Name of test
Shoulder external rotation
What it tests
The amount of shoulder external rotation, assessing the capsule and joint (to allow passive motion) and the posterior cuff (to power active motion)
How to do it
- Stand in front of the patient
- Ask them to keep their elbow at the side and point their hand at you (in gunslinger pose). Have the elbow flexed at 90.
- Ask the patient to externally rotate the hand as far as possible with the elbow held against the trunk.
- Repeat this assessment with passive motion and compare
- Last, have the patient hold the arm pointed forward as you attempt to push the hand towards the abdomen, to assess external rotation strength
The normal response
Anywhere from 45 to 90 degrees
But right should equal left and active should equal passive; disparities suggest abnormalities
What it means if not normal
Lost passive motion: tight capsule or arthritis
Lost or weak active motion: the posterior cuff may be deficient.
Excessive passive motion: subscapularis rupture
Comments
For throwing athletes, it's also important to test external rotation with the arm abducted and the elbow flexed (both to 90 degrees); that is, in a cocking position for throwing. Capsular tightness may limit internal or external rotation in throwers.
Citations
Bernstein J, 2004 Mar-Apr. "Evidence-based medicine." J Am Acad Orthop Surg 12 (2): 80-8 [PubMed]
Abstract:
Evidence-based medicine refers to an explicit process of using and evaluating information to make medical decisions. Evidence-based medicine, perhaps contrary to popular perception, requires its users to embrace uncertainty in medical decision making because information that is simultaneously true and complete cannot be attained. Recognizing medicine's inherent uncertainty, proponents of evidence-based medicine advocate using a five-step process for sound decision making: formulate answerable questions, gather evidence, appraise the evidence, implement the valid evidence, and evaluate the process. The formulation of answerable questions requires categorizing the facts of the case in terms that allow comparison to evidence gathered from prior studies. The appraisal of the evidence uses the tools of clinical epidemiology to assess the validity and applicability of the evidence. Implementation refers to the construction of a clinical plan based on the evidence collected as well as on the physician's judgment and patient's preferences. Finally, evidence-based medicine requires continued evaluation and refinement. The methods of evidence-based medicine are especially germane to contemporary medicine as physicians practice under increasing demands to deliver optimal outcomes yet face an ever-expanding body of medical knowledge.
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