Abstract
Aims
Accurate knowledge of the normal shoulder range of movement (ROM) is imperative for evaluating pathology and clinical success. However, in orthopaedic texts, the quoted normal shoulder ROM has significant variation. Furthermore we suspect there is a high incidence of intra and inter observer error during shoulder ROM examination.
The aims of our study were thus:
To perform a literature review and record the published values for normal shoulder ROM. Subsequently, to calculate the average of these published values.
To perform visual and goniometer measurement of shoulder ROM in 10 volunteers and assess the agreement between the two methods.
Methods
A literature search of textbooks, Pub Med and scoring systems was undertaken. Statistical analysis was performed to identify the average value of shoulder movements. Two researchers (specialist trainees in T&O) prospectively assessed 20 shoulders in 10 healthy volunteers. Second observations were made after two weeks. Visual estimation and goniometry assessments were conducted. Bland Altman analysis was performed.
Results
The literature review confirmed there to be a wide variation in the normal shoulder ROM. The published average and range values for specific shoulder movements were: forward flexion 165 (117–180), extension 54 (28–80), abduction 171 (117–189), internal rotation 74 (30–110), external rotation 83 (40–117).
ROM measurements showed a lack of agreement between visual and goniometer measurements and between time elapsed measurements. Significant intra and inter observer error was also identified. Abduction and external rotation were found to have the greatest disparity.
Conclusions
There is stark variation in published figures for normal shoulder ROM. We present the average of published figures. Orthopaedic texts describe different methods for measuring shoulder ROM, which may lead to further confusion and error. Due to the results, we question the validity of including shoulder ROM assessment within accepted scoring systems.
