Shoulder Range Of Motion

Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board

What Is Shoulder Range Of Motion?

The shoulder is the most mobile joint in the whole body and can move in lots of different directions. The different types of shoulder motion are:

• Flexion: lifting the arm forwards above your head aka shoulder elevation through flexion
• Extension: moving the arm backwards
• Abduction: lifting the arm out to the side and up above your head aka shoulder elevation through abduction
• Adduction: bringing the arm across the body at waist height
• External Rotation: twisting your arm outwards aka lateral rotation
• Internal Rotation: twisting your arm inwards aka medial rotation
• Horizontal Adduction: bringing your arm across the front of your body at shoulder height

Shoulder range of motion may be classified as:

• Active ROM: how far the shoulder can move on its own i.e. shoulder muscles actively working without any external help
• Passive ROM: how far the shoulder can be moved by an external force, typically another person i.e. the shoulder muscles are completely relaxed

In a normal, healthy shoulder, active and passive motion with be very similar with slightly more passive range than active.

However, if you have injured your shoulder, have an underlying shoulder condition or are in pain, then you may have limited shoulder range of motion, particularly active ROM.

What Is Normal Shoulder Range Of Motion?

Normal shoulder range of motion is typically

• Shoulder Flexion: 160-180^o
• Shoulder Extension: 60^o
• Shoulder Abduction: 170-180^o
• Shoulder Adduction: 30-50^o
• External Rotation: 90-105^o
• Internal Rotation: 60-70^o
• Horizontal Adduction: 130-140^o

Shoulder range of motion relies on a complex co-ordination of movement at the shoulder and shoulder blade, often in multiple directions to allow for full movement.

On a day to day basis, we don’t typically need full active or passive range of motion to be able to perform a majority of our daily tasks e.g. washing, dressing, opening door and jars, lifting and carrying objects.

The amount of functional range of motion needed at the shoulder for most activities is typically:

• Shoulder Flexion: 120^o
• Shoulder Extension: 45^o
• Shoulder Abduction: 130^o
• External Rotation: 60^o
• Internal Rotation: 50^o
• Horizontal Adduction: 115^o

This means that you can still perform most daily activities even if you have lost around 30% of shoulder ROM.

What Affects Shoulder Range Of Movement?

Range of motion in the shoulder will vary slightly depending on:

• Age: shoulder range of movement gradually decreases with age
• Gender: women usually have slightly greater ROM in their shoulders than men
• Hand Dominance: the shoulder of the dominant hand is usually slightly more flexible than the non-dominant arm with increased range of flexion, abduction and external rotation, but slightly decreased internal rotation

But the biggest impact on shoulder range of motion is an injury or condition which causes pain and restriction such as:

• Frozen Shoulder: reduces rotation (external more than internal) and flexion
  
  
• Impingement Syndrome: reduces abduction, often with a painful arc where the pain is worse between 60-120^o of abduction
  
  
• Tendonitis: can reduce range in any direction depending on which tendon is affected e.g. biceps tendonitis may reduce active flexion
  
  
• Rotator Cuff Tear: weakness with abduction and external rotation
  
  
• ACJ Problem: reduced horizontal adduction
  
  
• Fracture: likely to reduce range of motion in shoulder in all directions, depending on the severity of the break
  
  
• Muscle Tightness Or Weakness: can reduce range in any direction depending on which shoulder muscle is affected

If your shoulder range of movement is reduced in any direction, it is important to see your doctor to get an accurate diagnosis so you can get the right treatment.

