arm out to the side and elbow bent
- Instruction: “Try to move your arm to the side against my hand”
- Palpation: Posterior deltoid
- Substitution: Watch for trunk rotation
- Start Position: Seated with arm out to the side and elbow bent
- Stabilize: Support from beneath elbow
- Instruction: “Try to draw your arm across your chest”
- Palpation: Pectoralis major and anterior deltoid
- Substitution: Watch for trunk rotation
(Gett & Romaniw, 2021)
Shoulder horizontal abduction: Gravity eliminated, November 4, 2021. Courtesy of Shelby Nigon.
Shoulder horizontal adduction: Gravity eliminated, November 4, 2021. Courtesy of Shelby Nigon.
Shoulder External Rotation + Alternate and Shoulder Internal Rotation
External Rotation:
- Start Position: Client lays in prone position with testing arm hanging off the side of the table at the elbow joint. Humerus is abducted to a 90 degree angle and the elbow is flexed at a 90 degree angle.
- Stabilize: Proximal end of humerus bone
- Instruction: “Lift the back of your hand toward the ceiling.”
- Resistance: Therapist’s hand is placed on the distal end of the forearm and applies a downward force on the dorsal aspect.
Shoulder external rotation: Against gravity, November 4, 2021. Courtesy of Shelby Nigon.
Alternate External Rotation:
Start Position: Client is in the seated position with humerus abducted to 90 degrees and in full external rotation. The elbow is also bent to 90 degrees.
Stabilize: Distal end of humerus bone.
Instruction: “Try to move your hand back towards my hand.”
Resistance: Force is applied to the distal end of the forearm in the direction of internal rotation.
Internal Rotation:
- Start Position: Client lays in prone position with testing arm hanging off the side of the table at the elbow joint. Humerus is abducted to a 90 degree angle and the elbow is flexed at a 90 degree angle.
- Stabilize: Proximal to the elbow joint on the distal end of the humerus.
- Instruction: “Lift the palm of your hand toward the ceiling.”
- Resistance: Therapist’s hand is placed on the distal end of the forearm and applies a downward force on the volar aspect.
Shoulder external rotation alternate: Against gravity, November 4, 2021. Courtesy of Shelby Nigon.
Shoulder internal rotation: Against gravity, November 4, 2021. Courtesy of Shelby Nigon.
(Gett & Romaniw, 2021)
Shoulder External Rotation and Internal Rotation GE
External Rotation (GE):
Start Position: Client is in a seated position with humerus adducted and elbow flexed at 90 degrees.
Stabilize: Distal end of humerus against the body.
Instruction: “Try to move the back of your hand out to the side.”
Palpation: Subscapularis, teres major, latissimus dorsi, pectoralis major, and anterior deltoid.
Internal Rotation (GE):
Start Position: Client is in a seated position with humerus adducted and elbow flexed at 90 degrees.
Stabilize: Distal end of humerus against the body.
Instruction: “Try to move the palm of your hand in toward your stomach.”
Palpation: Subscapularis, teres major, latissimus dorsi, pectoralis major, and anterior deltoid.
(Gett & Romaniw, 2021)
Shoulder external rotation: Gravity eliminated, November 4, 2021. Courtesy of Shelby Nigon.
Shoulder internal rotation: Gravity eliminated, November 4, 2021. Courtesy of Shelby Nigon.
References:
Gett, M., & Romaniw, A. (2021, November 3). Manual muscle testing [PowerPoint slides]. Department of Health Sciences, Occupational Therapy, Chatham University. https://mylearning.chatham.edu/d2l/le/content/21252/viewContent/299633/View
Occupational Therapy Assessments 