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Active Range of Motion of the Shoulder: A Cross-Sectional Study of 6635 Subjects

Open AccessPublished:September 30, 2022DOI:https://doi.org/10.1016/j.jseint.2022.09.008

      Abstract

      Background

      Normative data for passive range of motion are well-established, but daily living is comprised of active motion. The purpose of this study was to establish normative values for active range of motion of the shoulder across age, sex, and arm.

      Hypothesis

      Our hypotheses were that active range of motion of the shoulder (1) decreases with age group, (2) differs between males and females, and (3) differs between right arm and left arm.

      Methods

      Shoulder active range of motion were captured with an eight-camera marker-less motion capture system. Data were collected for a heterogenous sample of 6635 males and females of all ages. For each subject, six shoulder motions were collected with maximum values measured: external rotation, internal rotation, flexion, extension, abduction, and horizontal abduction. Three-way repeated measures analyses were performed, with two between-subjects factors (age group and sex) and one within-subject factor (arm). The unadjusted threshold for statistical significance was α = 0.05.

      Results

      External rotation decreased with age (approximately 10º decrease from below 30 years to above 60 years). External rotation was approximately 5º greater in the right arm, while internal rotation was approximately 5º greater in the left arm. Flexion decreased with age (approximately 15º decrease from below 20 years to above 60 years). For age groups from 10 to 59 years, extension and horizontal abduction were approximately 5º to 10º greater in females than males. Abduction was greater for females than males. Abduction was also greater in younger people (ages 10-29) than older people.

      Conclusion

      In general, active range of motion of the shoulder decreases with age. Sex (male/female) and arm side (right/left) also influence shoulder range of motion.

      Keywords

      The anatomy of the shoulder complex allows for a wide range of activity in daily living and athletic activity. Deficiencies in shoulder range of motion can predispose athletes and others to shoulder injury.
      • Hams A.
      • Evans K.
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      Reduced shoulder strength and change in range of motion are risk factors for shoulder injury in water polo players.
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      • Wilk K.E.
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      Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers.
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      • Porterfield R.A.
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      Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: A Prospective study.
      Conversely, return to full range of motion can be challenging after surgical or nonsurgical treatment of shoulder injury.
      • Wilk K.E.
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      Return to sport participation criteria following shoulder injury: a clinical commentary.
      ,
      • Wilk K.E.
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      Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation.
      ,
      • Wilk K.E.
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      • Andrews J.R.
      Current Concepts in the Rehabilitation of the Overhead Throwing Athlete.
      Thus, comparing a person’s shoulder range of motion to normative values of healthy individuals is vital in the prevention and rehabilitation of shoulder injuries.
      Numerous studies have reported passive range of motion of the shoulder as defined by the American Academy of Orthopaedic Surgeons,

      American Academy of Orthopaedic Surgeons. Joint Motion: Method of Measuring and Recording. American Academy of Orthopaedic Surgeons; 1965.

