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Evaluation and Treatment of the Shoulder Complex: Summary
Posture Assessment • Forward head posture: Compensatory mechanism due to spinal changes in the thoracic and lumbar regions. • Scapula protraction/shoulder IR: Caused by increased kyphosis; if there is tightness in the rectus abdominis, the patient is pulled into increased trunk flexion/increased thoracic kyphosis. • Lumbar hyperlordosis: Caused by anterior pelvic tilt. • Knee hyperextension: Caused by anterior shift of the head of the femur; also results in anterior pelvic tilt. • Ankle plantarflexion = tibia falls posteriorly → tight gastrocnemius. Active Range of Motion and Passive Range of Motion • Active range of motion (AROM) assessment
LEARNING TIP! Overhead reach assessment Overhead reach screens: cervical posture, shoulder flexion and abduction mobility, thoracic mobility, and lumbopelvic stability.
○ If active range of motion is restricted, then shoulder passive range of motion (PROM) should be assessed. PROM will eliminate muscle and strength component of motion. Active and passive ROM restriction indicates a tightness issue. If active and passive ROM are restricted (indicating a tightness issue), this could be due to the joint capsule, the fascia, tightness in the muscle, or never mobility. Restricted AROM with full PROM indicates a weakness issue
Mobility of the Shoulder Complex
Normal ROM Functional ROM 180 degrees ~ 120 degrees
Capsular Restrictions Limiting Motion
Motion
• Posterior glenohumeral capsule • Inferior glenohumeral capsule • Posterior tilt of the scapula • Anterior glenohumeral capsule • Inferior glenohumeral capsule • Anterior tilt of the scapula • Anterior glenohumeral capsule • Inferior glenohumeral capsule • Upward rotation of scapula
Shoulder flexion
Shoulder extension
60 degrees –46 degrees
Shoulder abduction
180 degrees –128 degrees
• Not applicable
Shoulder horizontal adduction Shoulder lateral/ external rotation Shoulder medial/ internal rotations
180 degrees –116 degrees
(putting on seat belt)
• Anterior glenohumeral capsule • Medial glide of the scapulae • Posterior glenohumeral capsule • Lateral glide of scapulae
90 degrees –59 degrees
70 degrees
No functional ROM associated with this motion
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