Shoulder Extension

By Amanda Morch

I. Description of Motion:
Description: Shoulder extension is the movement of the arm posteriorly, in the scapular plane, away from the trunk.

Primary Movers:
- Latissimus Dorsi (Thoracodorsal nerve C6, 7, 8) 1, 2
- Deltoid (Posterior Fibers) (Axillary Nerve C5, 6)1, 2
- Teres Major (Lower Subscaularis Nerve C5, 6)1, 2

Secondary Movers:
- Triceps Brachii (Long Head) (Radial Nerve, C6, 7, 8)1, 2

II. Mobilizing – Increasing Range of Motion :

1. Wall Pec Stretch (Pec Minor)2
Position yourself at the end of a wall or doorway facing perpendicular to the wall. Raise arm to shoulder height and bend at the elbow. Place front of shoulder and arm against the wall and lean into it. Rotate body away from the wall until you feel a stretch in the front of your chest. Hold for 30 seconds and repeat 2 more times.
You can perform this stretch up to 3 times per day.

2. Doorway shoulder stretch (Anterior Deltoid)2
Position yourself at the end of a wall or doorway facing perpendicular to the wall. Place palm on the wall a little lower than shoulder height and bend elbow slightly. Turn body away from fixed arm until you feel a stretch. Hold for 30 seconds and repeat 2 more times.
You can perform this stretch up to 3 times per day

3. Flexion stretch on table3
Sitting on a stool or chair, with head down bend forward and place arm on table, Slide chair/stool backwards away from the table until a stretch is felt.
Hold for 30 seconds and repeat 2 more times.
You can perform this stretch up to 3 times per day

III. Indications for Stretching:
ROM: 0-45 but up to 60 degrees5

The major indication to stretch is when lacking the above range of motion. Stretching can increase range of motion, flexibility and assist overall in daily activities.

IV. Strengthening:

Prone Resisted Extension (Latissimus Dorsi, Teres Major, Rhomboids)3
Laying face down with head on a rolled up towel and arms at side, hold 1-5 pound weight. Raise arms just beyond body height.
Complete 3 sets of 10.
Repeat 2 to 3 times per week.
To progress; increase number of repetitions or weight of dumbbell (not to exceed 7 pounds).

Straight Arm Pull Down with Band (Latissimus Dorsi)4
With bands secured overhead, and standing with feet shoulder width apart. Grasp band with arm at shoulder height. Lower the band slowly and with control until in line with trunk and thighs. Breathe out as you lower the band.
Complete 3 sets of 10.
Repeat 2 to 3 times per week.
To progress; increase number of repetitions or band strength.

Isometric Extension (Latissimus Dorsi, Posterior Deltoid, Teres Major)3
Stand with your back to the wall, place ball under backside of arm. Using wall for resistance, push ball into wall with light pressure and hold for 10 seconds.
Repeat 10 times.
Repeat 2 to 3 times per week.
To progress: hold for longer and/or use more pressure.

V. Potential Clinical Syndromes or Etiologies:

Shoulder extension is an essential movement for wheelchair bound patients in particular, in which, at least 15 degrees of shoulder extension is needed.6, 7 Shoulder pain and injury can be a common factor in wheelchair propulsion. 7 By strengthening shoulder extension and stretching the shoulder flexors, wheelchair bound patients can improve their overall mobility and prevent some shoulder injury.

VI. Additional Web Based Resources:

Integrated Medical Group Home Exercise Programs:
http://www.imgpc.com/doctor_categories/physical-therapy/

The Effectiveness of Shoulder Exercises at Reducing Shoulder Pain and Increasing Function in Patients Using Manual Wheelchair for Locomotion: An Evidence-based Review
http://ptrehab.ucsf.edu/sites/ptrehab.ucsf.edu/files/documents/The%20Effectiveness%20of%20Shoulder%20Exercises%20at%20Reducing%20Shoulder%20Pain%20and%20Increasing%20Function%20in%20Patients%20Using%20Manual%20Wheelchair%20for%20Locomotion.pdf

VII. References

  1. Moore KL, Dalley AF, Agur AMR. Chapter 6: upper limb In: Clinically Oriented Anatomy. 6th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:670-819.
  2. ExRx.net Shoulder Articulations Website http://www.exrx.net/Articulations/Shoulder.html#anchor103519 Published 1999. Updated November, 16 2011. Accessed November, 12 2014.
  3. IMG Physical Therapy Home Exercise Shoulder http://www.imgpc.com/pdf/PT_HomeExerciseShoulder.pdf Published 2012. Accessed November, 12 2014.
  4. Bodybuilding.com Straight Arm Pull Down Website http://www.bodybuilding.com/exercises/detail/view/name/straight-arm-pulldown Published 2003. Updated October, 15 2014. Accessed November, 12 2014.
  5. Hislop HJ, Avers D, Brown M. Chapter 5: Testing the muscles of the upper extremity. In: Daniels and Worthingham’s Muscle Testing. Techniques of Manual Examination and Performance Testing. 9th edition. St. Louis, MO. Elseivier; 2014:79-202.
  6. Requejo PS, Mulroy SJ, Haubert LL, Newsam CJ, Gronley JK, Perry J. Evidence-based strategies to preserve shoulder function in manual wheelchair users with spinal cord injury. Top Spinal Cord Inj Rehabil 2008; 13(4): 86-119 doi: 10.1310/sci1304-86
  7. Koontz AM, Cooper RA, Boninger ML, Souza AL, Fay BT. Shoulder kinematics and kinetics during two speeds of wheelchair propulsion. Journal of Rehabilitation Research and Development 2002; 39(6): 635-650
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