Limited shoulder ROM

[hard_rox]

As I mentioned here, I've had some issues with my right shoulder. I've been doing rehab exercises, along with some of the Buchberger 12 routine, the last few months and have made noticable progress. While abduction and flexion have improved, I still have have an issue with what I would consider prone external rotation. As you can see from the picture, free shoulder rotation stops about 45 degrees above the floor. If I haven't done any activity to irritate the shoulder I can get the hand to the floor unassisted, although very, very slowly and after a "sticky" point about 6 inches off the floor. If the shoulder is sore, I might be able to get a few inches past 45 degress (using a 2 lb DB) but that's about it before it becomes painful.

My question: What is inhibiting the rotation of the shoulder? Tight internal rotators? Tight capsule? Something else? I try to do static stretching once a day with 2 lb DBs (if assistance is needed). Is there anything else I can do to help increase the ROM?

[Bill Hartman]

Start working on external rotation below 90 degrees of abduction.

Set the humerus at about 45 degrees of abduction and about 30 degrees flexion using a thick towel roll(this will put you in the plane of the scapula).

Use a broomstick or a cane or whatever to help push the shoulder into external rotation. This should be more comfortable than up at 90 degrees of pure abduction like you have in the photo.

The sticking point sounds like an impingement. Question is whether it's a correctable one by improving mechanics or if you've got an acromial morphology issue.

If you can get some soft-tissue work on your subscapularis and infraspinatus as well and make sure you're addressing internal rotation as well. You older photos were indicative of some significant stiffness in all planes.

Bill

[hard_rox]

Thanks for the quick response, Bill. It is greatly appreciated.

Set the humerus at about 45 degrees of abduction and about 30 degrees flexion using a thick towel roll(this will put you in the plane of the scapula).

I'm using a rolled towel under my arm to get me out to maybe 30 degrees abduction but I'll wedge it out more and bring it around into the scapular plane.

Use a broomstick or a cane or whatever to help push the shoulder into external rotation. This should be more comfortable than up at 90 degrees of pure abduction like you have in the photo.

I tried the broomstick stetch a few weeks ago and didn't notice much difference between the good & bad shoulder. Testing it again this morning yields the same result. Both arms go a back about 65 degrees from vertical, with only an inch or two less range on the bad side. Is this typical or should I be shooting for more ROM in both shoulders? As you said, it is much more comfortable to do than lying down.

The sticking point sounds like an impingement. Question is whether it's a correctable one by improving mechanics or if you've got an acromial morphology issue.

Regarding the "sticky" spot, rotation gets a little tougher about 6 inches from the floor. After that it feels like something moves out of the way in the shoulder or the humeral head gets into a groove because the hand moves much quicker/easier to the floor below that level. Don't know if that adds any insight or not but thought I'd throw it out there.

If you can get some soft-tissue work on your subscapularis and infraspinatus as well and make sure you're addressing internal rotation as well. You older photos were indicative of some significant stiffness in all planes.

Had an ART session already scheduled for this morning and that's what we worked on. I'm getting ART every two weeks and it's definitely a help. Regarding the internal rotation, is that for stretching alone or should I be adding resistance exercises?

[Bill Hartman]

I would still do this in supine BTW with the towel under the arm (between the floor and your arm not your ribcage and arm), and I was talking about range of motion not strength.

An inch or two difference (10-20 degrees of rotation) in the two sides may be the difference between impingement and no impingement.

Bill

[hard_rox]

Originally Posted by Bill Hartman

I would still do this in supine BTW with the towel under the arm (between the floor and your arm not your ribcage and arm), and I was talking about range of motion not strength.

Thanks for the clarification.