UL AROM/PROM

Question 1

Shoulder Flexion AROM

Answer 1

Supine, Knees up to avoid thoracic hyper extension. Can place shoulder off the table to get more than 180°.
Ask patient to lift their arm above their head.
Fulcrum: Humeral head
Stationary arm: Aligned with the trunk
Moving arm: aligned with midline of humerus
ROM: 180°

Question 2

Shoulder Flexion PROM

Answer 2

Supine, Knees up to avoid thoracic hyper extension. Can place shoulder off the table to get more than 180°.
Hold upper arm with one hand and forearm with the other and move arm above head, press on upper arm for overpressure.
End feel: Firm capsular

Question 3

Shoulder Extension AROM

Answer 3

Prone.
Ask patient to lift their arm up as far as possible. Control humeral head to avoid scapula protraction, hard to know when scapula movement starts. Can put bed head pillow under shoulder. Tell teacher if you are assessing extension with scapula movement. 
Fulcrum: Humeral head
Stationary arm: aligned with trunk
Moving arm: aligned with humerus
ROM: 45°

Question 4

Shoulder Extension PROM

Answer 4

Prone.
Hold humeral head down for stabilisation. Hold upper arm, just above the elbow and lift the arm up as much as possible.
End feel: firm capsular.

Question 5

Shoulder Abduction AROM

Answer 5

Supine
Ask patient to move their arm sideways towards their head with the palm facing up. If the head stops the movement, we can't go any further.
Fulcrum: head of humerus
Stationary arm: aligned with the sternum
Moving arm: aligned with the humerus 
ROM: 180°

Question 6

Shoulder Abduction PROM

Answer 6

Supine
Hold patients elbow and forearm/wrist. Can have elbow in 90° and move it sideways until end of ROM. Can’t do overpressure if head stops the movement.
End feel: Firm

Question 7

Shoulder Internal/External Rotation AROM

Answer 7

Supine, Shoulder 90° abduction, elbow 90° flexion, forearm neutral, rotation 0°, elbow outside of the bed.
Ask patient to bring their forearm forwards (internal rotation) or backwards (external rotation) without moving the elbow.
Watch that the shoulder is not moving upwards (scapula movement).
Fulcrum: olecranon
Stationary arm: perpendicular to the ground
Moving arm: Styloid process of ulna
ROM: IR: 70° ER: 90°

Question 8

Shoulder External/Internal Rotation PROM

Answer 8

Supine, Shoulder 90° abduction, elbow 90° flexion, forearm neutral, rotation 0°, elbow outside of the bed, resting on therapists thigh.
Press on humeral head if elbow is stable, otherwise hold under upper arm and with the other hand hold distal forearm. Bring the forearm down, either facing patients legs (internal rotation) or patients head (external rotation).
End feel: firm elastic capsular.

Question 9

Shoulder Flexion AROM

Answer 9

Supine, shoulder neutral, forearm supinated.
Put towel or pillow under patients upper arm.
Ask patient to bring their hand up towards their shoulder.
Fulcrum: Lateral epicondyle
Stationary arm: Aligned with humerus
Moving arm: Aligned with radial styloid process
ROM: 145°

Question 10

Shoulder Extension AROM

Answer 10

Supine, shoulder neutral, forearm supinated.
Put towel or pillow under patients upper arm, make sure it’s not blocking the extension.
Ask patient to bring their hand towards the ground.
Fulcrum: Lateral epicondyle
Stationary arm: Aligned with humerus
Moving arm: Aligned with radial styloid process
ROM: 0°

Question 11

Elbow Flexion PROM

Answer 11

Supine, shoulder neutral, forearm supinated.
Put towel or pillow under patients upper arm.
Hold wrist and lower forearm and bring it up as close to the shoulder as possible and provide overpressure by pressing on the distal forearm.
End feel: soft

Question 12

Elbow Extension PROM

Answer 12

Supine, shoulder neutral, forearm supinated.
Put towel or pillow under patients upper arm, make sure it’s not blocking the extension.
Stabilize upper arm, just above elbow and press down on the forearm.
End feel: hard.

Question 13

Forearm Pronation/Supination AROM

Answer 13

Supine, elbow 90° , forearm facing up, neutral wrist and shoulder.
Patient holding a pen in a fist. Ask patient to turn their forearm in each direction.
Fulcrum: ulnar styloid process (between 4 and 5 metacarpal)
Stationary arm: aligned with the humerus.
Moving arm: aligned with the pen.
ROM: 80° for both.

Question 14

Forearm Pronation/Supination PROM

Answer 14

Supine, elbow 90° , forearm facing up, neutral wrist and shoulder.
Hold patients distal forearm and mid/low forearm and twist it in each direction (mostly with distal portion).
End feel: Firm

Question 15

Wrist Flexion AROM

Answer 15

Sitting on a chair, forearm supported on bed with a towel and elbow approximately 90°, hand outside of the bed, palm facing down.
Ask patient to bring their hand down towards the bed edge.
Fulcrum: triquetrum
Stationary arm: aligned with lateral epicondyle
Moving arm: aligned with 5th metacarpal
ROM: 80°

Question 16

Wrist Extension AROM

Answer 16

Sitting on a chair, forearm supported on bed with a towel and elbow approximately 90°, hand outside of the bed, palm facing down.
Ask patient to bring their hand up towards their forearm.
Fulcrum: triquetrum
Stationary arm: aligned with lateral epicondyle
Moving arm: aligned with 5th metacarpal
ROM: 60°

Question 17

Wrist Flexion PROM

Answer 17

Sitting on a chair, forearm supported on bed with a towel and elbow approximately 90°, hand outside of the bed, palm facing down.
Stabilize patients forearm with one hand and hold just below the wrist (not the fingers) with the other and push it down towards the bed edge.
End feel: Firm

Question 18

Wrist Extension AROM

Answer 18

Sitting on a chair, forearm supported on bed with a towel and elbow approximately 90°, hand outside of the bed, palm facing down.
Stabilize patients forearm with one hand and hold just below the wrist (not the fingers) with the other and push it up towards their forearm.
End feel: firm

Question 19

Radial/Ulnar Deviation AROM

Answer 19

Sitting on a chair, forearm supported on bed with a towel and elbow approximately 90°, hand outside of the bed, palm facing down.
Ask patient to move their hand to each side without any rotation. Make sure wrist is not flexing, extending or rotating.
Fulcrum: Capitate
Stationary arm: aligned with forearm/lateral epicondyle
Moving arm: aligned with 3rd metacarpal (not finger!)
ROM: Radial: 20, Ulnar: 30.

Question 20

Radial/Ulnar Deviation PROM

Answer 20

Sitting on a chair, forearm supported on bed with a towel and elbow approximately 90°, hand outside of the bed, palm facing down.
Stabilize distal forearm with one hand, hold just below wrist with the other and move to each side. Make sure you are not flexing, extending or rotating the wrist/forearm.
End feel: Firm.