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Evaluation and Treatment of the Shoulder Complex: Summary
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
Orthopedic Tests • No longer considered special due to there being little information that supports their use • If going to use, best to use as a cluster Shoulder Complex Interventions Instrument-assisted soft tissue mobilization, joint mobilizations, joint manipulations, muscle energy techniques, kinesiology tape, thoracic mobility, shoulder flexion and internal rotation, shoulder extension and external rotation. Instrument-Assisted Soft Tissue Mobilization Gua sha is based on a traditional Chinese medicine. It uses an instrument with a flat edge that is moved along tissue by scraping or reddening until petechiae form, typically for one to two minutes. The patient should be positioned in a neutral comfortable position with the treatment area exposed while maintaining their modesty. The two main stroking techniques are long/slow and short/
Muscle-Selective Tissue Tension (MSTT) Musculotendinous Impairment Indication Strong/painless Normal tissue Strong/painful Tendinopathy Weak/painful Partial rear Weak/painless Complete tear Pain present = no formal manual muscle test (MMT) to avoid additional stress on painful tissue Accessory Motion Assessments • Posterior glide of humerus on scapula • Inferior glenohumeral glide • Scapula movement • Sternoclavicular inferior glide Muscle Length Tests • Pectoralis major • Biceps brachii • Latissimus dorsi • Supraspinatus/deltoid
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