Name of test

Shoulder external rotation

What it tests

The amount of shoulder external rotation, assessing the capsule and joint (to allow passive motion) and the posterior cuff (to power active motion)

How to do it

  • Stand in front of the patient
  • Ask them to keep their elbow at the side and point their hand at you (in gunslinger pose). Have the elbow flexed at 90.
  • Ask the patient to externally rotate the hand as far as possible with the elbow held against the trunk.
  • Repeat this assessment with passive motion and compare
  • Last, have the patient hold the arm pointed forward as you attempt to push the hand towards the abdomen, to assess external rotation strength

The normal response

Anywhere from 45 to 90 degrees

But right should equal left and active should equal passive; disparities suggest abnormalities

What it means if not normal

Lost passive motion: tight capsule or arthritis

Lost or weak active motion: the posterior cuff may be deficient.

Excessive passive motion: subscapularis rupture


For throwing athletes, it’s also important to test external rotation with the arm abducted and the elbow flexed (both to 90 degrees); that is, in a cocking position for throwing. Capsular tightness may limit internal or external rotation in throwers.



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