By: David Fathalikhani
I. Description of Motion
Shoulder rotation consists of a posterior slide of the humeral head within the glenohumeral joint capsule. Normal range of motion of IR varies greatly from person to person depending on types of activity engaged in, typical IR is at least 70 degrees of motion.1 The primary movers for GH IR are latissimus dorsi, pectorals major (clavicular head), and teres major, these muscles are innervated by throacodorsal n. (C6-C8), lateral pectoral n. (C5-C7) and subscapular n. (C5-C7) respectively.2
Lie on your side with involved shoulder down. Position shoulder into near 90 degrees of abduction and elbow flexion. Allow wrist to fall down towards table with gravity, use free hand to apply over pressure to increase the stretch. Hold for 10-20 seconds, repeat 3 times.
Standing Band Stretch:
Patient in standing with resistance band placed behind patient slightly above shoulder height. Have patient abduct and flex elbow to 90 degrees, shift weight forward to increase stretch as patients arm falls into external rotation. Hold 10-15 seconds repeat 3-4 times.
Standing Arm Behind Back Stretch:
Patient in standing, place involved arm behind back as far as he/she can comfortable reach. Drape belt or band from above with free hand down ones back, grasp band, and pull upwards with free hand to create tension and stretch as involved side is pulled up ones back. Hold 10-15 seconds, repeat 3-4 times.
III. Indications for Stretching
Patients with grossly limited IR (GIRD), individuals with excessively tight posterior capsule, or those with impingement like symptoms. Commonly needed for overhead throwing athletes with IR restriction.
Standing with Side Resistance band:
Patient in standing, resistance band anchored on wall at hip height. Instruct patient to flex elbow to 90 degrees and hold towel roll between elbow and hip. Instruct patient to internally rotate across one’s body and return to neutral position slowly. Progress to increased resistance band strength or cable with weight as needed. Begin 2 sets of 12 reps and progress accordingly.
Side Lying with Dumbbell:
Patient In side lying of involved side, shoulder in neutral position with 90 degrees of elbow flexion. Instruct patient to internally rotate upwards towards uninvolved side and return slowly back down to neutral. Use low weight dumbbell and progress accordingly with band or increased weight, begin with 2 sets of 12 reps and increase as needed.
Standing with Band Resistance:
Patient standing with band anchored to wall slight above shoulder height. Have patient abduct arm and flex elbow to 90 degrees, grasp band and shift weight forward to tension band. Instruct patient to internally rotate downwards, and control the return to starting position. Increase band resistance or progress to cable weight as needed. Begin with 2 sets of 12 repetitions and progress accordingly.
V. Potential Clinical Syndromes
Internal rotation stretching can be applied to many clinical cases of shoulder pain and pathology. IR stretching and strengthening is often needed for care of impingement syndromes, rotator cuff tears, or post surgical rehabilitation according to protocol.
VI. Additional Web Links
Below are some resources to further satisfy ones interests and curiosity as it relates to shoulder internal rotation.
1) http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/physical-examination-info/shoulder-physical-examination/ Accessed November 21, 2014
2) http://www.wheelessonline.com/ortho/internal_rotators_of_the_shoulder November 21, 2014