      showing changes across age groups,
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
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      Normal range of motion of joints in male subjects.
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      • Desrosiers J.
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      Shoulder Range of Motion of Healthy Elderly People.
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      • Gill T.K.
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      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      ,
      • Macedo L.G.
      • Magee D.J.
      Effects of age on passive range of motion of selected peripheral joints in healthy adult females.
      sex,
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
      ,
      • Desrosiers J.
      • Hébert R.
      • Bravo G.
      • Dutil É.
      Shoulder Range of Motion of Healthy Elderly People.
      ,
      • Gill T.K.
      • Shanahan E.M.
      • Tucker G.R.
      • Buchbinder R.
      • Hill C.L.
      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      and side-to-side
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
      ,
      • Crockett H.C.
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      • Wilk K.E.
      • Schwartz M.L.
      • Reed J.
      • Dugas J.R.
      • et al.
      Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers.
      ,
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      • et al.
      Changes in shoulder and elbow passive range of motion after pitching in professional baseball players.
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      • Bartolozzi A.R.
      • et al.
      A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players.
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      • Kelly J.D.
      Change in glenohumeral rotation and scapular position after a division i collegiate baseball season.
      • Wilk K.E.
      • Macrina L.C.
      • Fleisig G.S.
      • Aune K.T.
      • Porterfield R.A.
      • Harker P.
      • et al.
      Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: A prospective study.
      ,
      • Wilk K.E.
      • Macrina L.C.
      • Arrigo C.
      Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation.
      • Wilk K.E.
      • Macrina L.C.
      • Fleisig G.S.
      • Porterfield R.
      • Simpson C.D.
      • Harker P.
      • et al.
      Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers.
      • Wilk K.E.
      • Macrina L.C.
      • Fleisig G.S.
      • Aune K.T.
      • Porterfield R.A.
      • Harker P.
      • et al.
      Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: A Prospective study.
      in athletes, patients, and the general population. While passive range of motion is well established, daily living is comprised of active motion. Unfortunately, diagnosis of shoulder active range of motion has been limited due to the complexity of shoulder motion, the contribution of scapulothoracic motion to shoulder movement, and the use of manual instruments for measurement.
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
      ,
      • Gill T.K.
      • Shanahan E.M.
      • Tucker G.R.
      • Buchbinder R.
      • Hill C.L.
      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      The advent of new technologies may allow us to establish normative values of shoulder active range of motion and improve our ability to screen and prevent shoulder injuries. One such technology approved by the FDA is the DARI marker-less motion capture system, which has been used previously to assess lower extremity and full body movements in relation to injury risk and rehabilitation.
      • Bird M.B.
      • Mi Q.
      • Koltun K.J.
      • Lovelekar M.
      • Martin B.
      • Fain A.
      • et al.
      Unsupervised Clustering Techniques Identify Movement Strategies in the Countermovement Jump Associated With Musculoskeletal Injury Risk During US Marine Corps Officer Candidates School.
      ,
      • Cabarkapa D.
      • Whetstone J.M.
      • Patterson A.M.
      • Mosier E.M.
      • Cabarkapa D.V.
      • Fry A.C.
      Relationship between Health-Related Physical Fitness Parameters and Functional Movement Screening Scores Acquired from a Three-Dimensional Markerless Motion Capture System.
      ,
      • Daggett M.C.
      • Witte K.A.
      • Cabarkapa D.
      • Cabarkapa D.V.
      • Fry A.C.
      Evidence-Based Data Models for Return-to-Play Criteria after Anterior Cruciate Ligament Reconstruction.
      ,

      Ekanayake CD, DeMik DE, Glass NA, Kotseos C, Callaghan JJ, Ratigan BL. Comparison of Patient Reported Outcomes and Functional Assessment Using a Marker-less Image Capture System in End-Stage Knee Arthritis. J Arthroplasty. doi:10.1016/J.ARTH.2022.05.039

      This system utilizes eight cameras and software-based algorithms to measure active range of motion of each joint.
      The purpose of this study was to utilize marker-less motion capture to establish normative values for active range of motion of the shoulder across age, sex, and arm. Our hypotheses were that (1) normative values of shoulder range of motion would decrease with age, (2) there would be differences between males and females, and (3) there would be differences in range of motion between the right and left arm as most individuals are right-handed.

