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Range-of-Motion Testing

Excerpted with commentary from: Range-of-Motion Testing charts by Richard Finn and C. M. Shifflett. See examples of shoulder and rotator cuff pain that these tests help evaluate. See also our sampler of cervical tests from the charts and typical neck and head pain patterns coming from muscles and fascia. Get all the tests on 2 wallcharts for office or dojo. Order here while they're still on sale!

Rotator Cuff and Shoulder Girdle Tests

The following examples of muscle testing reveal muscle problems that may underlie rotator cuff or shoulder girdle pain and dysfunction. Always always get the appropriate medical attention and tests. An MRI is best for rotator cuff tears. Sonograms are reliable for detecting major tears (but not small ones).

Travell & Simons (1999) pointed out that . . . "Painfully restricted motion at the shoulder ("frozen shoulder") that is due to adhesive capsulitis exhibits less pain and more rigidity than does comparable restriction that is caused by myofascial TrPs [trigger points]. True adhesive capsulitis often requires short-term steroid therapy, which may be given orally. However . . . Multiple TrPs in the rotator cuff muscles, especially in the subscapularis muscle, can mimic the symptoms of adhesive capsulitis. When a patient has not responded well to treatment for the diagnosis of adhesive capsulities, the clinician needs to consider TrP sources for the patient's symptoms. When TrPs are producing the symptoms, appropriate TrP therapy (without steroids) should be initiated. It is not unusual for both conditions to coexist. Both need treatment."

Travell, J. G. and Simons, D. G. (1999),Myofascial Pain and Dysfunction-- The Trigger Point Manual, p. 488. See also their extensive section on differential diagnosis of shoulder and rotator cuff problems starting on p. 544. Available from www.lww.com

Mouth Wraparound Test Infraspinatus DBAL Middle Deltoid SBAL Subscapularis DBAL Posterior Deltoid SBAL Supraspinatus Teres Major SFAL Latissimus Dorsi SFAL/BFL Levator Scapula DBAL Splenius Cervicis SL Teres Minor DBAL Coracobrachialis	This is the single most important test for shoulder girdle dysfunction. Combine with Backrub Test , below. Position patient’s head at 45^o to shoulders. Patient reaches arm around back of head to mouth. Substitution: Increasing head angle to reach hand. Maintain proper posture. A. No restriction: Short upper arms should reach corner of mouth; Normal arms: center of mouth; Hypermobile arms: opposite side of mouth. B. Restriction: Primarily middle deltoid/infraspinatus with other possible involvement.If patient is: Unable to reach back of neck: subscapularis. Able to reach to ear only: infraspinatus. Able to reach over head but not behind it: posterior deltoid, coracobrachialis. Unable to hold arm in abduction: supraspinatus. Unable to rotate head to 45^o for this test. See Cervical Rotation Test.
Backrub Test Coracobrachialis Anterior Deltoid SBAL	Patient reaches across lower back to opposite side. Note distance achieved and difference between one side and the other. Press at elbow, pushing arm downward and slightly to the rear (away from the body). A. No restriction: Knuckles of palm extend beyond spine. B. Restriction: Knuckles reach only to midline. Restriction rare in persons of normal weight. Failure, or pain or weakness on resistance: severe restriction in coracobrachialis, or a severely injured anterior deltoid; see Arm Abduction Test. Unable to reach behind back: supinator; see Supinator Test.
Hand to Shoulder Blade Test Infraspinatus DBAL Anterior Deltoid SBAL Supraspinatus Subscapularis DBAL Supinator Pectoralis Major FF, SFAL Latissimus Dorsi SFAL, BFL Teres Minor DBAL	Patient reaches open hand behind back, wrist straight. Observe hand level relative to spine of scapula. Measure any side-to-side variation. Substitution: Bending wrist to reach higher up back. A. No restriction: Fingertips reach spine of scapula. B. Restriction: Fingertips cannot reach spine of scapula. If patient: Can barely reach hip pocket: infraspinatus (primary) and anterior deltoid (secondary). See Arm Abduction Test. Supraspinatus usually involved with infraspinatus (see Mouth Wraparound Test) or upper trapezius (see Cervical Lateral Flexion Test). Is slightly restricted after treating infraspinatus: teres minor. Can overcome shortening and weakness through passive motion (such as walking fingers or wrist up back: subscapularis. Has restriction with pain in supinator reference area of thumb; difficulty bending elbow to reach behind back. See Supination Test. Still has restriction after working the above: pectoralis major (see Shoulder Drop Test), latissimus dorsi (see Overhead Reach Test).
Overhead Reach Test Triceps DBAL Teres Major SFAL Latissimus Dorsi SFAL, BFL	Patient brings arms together over top of head as if clapping hands. Determine whether patient can bring arms in to touch ears, palms together, fingers level. Substitution: Tilting arms away from short side to equalize reach. A. No restriction: Can touch ears with insides of arms, arms reach same height, fingertips aligned. B. Restriction: With severely shortened triceps or teres major, one arm or (or both) will be bent, and it may be difficult or painful to press arms to ears. If not possible to move arm behind ears, teres major (see Mouthwrap Test), coracobrachialis (see Backrub Test), and latissimus dorsi may also be involved.
Over Shoulder Reach Triceps DBAL	Raise arm to shoulder level, arm out, palm up. Flex elbow to place palm on same-side shoulder, palm down. Slide palm down back, pointing elbow to ceiling. Substitution: Dropping head forward to bring ear forward of arm. Shifting arm out to side to relieve tightness in triceps. Keep and elbow perpendicular to body. A. No restriction: Elbow vertical or beyond ear. B. Restriction: Cannot point elbow to ceiling. Note: The photo from which this sketch was made was not a staged shot. It was actual Before & After range of motion. Compare active triceps trigger points in B with improved range of motion immediately after treatment (A).

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