Shoulders

Described below are some of the shoulder functions which may, to some extent, be temporarily lost following dislocation. The physiotherapist can help the patient regain these movements to the fullest range possible and to strengthen the relevant muscles.

Forward Flexion

The straight arm is raised in front of the body, with the palm down, as high as possible (Fig. 4a).

Abduction

The straight arm is raised at the side, with the palm down, as high as possible. (Fig. 4b)

External Rotation

The elbows are held by the sides of the body, bent at 90^o with palms facing each other. Then, keeping the elbows in contact with the body, the hands are spread outwards as far as possible. (Fig 4c)

Internal Rotation (Hand Behind Back)

The arm is put behind the back with the elbow bent. The person reaches as far up the back as possible. (Fig 4d) This distance is measured from a specific point on the spine.

Supraspinatus Strength Test

Supraspinatus strength is tested with the arm held at 90^o of scapular elevation. The patient resists a downward force applied by the examiner on the patient's arm (Fig. 4e).

External Rotation Strength Test

Strength in external rotation is tested with the elbow held by the side and flexed at 90^o, with the patient applying outward resistance against the examiner's inward push on the hand (Fig. 4f).

Internal Rotation Strength Test

This movement is in the opposite direction to external rotation. To test strength in internal rotation, the patient resists inward pressure applied by the examiner's hand.

Subscapularis Strength (Lift-off) Test

To test the strength of the subscapularis muscle, the hand of the affected shoulder is placed behind the back. The patient pushes outward, countering an inward push on the palm applied by the examiner (Fig 4g). The examiner can measure the current strength of the subscapularis muscle by determining how much force is needed to resist the patient's attempt to lift his/her hand from the back.

Warning: Do not attempt any of these procedures unless you are fully trained as serious damage may result. Always seek expert medical advice and aid.