How to assess shoulder strength

Assess function at the shoulder 

  • Ask the person to put their hand behind their head 


If the person has signs of reduced muscle strength while performing this movement, assess all individual shoulder movements on both sides using the MRC muscle power test.


Question

Which of these are signs of reduced muscle strength when a person lifts their hand behind their head ?

  •  a. Lifting their arm is slower on one side compared to the other
  •  b. Lifting their hand behind their head is not smooth
  •  c. Lifting their hand behind their head is the same on both sides
  •  d. Both a and b are correct

If you selected d, you are correct.

If you selected, a, you are not correct. A reduced speed of movement may indicate reduced strength.

If you selected b, you are not correct. Loss of smooth movement may indicate reduced strength.

If you selected c, you are not correct. If the movement is performed the same as the other side, unless there is reduced strength on both sides, it is unlikely that there is reduced strength on the side you are assessing.

Assess function at the shoulder by asking person to put their hand behind their head

<Reaching hand behind head>


We will now learn how to assess strength of individual movements at the shoulder.

How to assess shoulder flexion strength 

Positioning of person: 

  • For grade 0-2 (gravity eliminated): person in side lying with knees bent to 90 degrees 
  • For grade 3-5: person seated, elbows slightly flexed and thumb pointed up 


Clinician positioning and handling: 

  • For grade 0-2: stand next to test side, support arm by holding forearm and upper arm 
  • For grade 3-5: stand on test side in seated position, provide resistance against the direction of movement, just above the elbow 


 Instructions for person: 

  • ‘Lift arm up in front of you with thumb pointing upwards’


Watch these videos to learn how to assess shoulder flexion strength.


Assess shoulder flexion strength grade 0-2 

 

Assess shoulder flexion strength grade 3-5 

  

How to assess shoulder abduction strength 


Positioning of person: 

  • For grade 0-2 (gravity eliminated): there is no true ‘gravity eliminated’ position for this test, however, supine with arm supported above bed will minimize resistance of gravity 
  • For grade 3-5: person seated, thumb pointed up 


Clinician positioning and handling:

  • For grade 0-2: stand next to test side, support arm by holding forearm and upper arm 
  • For grade 3-5: stand on test side in seated position, provide resistance towards the midline of the body, against the direction of movement, at the lateral upper arm 

  

Instructions for person: 

  • ‘Lift arm up towards sky with thumb pointing upwards’


Watch these videos to learn how to assess shoulder abduction strength.

Assess shoulder abduction strength grade 0-2 

        

Assess shoulder abduction strength grade 3-5 

  

How to assess shoulder external rotation strength 


Positioning of person: 

  • For grade 0-2 (gravity eliminated): person in prone 
  • OR for grade 0-5: person seated, thumb pointing upwards 


Clinician positioning and handling: 

  • For grade 0-2: stand level with shoulders and test only the nearest side, to test the opposite side, move around to the other side of the bed 
  • OR For grade 0-5: stand on test side of person in seated position, provide resistance at the forearm 


Instructions for person: 

‘Keep your elbow close to your ribs and move your forearm away from your body’


Watch these videos to learn how to assess shoulder external rotation strength.


Assess shoulder external rotation strength grade 0-5 

  

Activity

Practice performing each of the muscle strength assessments for a colleague:

  • Shoulder flexion
  • Shoulder abduction
  • Shoulder external rotation

Practice assessing in gravity eliminated and against gravity positions.

Time: 15 mins

Post any questions on the discussion forum.

Congratulations, you have now learnt how to assess muscle strength for the shoulder. 

Learning how to properly assess muscle strength for each movement will take time so we encourage you to practice assessing each movement in your own time as well as in this module.