Excerpted with commentary from our Range-of-Motion
Testing charts. 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. All these tests and more are available as a set of two wallcharts for office or dojo.
Rotator Cuff and Shoulder Girdle Tests
The following tests reveal muscle problems
that may underlie shoulder pain and dysfunction.
Always get appropriate medical attention and tests. (For rotator cuff tears,
a sonograms for major tears, but not small ones; an MRI best detail.) But always
A "frozen shoulder" resulting from adhesive capsulitis can be less
painful and more rigid than a shoulder restricted by myofascial TrPs [trigger points].
TrPs in rotator cuff muscles, especially subscapularis,
can mimic adhesive capsulitis symptoms. On the other hand, it is not unusual for
both conditions to coexist; both need appropriate treatment.
For extensive information on differential diagnosis of shoulder and rotator cuff
problems see Travell, J. G. and Simons, D. G. (1999),Myofascial Pain and Dysfunction--
The Trigger Point Manual, Vol. 1. Available from www.Amazon.com and www.lww.com
Infraspinatus Teres Major
This is the single most important
test for shoulder girdle dysfunction. Combine with Backrub
Substitution: Increasing head angle to reach
hand. Maintain proper posture.
- Position patient’s head at 45o to shoulders.
- Patient reaches arm around back of head to mouth.
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,
- Unable to hold arm in abduction: supraspinatus.
- Unable to rotate head to 45o for this test.
See Cervical Rotation Test.
- Patient reaches across lower back to opposite side.
- Note distance achieved and difference between one side and the
- 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
Shoulder Blade Test
Patient reaches open hand behind back, wrist
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
- 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
- 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
- Still has restriction after working the above: pectoralis
major (see Shoulder Drop Test), latissimus dorsi (see
Overhead Reach Test).
|Overhead Reach Test
Patient brings arms together
over top of head as if clapping
Determine whether patient can
bring arms in to touch ears, palms together, fingers
arms away from short side to equalize
A. No restriction: Can
touch ears with insides of arms, arms reach same height, fingertips
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
- 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
Substitution: Dropping head forward to bring ear forward of arm. Shifting
arm out to side to relieve tightness in triceps. Keep arm and elbow perpendicular
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 shows
actual Before & After treatment range of motion. Compare active pre-treatment triceps trigger points
(B) with improved range of motion immediately after treatment (A).
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