      Methods

      Sterling IRB determined this retrospective analysis of anonymous, previously collected clinical data to be exempt from IRB review. From 2018 to 2022, active range of motion data were collected for patients, athletes, and clients at 51 facilities throughout the United States via multi-camera marker-less motion capture technology (DARI Motion, Overland Park, KS, USA). At each facility, a motion capture system collected data with eight cameras electronically synchronized to their mainframe computer. The marker-less system used Captury Live (The Captury GmbH, Saarbrücken, Germany) tracking software, which implements methods previously described.
      • Stoll J.
      • Kohlbecher S.
      • Marx S.
      • Schneider E.
      • Einhäuser W.
      Mobile three dimensional gaze tracking.
      Both the human body and image domain were represented by Sums of spatial Gaussians (SoG). The skeletal motion was estimated by optimizing a continuous and differentiable model-to-image similarity measure. While in the work of Stoll et al,
      • Stoll J.
      • Kohlbecher S.
      • Marx S.
      • Schneider E.
      • Einhäuser W.
      Mobile three dimensional gaze tracking.
      the similarity measure was based on color similarity; the current approach combines the color similarity with a term computed by a Deep Convolutional Neural Network. The DARI markerless system has been used in several recent studies to measure active range of motion for a variety of activities.
      • Bird M.B.
      • Mi Q.
      • Koltun K.J.
      • Lovelekar M.
      • Martin B.
      • Fain A.
      • et al.
      Unsupervised Clustering Techniques Identify Movement Strategies in the Countermovement Jump Associated With Musculoskeletal Injury Risk During US Marine Corps Officer Candidates School.
      ,
      • Cabarkapa D.
      • Whetstone J.M.
      • Patterson A.M.
      • Mosier E.M.
      • Cabarkapa D.V.
      • Fry A.C.
      Relationship between Health-Related Physical Fitness Parameters and Functional Movement Screening Scores Acquired from a Three-Dimensional Markerless Motion Capture System.
      ,
      • Daggett M.C.
      • Witte K.A.
      • Cabarkapa D.
      • Cabarkapa D.V.
      • Fry A.C.
      Evidence-Based Data Models for Return-to-Play Criteria after Anterior Cruciate Ligament Reconstruction.
      ,

      Ekanayake CD, DeMik DE, Glass NA, Kotseos C, Callaghan JJ, Ratigan BL. Comparison of Patient Reported Outcomes and Functional Assessment Using a Marker-less Image Capture System in End-Stage Knee Arthritis. J Arthroplasty. doi:10.1016/J.ARTH.2022.05.039

      ,

      Fleisig GS, Slowik JS, Wassom D, Yanagita Y, Bishop J, Diffendaffer A. Comparison of marker-less and marker-based motion capture for baseball pitching kinematics. doi:10.1080/14763141.2022.2076608

      ,
      • Sonnenfeld J.J.
      • Crutchfield C.R.
      • Swindell H.W.
      • Schwartz W.J.
      • Trofa D.P.
      • Ahmad C.S.
      • et al.
      An Analysis of In Vivo Hip Kinematics in Elite Baseball Batters Using a Markerless Motion-Capture System.
      One of these studies compared the marker-less motion data to a “gold standard” marker-based data and showed similar consistency of joint angle calculations for each system, although the magnitudes of angle measurements differed between the two systems.
      • Fleisig G.S.
      • Slowik J.S.
      • Wassom D.
      • Yanagita Y.
      • Bishop J.
      • Diffendaffer A.
      Comparison of marker-less and marker-based motion capture for baseball pitching kinematics.
      For each subject, six shoulder motions were collected with maximum values measured: external rotation, internal rotation, flexion, extension, abduction, and horizontal abduction. Instructions for the six motions are shown in Table 1.
      Table 1Instructions explained and demonstrated to subjects
      Shoulder Abduction
      • Stand tall with arms at sides, elbows straight, and palms facing forward,
      • Raise arms laterally until overhead,
      • Return arms to starting position,
      • Maintain straight elbows and palms forward throughout movement.
      Shoulder Horizontal Abduction
      • Stand tall with arms extended forward at shoulder height, and palms facing each other,
      • Pull arms away from each other through the shoulders,
      • Go as far back as possible,
      • Return to the starting position.
      Shoulder Internal/External Rotation
      • Stand tall with the shoulders and elbows at 90-deg, and palms facing down,
      • Rotate arms up and back as far as possible,
      • Then rotate arms down and back as far as possible,
      • Return to the starting position.
      Shoulder Flexion/Extension
      • Stand tall with arms at sides and palms facing in toward the body,
      • Raise arms up and back as far as possible,
      • Then bring arms down and back as far as possible,
      • Return to the starting position.
      To eliminate a weighting bias from multiple entries from some subjects, only one capture for each participant was included in analyses. Data from all facilities were de-identified prior to the researchers receiving them for use in the current study.
      Subjects were categorized by their sex (male or female) and by their age group (10-19, 20-29, 30-39, 40-49, 50-59, 60-69, or over 69 years of age). For each shoulder parameter, a three-way repeated measures analysis was performed, with two between-subjects factors (age group and sex) and one within-subject factor (arm). If there was a significant interaction effect, associated main effects were not reported, with subsequent analyses looking at simple main effects. All pairwise comparisons included a Bonferroni adjustment for multiple comparisons. For all analyses, the unadjusted threshold for statistical significance was set at α = 0.05. Partial eta-squared (ηp2) was reported as a measure of the effect size, with the standard minimum thresholds of 0.01, 0.06, and 0.14 used to determine small, medium, and large effect sizes, respectively.

