Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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PASSIVE TESTS-Passive external rotation

Positioning.

The subject stands with the upper arm alongside the body and the elbow flexed to a right angle. The examiner stands level with the
subject’s arm and stabilizes the elbow with his trunk. One hand is placed on the contralateral shoulder to stabilize the shoulder girdle and
trunk; the other takes hold of the distal forearm.

Procedure.

Rotate the arm outwards, meanwhile assuring the vertical position of the humerus, until the movement comes to an elastic stop Common mistakes:

o The shoulder girdle is not well enough fixed
so that trunk movement is allowed to happen.
o The elbow is not well stabilized so that
shoulder abduction or extension occurs.
o The movement is not performed to the end of
the possible range.

Normallunctional anatomy:

o Rallge: 90°
o Elldleei: elastic
• LimitiHg structures:

– the anterior portion of the joint capsule
– the internal rotator muscles of the shoulder
– contact between the greater tuberosity of
the humerus and the posterior part of the
glenoid labrum.

Common pathological situations:

• Pain on full passive external rotation is one of the first signs of shoulder arthritis. External rotation also stretches the acromioclavicular
ligaments and the subscapularis tendon, and squeezes the subdeltoid bursa.
• Isolated limitation occurs in contracture of the anterior capsule and in subcoracoid bursitis.
o The movement is markedly limited as part of a capsular pattern of limitation of movement in moderate or more advanced arthritis.
Depending on the condition being either acute or chronic, the end-feel will be either of muscle spasm or hard.
o Excessive range may indicate shoulder
instability.

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