How is range of motion (ROM) evaluated during the physical exam in rotator cuff injuries?

Updated: Oct 25, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Evaluate total active and passive ROM in all planes and scapulohumeral rhythm.

Maximal total elevation occurs in the plane of the scapula, which lies approximately 30° forward of the coronal plane.

Patients with rotator cuff tears tend to have a decrease in GH motion and an increase in ST motion during active shoulder elevation.

Decreased active elevation with normal passive ROM is usually observed in rotator cuff tears secondary to pain and weakness. When both active and passive ROM are decreased similarly, this usually suggests onset of adhesive capsulitis.

Assess internal rotation by having the patient reach an extended thumb up the spine. Patients with normal internal rotation reach the T5-T10 level. Note that overhand throwers often develop excess external rotation (up to 15-20°) on the throwing side, which is usually accompanied by loss of internal rotation on the same side.

Note any accompanying pain and specific pain location in ROM testing.

The impingement syndrome associated with rotator cuff injuries tends to cause pain with elevation ranging from 60-120° when the rotator cuff tendons are compressed against the anterior acromion and coracoacromial ligament.


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