Date of Paper/Work
Type of Paper/Work
Doctor of Physical Therapy (DPT)
Cort J. Cieminski
A common impairment seen in individuals with shoulder pathology is decreased internal rotation (IR), or glenohumeral IR deficit (GIRD). The literature has indicated that there are several different contributing factors to GIRD that include posterior capsule tightness, humeral retroversion, and posterior shoulder muscle stiffness. The supine position is the current standard for measuring IR range of motion (ROM). However, there is a lack of consistency of stabilization of the shoulder during this test. Researchers, therefore, have studied other positions for measuring IR ROM, such as sidelying, which provides a consistent degree of stabilization of the scapula. In the sidelying position, it has been purported that the scapula is stabilized by the subject’s own body weight, and is therefore not dependent on the examiner. This sidelying IR ROM position was found to be more reliable when compared to that of the supine IR ROM. Currently, however, there are no reported normative IR ROM values for either the sidelying or semi-sidelying positions for overhead athletes or non-athletes.
The purpose of this study was to establish normative values for shoulder IR ROM in the sidelying and semi-sidelying positions for both an overhead athlete and non-athlete group. In addition, these IR ROMs were compared to the standard supine position.
One hundred fourteen overhead athletes [57 males, mean age 21.8 (± 4.9), range 18-47; 57 females, mean age 21.4 (± 5.3), range 18-56] and 204 non-athlete subjects [63 males, mean age 36.9 (± 25.1), range 18-70; 141 females, mean age 33.4 (± 14.4), range 18-89] without shoulder pathology participated in this study. Two measurements of passive IR ROM for the dominant and non-dominant shoulders were gathered in a supine, semi-sidelying, and sidelying position using a bubble inclinometer. Additional measurements of bilateral passive external rotation ROM were taken in the athlete group. Inter-rater and intra-rater reliability for all six investigators were established prior to data collection.
The sidelying mean for the athletic population was 43.4º (± 8.3°) for the dominant side and 55.2º (± 9.8°) for the non-dominant side. There was a significant difference between total arc measurements when measured in supine vs. sidelying. The difference between the two was significantly greater on the dominant side (15.0º difference) compared to non-dominant side (12.4º difference). The mean value for sidelying position for non-overhead athletes was 46.9° (± 12.4°) for the dominant shoulder and 53.6° (± 11.9°) for the non-dominant shoulder. Supine and semi-sidelying IR ROM were not significantly different from each other except in the non-dominant shoulder in athletes. Sidelying IR ROM was significantly different from both the supine and semi-sidelying positions.
This study was the first to establish normative IR ROM values other than the standard supine position, namely the semi-sidelying and sidelying positions for both an overhead athlete and non-athlete group. The sidelying position yielded significantly smaller IR ROM values for dominant and non-dominant shoulders within both groups compared to the supine and semi-sidelying positions. Clinicians can use these results when evaluating IR ROM loss in their patients and it is suggested that therapists use the sidelying IR ROM position, due to its improved reliability as an outcome measure.
Indrelie, Alisse; Kelly, Shannon; Klaers, Hugo; Nawrocki, Tatia; and Stelzmiller, Michael, "Establishment of Normative Shoulder Internal Rotation Passive Range of Motion Values in the Sidelying and Semi-sidelying Positions" (2014). Doctor of Physical Therapy Research Papers. 37.