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How To Treat Shoulder Limited Range Of Motion

Improving movement will depend on what has limited shoulder range of motion in the first place but will usually involve a combination of:

• Medication: pain relief e.g. paracetamol/Tylenol and/or non-steroidal anti-inflammatories e.g. ibuprofen/Advil to reduce pain and inflammation
  
  
• Shoulder Range Of Motion Exercises: Shoulder stretches and strengthening exercises will help to improve strength, flexibility and control. Scapular stabilisation exercises are also important as the help control the position and motion of the shoulder blade which can have a big impact of shoulder movement
  
  
• Heat/Ice: using ice or heat can help to improve range of motion in the shoulder. Ice packs tend to work best in the early stages after acute injuries to reduce pain and swelling whereas heat pads tends to work better with more chronic problems by improving circulation and flexibility
  
  
• Joint Mobilisations: Manual techniques such as joint mobilisations and tissue stretches performed by a physical therapist can be a really helpful way to treat limited shoulder range of motion. They help to restore the natural glide, spin and roll movements at the shoulder to free up movement. Joint mobilisations should always be combined with shoulder range of motion exercises to prevent the structures from tightening up again
  
  
• Keep Active: our bodies are designed to be used, and keeping active and healthy helps to ensure good joint health. Regular exercise such as cycling, swimming or jogging can help prevent joint stiffness and muscle weakness/tightness

How To Measure Shoulder ROM

The most accurate way to measure shoulder range of motion is to use a goniometer. A goniometer looks like a circular protractor with two arms coming out of it.

In the middle of the circular part (axis) you’ll find a full 360^o arc measured out. There are two arms, one which extends directly out of the circular part (static arm) and a moveable arm which sits on top.

You will place the goniometer in a slightly different place depending on which movement you are measuring. It is very hard to take an accurate goniometer measurement yourself, you will need to get someone else to help.

Shoulder Flexion/Extension ROM

Shoulder Abduction ROM

Shoulder Rotation ROM

Other Ways To Measure

If you don’t have access to a goniometer, there are other ways you can measure shoulder range of motion. They may be slightly less accurate but they give useful feedback and help you keep track of changes.

1. Guesstimate: You can eye ball to estimate the range of motion in the shoulder. Many physios will do this rather than using a goniometer. There is often a high measurement discrepancy between individuals but you can reduce the error by always having the same person doing the estimating.
   
   
2. Phone App: There are various phone apps out there for Apple and Android that can be used to measure shoulder range of motion, two of the most popular being “Reflex Shoulder” on Apple and “PhysioMaster: Physical Therapy” on Android
   
   
3. Photos: take a photo of yourself at the end range of each movement and then measure the angles as described above

Range Of Motion In Shoulder Summary

Shoulder range of motion refers to how far the shoulder can move in different directions.

The main movements at the shoulder are flexion, extension, abduction, adduction, internal and external rotation and horizontal adduction.

There are two types of shoulder range of motion, active and passive. Functional shoulder range of motion refers to how much movement is required to perform most daily activities and tends to be about 30% less than normal full shoulder range of movement.

Limited shoulder range of motion is typically due to shoulder injuries or conditions such as impingement syndrome, rotator cuff tears, bursitis or tendonitis.

Limited shoulder range of motion can usually be improved with a combination of medication, shoulder range of motion exercises, ice, heat and physical therapy.

You may be interested in the following articles:

• Front Shoulder Pain
• Pain On Top Of Shoulder
• Pain Behind The Shoulder
• Shoulder Clicking & Grinding
• Shoulder, Arm & Hand Pain
• Burning Shoulder Pain
• Elbow Range Of Motion

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Medical & Scientific References

1. Shoulder Range Of Movement. FP Notebook
2. An Analysis Of Functional Shoulder Movements During Task Performance Using Dartfish Movement Analysis Software. International Journal Of Shoulder Surgery
3. Shoulder Range Of Movement In The General Population: Age And Gender Stratified Normative Data Using A Community-Based Cohort. BMC Musculoskeletal Disorders
4. Concept And Simulation Of An Alternative Design For An Orthopaedic Shoulder Implant. Journal Of Medical Engineering & Technology
5. Shoulder Structure And Function: The Impact Of Osteoarthritis And Rehabilitation Strategies. Journal Of Hand Therapy

Page Last Updated: November 12th, 2024
Next Review Due: November 12th, 2026

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