Evaluation of the Stiff Shoulder.

Last updated Thursday, February 10, 2005

Physical examination

Steps in examination

First, obtain a quick assessment of the overall shoulder motion by examining the maximal ranges of elevation, external rotation, internal rotation and cross body adduction.

Then proceed to determine the humeroscapular range by stabilizing the scapula with one hand and putting the humerus through a passive range of motion with the other. The patient should remain relaxed during this examination to assure that muscle contraction is not limiting motion. Specific ranges of humeroscapular elevation and rotation can be measured by determining the positions that the humerus can attain in relation to the four palpable scapular reference points. Humeroscapular elevation of less than 90 degrees indicates stiffness, especially if it is less than the contralateral normal shoulder.

Localized areas of capsular tightness or adhesions are identified by the pattern of motion restriction. For example, a shoulder with limited humeral elevation in anterior scapular planes, limited cross body adduction, and limited internal rotation is likely to have tightness of the posterior capsule. A post-operative shoulder with isolated limitation of external rotation with the arm at the side is likely to have some combination of the following problems: scarring at the humeroscapular motion interface between the coracoid muscles and the subscapularis, excessive tightness of the subscapularis and anterior capsule, or contracture of the rotator interval capsule. Finally, a shoulder with limited elevation after a previous acromioplasty is likely to have scarring at the humeroscapular motion interface between the acromion, deltoid, and rotator cuff.

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