Does hand-behind-back range of motion accurately reflect shoulder internal rotation range of motion?
KA Ginn
, ML Cohen, RD Herbert

Introduction: Shoulder internal rotation (IR) range of motion (ROM) is commonly assessed by a method whereby the hand is placed behind the back and the distance reached by the tip of the extended thumb is recorded. This indirect method of measuring shoulder IR ROM is part of the standardised shoulder assessment adopted by the American Shoulder and Elbow Surgeons (Richards et al 1994).

Purpose of research: The aim of this study was to assess the validity of measuring active IR ROM using the indirect hand-behind-back (HBB) ROM method in subjects with shoulder pain of mechanical origin.

Methods: One hundred and thirty-seven subjects with unilateral shoulder pain were recruited. Seventy-seven subjects had decreased abduction and/or flexion ROM accompanying their shoulder pain and 60 subjects had a painful arc of abduction and/or flexion motion but retained full ROM.  Hand-behind-back ROM was determined by measuring the distance between T1 spinous process and the radial styloid process with a tape measure.  Active shoulder IR ROM was measured using photography in supine in 45° or 90° abduction. 

Results: Correlation co-efficients adjusted for measurement error were calculated.  Hand-behind-back ROM demonstrated only a low to moderate correlation with active shoulder IR ROM with Pearson’s r values ranging from 0.41 to 0.56.  

Conclusion: Active HBB ROM is not an accurate method of measuring active shoulder IR ROM in patients with shoulder pain.

Clinical implications: These results suggest that it is not valid to make clinical decisions based on the assumption that HBB ROM accurately reflects IR ROM in patients with shoulder pain with and without accompanying stiffness.  This assumption may be contributing to inaccurate diagnoses and the implementation of inappropriate treatment strategies.


Richards R, Bigliani L, Gartsman G, Iannotti J and Zuckerman J. A standardised method for the assessment of shoulder function. J Shoulder Elbow Surg 1994;3:347-52.