AROM, PROM & MMT of Shoulder Flashcards
What movements are possible at the shoulder?
Flexion/Extension Abduction/Adduction Medial/Lateral rotation Elevation/Depression Protraction/Retraction
Would evaluate these movements from anterior and posterior aspects
What functional movements could you ask them to do?
Lifting something Getting something from cupboard Fastening bra Washing hair Taking off jacket
How would you conduct goniometry of flexion?
Pt - half lying or seated, arm at side, palm facing medially
PT - to side and back diagonally
Axis - lateral aspect of humeral head centre, 2.5cm inferior to lateral aspect of acromion
Stationary arm - parallel with midline of trunk
Moveable arm - lateral epicondyle of humerus
Command - keep elbow straight, move arm forwards and upwards as far as you can
How would you conduct goniometry of extension?
Pt - prone, arm rested on plinth, palm facing medially
PT - to side and back diagonally
Axis - lateral aspect of humeral head centre, 2.5cm inferior to lateral aspect of acromion
Stationary arm - parallel with midline of trunk
Moveable arm - lateral epicondyle of humerus
Command - keep elbow straight, move arm backwards as far as you can
How would you conduct goniometry of abduction?
Pt - supine on plinth, palm face medially
PT - to side and back diagonally
Axis - placed over anterior midpoint of GH joint, 1.5cm inferior and lateral to coracoid process
Stationary arm - parallel with mid sternal line
Moveable arm - lateral epicondyle of humerus
Command - keep elbow straight, move arm outwards and upwards toward your head as far as you can, keep your palm facing inwards
How would you conduct goniometry of adduction?
Pt - supine on plinth, palm face medially
PT - to side and back diagonally
Axis - placed over anterior midpoint of GH joint, 1.5cm inferior and lateral to coracoid process
Stationary arm - parallel with mid sternal line
Moveable arm - lateral epicondyle of humerus
Command - keep elbow straight, move arm inwards across body towards opposite side
How would you conduct goniometry of internal rotation?
Pt - supine on plinth, shoulder at 90degrees abduction, elbow flexed at 90 degrees, forearm pronated, towel under humerus
PT - to side
Axis - olecranon process of ulna
Stationary arm - parallel to floor
Moveable arm - parallel to ulna to styloid process
Command - move palm downwards towards floor
How would you conduct goniometry of external rotation?
Pt - supine on plinth, shoulder at 90degrees abduction, elbow flexed at 90 degrees, forearm pronated, towel under humerus
PT - to side
Axis - olecranon process of ulna
Stationary arm - parallel to floor
Moveable arm - parallel to ulna to styloid process
Command - move palm backwards towards plinth
Capsular pattern of shoulder
Active and passive movements restricted
External rotation > Abduction > Internal rotation
Prime movers of shoulder flexion
Anterior deltoid Pec major (clavicular part) Coracobrachialis
Prime movers of shoulder extension
Posterior deltoid
Latissimus dorsi
Teres major
Prime movers of shoulder abduction
Deltoid
Supraspinatus
Prime movers of shoulder lateral rotation
Infraspinatus
Teres minor
Posterior deltoid
Prime movers of shoulder medial rotation
Latissimus dorsi
Anterior deltoid
Pec major
Subscapularis
Prime movers of horizontal adduction
Pec major
Expected ROM of shoulder extension
0-60
Expected ROM of shoulder internal rotation
0-70
Expected ROM of shoulder external rotation
0-90
Expected ROM of horizontal adduction
0-135
Expected ROM of flexion (elevation)
0-180 (0-60 GH)
Expected ROM of abduction (elevation)
0-180 (0-30 GH)
End feel of extension, int rotation, ext rotation and flexion
Firm
Tissue stretch
End feel of horizontal adduction
Firm/Soft
Tissue stretch/apposition
End feel of abduction
Firm/hard
Tissue stretch/bone
How would you assess AROM of flexion?
Ask pt to have arms by side with thumbs facing forward
Ask pt to lift both arms, keeping them straight, out in front of them and all the way above their heads as far as they can go
How would you assess AROM of extension?
Ask pt to have arms by side with thumbs facing forward
Ask pt to move arms back as far as possible
Ensure pt movement is in shoulder and does not compensate by leaning forward or rotating scapula
How would you assess AROM of abduction?
Pt in anatomical position
Ask them to have arms by side with hands facing forward
Ask them to raise both arms up to the side of their head as far as they can
How would you assess AROM of lateral rotation?
Ask pt to bend elbow to 90
Keep upper arm and elbow tight in to their side
Ask them to move wrist and hands out to the side as far as they can
Make sure they are not abducting arm
How would you assess AROM of medial rotation?
Ask patient to reach as far up their back as possible with their thumb
Normal = reaching spinous processes of T5-T10
How would you assess AROM of horizontal adduction?
Ask pt to bring arms out so they are in line with shoulders
Ask pt to bring arms across body as far as they can
How would you assess AROM of protraction?
Ask pt to bring shoulders as far as they can to the front as if they are trying to make them touch in front of them
How would you assess AROM of retraction?
Ask pt to squeeze shoulder blades together as if you are trying to make them touch behind you
How would you assess AROM of elevation?
Ask pt to shrug shoulders bringing them up to their ears
How would you assess AROM of depression?
Ask them to do the opposite of shrugging shoulders
Pushing them as far as possible towards the floor as they can
How would you conduct resisted isometric testing of flexion?
PT to side of pt
One hand at middle of anterior arm pushing backwards
Ask pt to bring arms forward and meet your resistance
How would you conduct resisted isometric testing of extension?
PT to side of pt
One hand at middle of posterior arm pushing forwards
Ask pt to move arms backwards and meet your resistance
How would you conduct resisted isometric testing of abduction?
PT in front of pt
Place both hands on both arms
Ask pt to lift arms up and out to the side and meet your resistance
How would you conduct resisted isometric testing of lateral rotation?
PT in front of pt
Ask pt to bend elbow, keeping arm and elbow in to their side
PT places hand on lateral arm and ask pt to move forearm out to the side to meet your resistance
How would you conduct resisted isometric testing of medial rotation?
PT in front of pt
Ask pt to bend elbow, keeping arm and elbow in to their side
PT places hand on medial arm and ask pt to move forearm inwards to meet your resistance
How would you clear the neck?
Do a full assessment of AROM of the joint to see if any movements replicate their symptoms
Flexion/Extension (bring chin to chest)
Rotation - turn head to left and right
How would you clear the elbow?
Do a full assessment of AROM of the joint to see if any movements replicate their symptoms
Flexion/Extension
Supination/Pronation
Prime mover of scapula elevation
Descending part of trapezius
Prime mover of scapula protraction
Serratus anterior
Prime mover of scapula retraction
Middle part of trapezius
