By Omaid Quraishi
Description of Motion
External rotation of the Glenohumeral joint consists of the posterior roll and anterior glide of the head of the humerus on the glenoid fossa. Normal ROM for external rotation of the glenohumeral join is 90 degrees.1 The primary muscles responsible for external rotation of the shoulder are infraspinatus, which is supplied by the suprascapular nerve, and teres minor, which is supplied by the axillary nerve. Posterior deltoid also helps with glenohumeral external rotation and is supplied by the axillary nerve.2
Stretching/Mobilization
Sleeper Stretch- Lie on your side with your operating shoulder positioned in 90 degrees of abduction. Keep the elbow that is in contact with the table flexed to 90 degrees. Slowly apply a stretch with the opposite arm in the direction of shoulder internal rotation. Hold for 15 to 30 seconds.3
Passive Internal Rotation Stretching- Lie on your back with your shoulder abducted to 90 degrees and elbow flexed to 90 degrees. Have a PT internally rotate your shoulder making sure that the shoulder stays on the table at all times. Hold for 15 to 30 seconds.
Towel Stretch- Put a towel or a rope behind your back with one hand, and use your other hand to hold the towel from the bottom. Gently pull the towel up with the top arm keeping the bottom arm relaxed. Hold for 15-30 seconds.
All these stretches should be completely pain free. You should feel a stretch in the back of your shoulder especially around the muscle that externally rotates the shoulder. These stretches can be done 5-7 times per week, 2-3 sets per day.
Indications for Stretching
*Lack of internal rotation of the shoulder that limits an individual’s functional activities.
*Patients with tight posterior capsulthat are diagnosed with frozen shoulder.4
*Individuals who have lost normal shoulder ROM and their functional activities are compromised due to Rotator Cuff Tendonitis, Bursitis, and Impingement.
Strengthening
External rotation in side lying- Lie on the non-involved side. Flex the operating arm to 90 degrees and have a towel in between your ribs and interior border of the humerus. Slowly rotate your shoulder externally, your hand should be moving towards the ceiling. Hold for 1-2 seconds and then slowly lower it back down.56
External rotation in prone- Lie prone on the table and have your operating arm in 90 degrees of abduction, elbow flexed to 90 degrees and hand facing the floor. Slowly rotate your shoulder externally, keep the elbow flexed to 90 degrees and try to bring your arm at the same level as your shoulder or aligned with the table. Hold for 1-2 seconds at the end range and then slowly come back to the starting position.
External Rotation in standing-Anchor a thera-band to a post at elbow level. Stand sideways to the post with the non-operating side closer to the post and grab one end of the thera-band with the operating hand. Flex the operating arm to 90 degrees and have a towel in between your ribs and interior border of the humerus. Slowly rotate your shoulder externally, hand moving away from the post. Hold for 1-2 seconds at the end range and then slowly come back to the starting position.
Try to do these exercises 3-4 times a week, 15-20 reps and around 2-3 sets. As you get stronger you can increase the weight or resistance of the thera band.
Potential Clinical Syndromes or Etiologies and Additional Web Based Resources for More Information
Rotator cuff tears- A tear in any of the rotator cuff muscles.
http://morphopedics.wikidot.com/rotator-cuff-tears
Rotator Cuff Tendonitis- An inflammation of any of the four rotator cuff tendons.
http://morphopedics.wikidot.com/rotator-cuff-tendinitis
Frozen shoulder- Loss of normal shoulder ROM due to pain and inflammation.
http://www.ncbi.nlm.nih.gov/pubmed/24664198
Shoulder Impingements- Pinching of the rotator cuff tendons between the acromion OR the glenoid rim and the humerus.
http://morphopedics.wikidot.com/shoulder-joint-impingement-type-syndromes
Shoulder instability- Could be due to altered structural integrity such as hyperelasticity of capsule, tear in the labrum, muscular imbalance.
http://www.praxisteam-lindner.de/de/leistungen/pdfs/news_file_88.pdf
http://orthoinfo.aaos.org/topic.cfm?topic=a00529
http://morphopedics.wikidot.com/shoulder-joint-instability-syndromes