      Results

      Data were captured for 6635 individuals at athletic team and performance centers (n=3980 individuals), healthcare centers (n=2142), wellness facilities (n=327), and military bases (n=186). The resulting number of subjects in each age-sex combination are provided in Table 2. Mean values and confidence intervals for each shoulder motion are presented in Figure 1 and Table A-1 (in Appendix A). Data are shown for each sex (male and female) and each arm (right and left) for each age group. Significant differences between age, sex, and arm groups are shown in the tables in Appendix B.
      Table 2Number of participants in each age group for males and females.
      10 to 19 yrs20 to 29 yrs30 to 39 yrs40 to 49 yrs50 to 59 yrs60 to 69 yrs70 yrs and upTOTAL
      Male11291321748538342116334227
      Female77877231125019877222408
      TOTAL190720931059788540193556635
      Figure thumbnail gr1
      Figure 1Maximum shoulder angle vs. age. Blue lines correspond to males, while pink lines correspond to females. Solid lines correspond to right arms, while dashed lines correspond to left arms. Error bars denote 95% confidence intervals.

      External Rotation

      External rotation decreased significantly with age (p<0.001), and the effect size was small, approaching medium (ηp2=0.057). Among the 21 age group pairwise comparisons, 17 showed significant differences (Table B1-1). There was also as a statistically significant but trivial interaction effect between sex and arm (p<0.001, ηp2=0.003). Pairwise comparisons revealed that males had greater external rotation than females for right arms, but there was no difference for left arms (Table B1-2). Both males and females had significantly greater external rotation in their right arm (Table B1-3), with a greater difference in males than in females (4.6° vs. 2.8°).

      Internal Rotation

      There was statistically greater (p<0.001) internal rotation in the left shoulder than right shoulder (Table B2-1), and the effect size was small (ηp2=0.027). There was also a statistically significant interaction but trivial effect between age and sex (p=0.001, ηp2=0.003). Among males, there were statistically significant pairwise comparisons between age groups, but with inconsistency regarding whether the older or younger group in these comparisons had higher value (Table B2-2). In contrast, among females, no age group effect was found (Table B2-3). For the three youngest age groups, females had greater internal rotation than males; however, there was no such difference found in the other four age groups (Table B2-4).

      Flexion

      There was a statistically significant but trivial interaction effect between age and arm (p<0.001, ηp2=0.007). In both the right and left arms, there were numerous differences in pairwise comparisons between age groups (Tables B3-1 & B3-2), with the younger group producing greater flexion than the older group. For the two youngest age groups, the left arm had greater flexion than the right arm (Table B3-3). For the next three age groups, the right arm had greater flexion than the left arm. For the two oldest age groups, there was no difference found between the arms. Differences between males and females were not statistically significant (p=0.13).

      Extension

      There was a statistically significant but trivial interaction effect between age and sex (p=0.02, ηp2=0.002). Among the 21 age group pairwise comparisons within males, only three revealed statistically significant differences (Table B4-1). Among females, no age group effect was found (Table B4-2). While there was no statistically significant difference between sexes for the two oldest age groups, females had greater extension than males for the five younger age groups (Table B4-3).
      There was also a statistically significant but trivial interaction effect between age and arm (p<0.001, ηp2=0.004). For the right arm, no age group effect was found (Table B4-4). Among the 21 age group pairwise comparisons for the left arm, only three revealed statistically significant differences (Table B4-5). Finally, while there was no significant difference between arms for the oldest age group, the right arm had greater extension for the other six age groups (Table B4-6).

