Shoulder Arom Flexion: Understanding The Basics

Shoulder Active Range of Motion (AROM) is a test to assess the degree of freedom a patient has in their shoulder complex. It is used to evaluate the patient's range of motion and determine the severity of pathologies such as frozen shoulder or rotator cuff pathology. During the AROM assessment, the patient is guided through various movements to evaluate their shoulder's flexibility and identify any limitations. The patient's position and specific instructions for each movement are carefully considered to ensure accurate evaluation. The AROM assessment provides valuable information for diagnosis and treatment planning, helping to improve shoulder mobility and range of motion.

Shoulder flexion and extension

Shoulder Flexion

Shoulder flexion refers to the movement of raising the arm forward and upward in front of the body. It is the action of lifting your arm to reach or touch something in front of you. This movement is integral to most sports that use the upper body. For example, a volleyball player passing or a basketball player shooting a three-pointer both use shoulder flexion.

Shoulder flexors include the deltoid, pectoralis major, and coracobrachialis. The front end of the deltoid and the clavicle, the pectoralis major is the prime mover of shoulder flexion, and the coracobrachialis is a synergistic muscle, meaning it assists the main factors. The average range of shoulder flexion is 180 degrees.

Shoulder Extension

The extension is the opposite of flexion. It is the movement of the arm directly behind the body, as in receiving a baton in a relay race. Shoulder extension occurs at the humeral joint, also known as the shoulder joint, and involves the coordinated action of various muscles connecting the shoulder girdle to produce a smooth, flowing movement. The normal range of motion for shoulder extension is between 45 and 60 degrees.

The latissimus dorsi, teres major, and posterior deltoid are the primary shoulder extensors.

Shoulder abduction

The supraspinatus is the primary muscle responsible for the first 15 degrees of abduction. The deltoid then takes over, controlling abduction from 15 to 90 degrees. Finally, the trapezius and serratus anterior coordinate with each other and the scapula to facilitate abduction beyond 90 degrees.

The supraspinatus originates from the supraspinous fossa of the scapula, passing under the acromion to insert on the superior facet of the greater tubercle of the humerus. It plays a crucial role in stabilising the humeral head in the glenoid fossa, providing resistance to gravitational forces acting on the joint. The deltoid, named after the Greek letter delta due to its triangular shape, is composed of three heads: anterior, lateral, and posterior. These heads originate from different parts of the clavicle, acromion process, and scapula, respectively, and converge to insert onto the deltoid tuberosity of the humerus. The trapezius is a large, superficial back muscle that can be divided into three functional parts: descending (superior), middle, and ascending (inferior). The serratus anterior, on the other hand, is a saw-shaped muscle originating from the upper eight ribs and inserting on the inner medial border of the scapula.

The ability to abduct the arm is essential for achieving a full range of motion. However, it is also one of the reasons why the shoulder is susceptible to injuries and dislocations. The shoulder is the most mobile joint in the human body, but this comes at the cost of decreased stability. The glenohumeral joint, in particular, is a ball-and-socket joint with a complex, dynamic articulation. The humeral head connects with the glenoid cavity of the scapula, and this connection is stabilised by the rotator cuff muscles, which attach to the joint capsule. The rotator cuff muscles include the supraspinatus, infraspinatus, subscapularis, and teres minor.

Shoulder adduction

The shoulder is one of the most freely moveable areas in the human body due to the articulation at the glenohumeral joint. It is a structurally and functionally complex joint that allows for a high range of motion. However, this comes at the expense of decreased stability, making the shoulder prone to dislocation and injury.

The prime mover for shoulder adduction is the pectoralis major. Other muscles involved in shoulder adduction include the latissimus dorsi, teres major, triceps, and coracobrachialis.

To perform shoulder adduction, start with your arm extended straight out in front of your body, with your hand in line with your shoulder. Keeping your hand and arm at shoulder height, bring your arm horizontally towards the middle of your body. This movement is called shoulder horizontal adduction.

You can also perform shoulder adduction exercises at home using an exercise band. Stand while holding the exercise band towards the wall, with your arm up and out to the side and your elbow straight, palm facing down. With appropriate tension on the band, pull your hand towards your body without bending your elbow, keeping your palm pointed down and towards your body. Slowly return to the starting position. Repeat 2 sets of 15 reps.

If you are experiencing shoulder pain with adduction, you may have subacromial impingement or rotator cuff tendonitis. Your doctor will be able to administer the appropriate test to reach a diagnosis.

Shoulder forward flexion

The shoulder joint is a complex system comprising five joints and three bones: the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). This arrangement allows for a wide range of motions, including flexion, extension, and adduction.

The typical range of motion for shoulder flexion is 180 degrees, enabling individuals to move their arms from the sides of their body to above their head. This movement is facilitated by several muscles, including the pectoralis major, anterior deltoid, coracobrachialis, biceps brachii, teres major, subscapularis, and coracobrachialis.

To improve shoulder flexion, various exercises can be performed. One such exercise involves standing and holding a weight in the hand of the target shoulder. Keeping the arm straight, the weight is slowly raised overhead without causing pain. It is important not to raise the arm above the head unless advised to do so by a healthcare professional. The weight is then lowered slowly back to the starting position.

Another exercise for shoulder flexion involves the use of an exercise band. The band is wrapped around a stable object near the foot, and the individual grasps the band with the hand of the target shoulder. With the arm straight, the band is slowly pulled upwards and past the head, again without causing pain, and avoiding raising the arm above the head unless cleared to do so.

It is important to note that repetitive shoulder flexion or improper posture during this movement can increase the risk of musculoskeletal injuries. Therefore, it is crucial to maintain correct form and seek guidance from a healthcare provider or physical therapist when performing shoulder flexion exercises.

Shoulder internal rotation

To perform an internal rotation exercise, sit in a chair and place a rolled-up towel between your elbow and side. Bend your elbow to 90 degrees and gently squeeze the towel with your elbow to stabilise the movement. Holding a weight with your thumb pointing up, slowly move the weight across your chest until your hand reaches your opposite arm. Hold this position for the desired duration, typically around 30 seconds, before slowly returning to the starting position.

It is important to stretch before performing internal rotation exercises to increase your range of motion and prevent injury. A simple stretch for the internal rotators is the crossover arm stretch. To perform this stretch, relax your shoulders and hold your upper arm with the opposite hand. Pull your arm across your chest until you feel a stretch, hold for 30 seconds, and then return to the starting position.

Internal rotation exercises can also be performed with an exercise band. Tie one end of the band to a heavy, secure object and repeat the same movement as with the weight, pulling the band across your chest and holding the position for the desired duration.

By incorporating internal rotation exercises into your routine at least twice a week, you can improve the endurance of your rotator cuff muscles, boost athletic performance, and reduce your risk of injury.

Frequently asked questions