Dr. Kevin Yip

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

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Passive tests-Passive internal 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 opposite shoulder to stabilize the shoulder girdle and
trunk; the other takes hold of the distal forearm.

Procedure.

Bring the subject’s forearm behind her back and move her hand away from her body as far as possible.

Common mistakes:

• The shoulder is held in too much abduction.
• The elbow is pulled backwards, which creates an extension of the shoulder instead of internal rotation.
• The hand is moved upwards instead of backwards.

Normal functional anatomy:

• Rallge: 90°
• Elld-feel: elastic
• Limiting structures:
– the posterior part of the joint capsule
– the external rotator muscles of the shoulder
– contact between the lesser tuberosity of the humerus and the anterior part of the glenoid labrum of the scapula.

Common pathological situations:

• Pain at the end of range may occur in lesions of the infraspinatus and supraspinatus tendons, and also of the acromioclavicular
ligaments.
• Pajn at mjd-range may occur in rotator cuff tendinitis or in subacromial bursitis.
• More or less limitation is found as part of a capsular pattern of limitation of movement in moderate and severe arthritis.
• Excessive range may indicate shoulder instability.

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