Shoulder Goniometry

Flexion

Patient Instructions: 

Once the goniometer is aligned properly ask the patient to lift the arm up just as if they were raising their hand to ask a question.  Be sure that the patient keeps the palm of their hand facing in toward their body. 

Starting Position:

·        Patient is supine with arm at side and the palm of the hand facing the body.

·        The fulcrum of the goniometer is placed over the acromion process.

·        The stationary and moving arms are aligned with the midline of the humerus and lateral epicondyle.

Ending Position:

·        The moving arm remains in line with the lateral epicondyle and midline of the humerus.  The examiner should be supporting the patient’s extremity.

·        The stationary arm should remain in its starting position, only now it should be in line with the lateral midline of the thorax.

Normal ROM for glenohumeral flexion is 160 to 180 degrees; in the picture the patient is in 180 degrees of flexion.

Extension

Patient Instructions:

            Ask the patient to simply lift their arm off the table as far as they can.

Starting Position:

·        Patient is prone with arm at side; make sure the head is facing away from the shoulder being tested.  Elbow should be bent slightly and the palm facing in toward the body.

·        The fulcrum is placed over the acromion process. 

·        The stationary and moving arms are aligned with the lateral midline of the humerus and the lateral epicondyle.

Ending Position:

·        The moving arm remains in line with the lateral epicondyle and the examiner should support the patient’s extremity.

·        The stationary arm should be in line with the midline of the thorax.

Normal ROM for glenohumeral extension is 40 to 60 degrees; in the picture the patient is in 61 degrees of extension.

Abduction

Patient Instructions:

Have the patient bring their arm out to their side and as close to their head as they can.  Make sure that their palm faces upward throughout the motion.

Starting Position:

·        The patient is supine with arm at side; the palm should be facing anteriorly.

·        The fulcrum is placed at the acromion process.

·        The stationary and moving arms are aligned with the anterior midline of the humerus.

Ending Position:

·        The stationary arm should remain still and parallel to the sternum. 

·        The moving arm should still be resting at the anterior midline of the humerus.

Normal ROM should be between 160 and 180 degrees; the patient in the picture is in 174 degrees of abduction.

Medial (Internal) Rotation

Patient Instructions:

            Ask the patient to rotate their arm down as far as they   can.

Starting Position:

·        Supine with 90 degrees of shoulder abduction and the elbow is in 90 degrees of flexion.  The table should not support the elbow. 

·        The fulcrum should be centered over the olecranon process. 

·        The moving arm is aligned with the ulnar styloid and the stationary arm should be perpendicular to the floor.

Ending Position:

·        Same as above

Normal ROM is 60-70 degrees; the patient is in 68 degrees of internal rotation.

Lateral (External) Rotation

Patient Instructions:

            Ask the patient to rotate their arm up toward their head as far as they can.

Starting Position:

·        Supine with 90 degrees of shoulder abduction and 90 degrees of elbow flexion.  The table should not support the elbow.  (Refer to above picture)

·        Fulcrum should be on the olecranon process.

·        The moving arm should be aligned with the ulnar styloid and the stationary arm should be perpendicular to the floor.

Ending Position:

·        Same as above

Normal ROM is between 80-100 degrees; the patient in the picture is in 93 degrees of external rotation.

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