      Abduction

      Overall, there was a trend in which abduction was greater for females than males and greater for the left arm than right arm. Abduction was greatest in the two youngest groups. The age*sex*arm interaction effect was statistically significant but trivial (p=0.01, ηp2=0.003), with numerous statistical differences in pairwise comparisons (Tables B5-1 through B5-6).

      Horizontal abduction

      Overall, there was a trend in which horizontal abduction was greater for females than males. There was a statistically significant but trivial interaction effect between sex and age (p<0.001, ηp2=0.005). Among males, horizontal abduction did not change with age (Table B6-1). In contrast, among females, horizontal abduction was greatest in the two youngest age groups (Tables B6-2 & B6-3).
      There was also a statistically significant but trivial interaction effect between age and arm (p<0.001, ηp2=0.006). For both the right and left arms, horizontal abduction was greatest in the two youngest age groups (Tables B6-4 & B6-5). Finally, there was large inconsistency among age groups regarding which arm had greater maximum horizontal abduction angle (Table B6-6).

      Discussion

      Our hypothesis that motion decreases with age was partially supported. External rotation and flexion decreased significantly with age. Abduction decreased in males from the teens into the thirties, whereas horizontal abduction decreased in females from the teens into the thirties. These results are consistent with previous studies showing decrease in shoulder active range of motion with age.
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
      ,
      • Gill T.K.
      • Shanahan E.M.
      • Tucker G.R.
      • Buchbinder R.
      • Hill C.L.
      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      Previous studies of passive range of motion reported decreased shoulder motion with age,
      • Desrosiers J.
      • Hébert R.
      • Bravo G.
      • Dutil É.
      Shoulder Range of Motion of Healthy Elderly People.
      ,
      • Macedo L.G.
      • Magee D.J.
      Effects of age on passive range of motion of selected peripheral joints in healthy adult females.
      while age-related changes for other joints (knee, hip, and elbow) were not significant.
      • Macedo L.G.
      • Magee D.J.
      Effects of age on passive range of motion of selected peripheral joints in healthy adult females.
      As hypothesized, there were several significant differences between males and females. Under age 40, external rotation of the right shoulder was greater for males than females; however, there were no significant differences in external rotation of the left shoulder. This contradicts previous studies showing greater external rotation in females.
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
      ,
      • Gill T.K.
      • Shanahan E.M.
      • Tucker G.R.
      • Buchbinder R.
      • Hill C.L.
      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      Several other parameters in the current study were greater for females than males. Females consistently had greater abduction than their male counterparts. This is consistent with the findings of Barnes et al,
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
      whereas Gill et al reported greater abduction for males than females.
      • Gill T.K.
      • Shanahan E.M.
      • Tucker G.R.
      • Buchbinder R.
      • Hill C.L.
      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      Under 60 years of age, extension and horizontal abduction were greater for females than males. Under 30 years of age, internal rotation was greater for females than males.
      Our third hypothesis was also supported by the data, as there were significant differences between left and right shoulder range of motion. While arm dominance was not recorded with data collection, it is reasonable to assume that the vast majority of subjects were righthanded as approximately 90% of the general population is righthanded. In the study by Gill et al, 11% of participants were left-handed and shoulder range of motion differences between right and left arms mirrored differences between dominant and nondominant arms.
      • Gill T.K.
      • Shanahan E.M.
      • Tucker G.R.
      • Buchbinder R.
      • Hill C.L.
      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      Thus, differences between right and left shoulder range of motion in the current study likely reflect differences between dominant and nondominant shoulders, respectively. External rotation was greater in the right arm, while internal rotation was greater in the left arm. Similar discrepancies are well-documented between dominant and nondominant shoulder passive ranges of motion, especially with the throwing and non-throwing arms of athletes.
      • Wilk K.E.
      • Macrina L.C.
      • Fleisig G.S.
      • Aune K.T.
