Shoulder Flexion

I. Description of Motion:

Shoulder Flexion movement and innervation1

Prime Mover: Anterior deltoid (Axillary-C5,C6)
Secondary : Pectoralis major clavicular head (lateral pectoral-C5, C6), coracobrachialis
biceps brachii (musculocutaneous-C5,C6,C7)

II. Mobilizing – Increasing Range of Motion3

1.) Overhead Lats Stretch
a. Start by sitting in a chair or standing upright with back straight.
b. Raise your left arm overhead and keep it straight.
c. Take your right arm and grasp the elbow of the left arm.
d. Pull left arm down to the opposite shoulder slowly until you feel a stretch in the back of your shoulder into your back.
e. If you do not feel a stretch, lean toward the pulling arm.
Length of Time: 30 seconds
Frequency of Stretch: 3x at once – 3x a day
Feeling Patient Should Experience: Stretch down the back of your shoulder and into your back.

2.) Latissimus Dorsi Self Massage Stretch
a. Start by laying on a mat on your side with your lower leg bent to 90 degrees.
b. Place a foam roller under the outer aspect of your back just below your axillary.
c. Reach both of your arms above your head and grasp your hands together.
d. Using your legs, move your body forwards and backward slowly to move the roller up the side of your body/back.
e. Stretch can be done with hands behind head or arms across chest.
f. Stretch should not be causing pain.
Length of Time: 30-90 seconds
Frequency of Stretch: 3x a day
Feeling Patient Should Experience: Stretch down the back of your shoulder and into your back.

3.) Posterior Deltoid Stretch
a. Start by sitting in a chair or standing upright with back straight.
b. Bring your left arm across your body.
c. Grab your left elbow with your right arm.
d. Pull your right arm down and across your body towards the right side.
e. Concentrate on stretching your rear delt.
Length of Time: 30 seconds
Frequency of Stretch: 3x at once – 3x a day
Feeling Patient Should Experience: Stretch in the back of your shoulder.

III. Indications for Stretching:
The literature supports stretching and mobilizing for improving shoulder flexion for glenohumeral internal rotation deficit (GIRD), tight latissumus dorsi, and frozen shoulder.2

IV. Strengthening:4
Assisted Shoulder Flexion:
Start in a Supine Position with arms by your side. Clasp hands together and keep elbows straight. Proceed to raise arms above your head.
Repeat 10 to 20 times.
Do 3 sessions a day.
Progression: Start in a Sitting position and repeat the exercise.

Shoulder Front Raises
Start in a standing position. Hold a weight in hand with thumbs facing forward. Raise arm towards the ceiling until arms are parallel with the floor.
Repeat 10-20 times
3 sessions a day.

Wall Crawl
Start in a standing position. With elbow straight, use fingers to " crawl " up wall or door frame as far as possible. Hold 10 seconds. Repeat 3 times.
Do 3 sessions a day.

V. Potential Clinical Syndromes or Etiologies:
Shoulder flexion limitations are often associated with most shoulder pathologies for patients.5

Some examples are:
Shoulder impingement
Labral Tears
Rotator Cuff tear
Frozen Shoulder

VI. Additional Web Based Resources:
http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/StandardsofCare.aspx
http://www.orthoassociates.com/SP11Ca/

VII. References
1. Wattanaprakornkul D, Cathers I, Halaki M, Ginn KA. The rotator cuff muscles have a direction specific recruitment pattern during shoulder flexion and extension exercises. J. Sci. Med. Sport 2011;14:376-382. doi:10.1016/j.jsams.2011.01.001
2. Mullaney MJ, Nicholas SJ. Rehabilitation of shoulder impingement. Tech. Shoulder Elb. Surg. 2014;15:40-45. doi:10.1097/BTE.0000000000000010.
3.Moore KL, Dalley AF, Agur AMR. Chapter 6: upper limb In: Clinically Oriented Anatomy. 6th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:670-819.
4.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.
5.Nicholson G. Rehabilitation of common shoulder injuries. Clinics In Sports Medicine [serial online]. October 1989;8(4):633-655. Available from: SPORTDiscus, Ipswich, MA. Accessed December 6, 2014.

By: Zach Harmon

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