      • Porterfield R.A.
      • Harker P.
      • et al.
      Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: A prospective study.
      ,
      • Wilk K.E.
      • Macrina L.C.
      • Fleisig G.S.
      • Aune K.T.
      • Porterfield R.A.
      • Harker P.
      • et al.
      Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: A Prospective study.
      ,
      • Wilk K.E.
      • Meister K.
      • Andrews J.R.
      Current Concepts in the Rehabilitation of the Overhead Throwing Athlete.
      The increase in external rotation and decrease in internal rotation in the dominant arm are associated with glenoid and humeral retrotorsion, as first shown by Crockett et al
      • Crockett H.C.
      • Gross L.B.
      • Wilk K.E.
      • Schwartz M.L.
      • Reed J.
      • Dugas J.R.
      • et al.
      Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers.
      Wilk et al introduced the concept of total range of motion, defined as the summation of external rotation and internal rotation. Wilk and others have shown that while the dominant arm has greater external rotation and less internal rotation than the nondominant arm, the total passive range of motion of the two shoulders is about the same.
      • Wilk K.E.
      • Macrina L.C.
      • Fleisig G.S.
      • Aune K.T.
      • Porterfield R.A.
      • Harker P.
      • et al.
      Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: A prospective study.
      ,
      • Wilk K.E.
      • Macrina L.C.
      • Fleisig G.S.
      • Aune K.T.
      • Porterfield R.A.
      • Harker P.
      • et al.
      Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: A Prospective study.
      ,
      • Wilk K.E.
      • Meister K.
      • Andrews J.R.
      Current Concepts in the Rehabilitation of the Overhead Throwing Athlete.
      Combining external rotation and internal rotation data from the current study, a posthoc analysis of total rotation active range of motion was produced (Figure 2). There was a significant interaction among arm, sex, and age (p=0.03). While total active range of motion tended to be slightly greater for the right arm; this difference reached statistical significance for fewer than half of the age/sex subgroups (Table B7-6).
      Figure thumbnail gr2
      Figure 2Total range of motion (ER+IR) vs. age. Blue lines correspond to males, while pink lines correspond to females. Solid lines correspond to right arms, while dashed lines correspond to left arms. Error bars denote 95% confidence intervals.
      Differences in extension and abduction were also shown. Extension was greater in the right shoulder. For male subjects, abduction was greater in the left shoulder. Gill et al reported greater abduction in males than females,
      • Gill T.K.
      • Shanahan E.M.
      • Tucker G.R.
      • Buchbinder R.
      • Hill C.L.
      Shoulder range of movement in the general population: Age and gender stratified normative data using a community-based cohort.
      whereas Barnes et al found greater abduction in females than males.
      • Barnes C.J.
      • van Steyn S.J.
      • Fischer R.A.
      The effects of age, sex, and shoulder dominance on range of motion of the shoulder.
      As with all studies, this investigation had limitations. This study used data from a large, heterogenous sample. While this enabled us to established normative data for active range of motion, future research may focus on specific groups based upon recreational activities, work, and lifestyle, such as athletes, workers, or injured people. Another limitation was the omission of arm dominance. The current study found significant differences between ranges of motion of the left shoulder and right shoulder because left and right correlated to nondominant and dominant, respectively, for most people. However, knowing arm dominance of individual would have strengthened the statistical differences even further. Statistically, the large number of comparisons analyzed created a high chance of Type I error; thus, our interpretation focused on clusters of multiple differences observed. Furthermore, this study assessed active range of motion without controlling for motion compensations or abnormal movements.

      Conclusion

      In conclusion, active range of motion of the shoulder decreases with age. The profiles of these decreases differ across specific shoulder motions. Differences were also demonstrated between sex (male/female) and arm side (right/left), although their effects were less pronounced than that of age. It is also important to note that there are numerous interactions in range of motion measurements between age, sex, and arm. This study should enhance the clinician’s appreciation and recognition of shoulder active range of motion during their clinical examinations and help establish personalized goals.

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