Range of Motion for the Shoulder: What Every Disabled Veteran Should Know

Many veterans leave the service with shoulder problems. Strain and disabilities to the shoulders are common during deployment, training, and combat. Not being able to use your shoulder can affect your ability to work and limit daily life. For example, you may not be able to safely drive, lift objects, care for children, or maintain your home.

Veterans who have a disability resulting from a shoulder injury during service may be entitled to VA benefits.

Shoulder Anatomy

The shoulder is two different joints and a network of connective tissue and muscles. The acromioclavicular joint is where the shoulder blade or scapula meets the collar bone or clavicle. The glenohumeral joint is where the ball at the top of the upper arm bone or humerus fits into the glenoid joint socket.

The rotator cuff is a network of four tendons that connect the humerus to the scapula. Tendons are fibrous tissues that connect muscle to bone. They stretch and contract during movement. The shoulder also contains ligaments, the fibrous tissues that connect one bone to another bone.

The shoulder joints are surrounded by muscles that keep the bones fitted tightly together. Protective tissues called the labrum line the joint socket. A fluid-filled sac called a joint capsule surrounds the joint and provides lubrication to ease movement in the shoulder.

Optimal Range of Motion for Shoulder

The shoulder’s anatomy is complex, but all the different moving parts allow a wide range of motion in the joint. The shoulder moves with every arm motion. The joint should allow the arm to move in multiple directions without any pain.

There are several range-of-motion tests that a doctor would do to assess your shoulder:

• Forward Flexion: Extend each arm in front of the body and raise it as high as possible. The ideal flexion is 180 degrees.

• Extension: Extend each arm back with the palms facing the front of the body. The ideal extension is 45-60 degrees.

• Abduction: Extend each arm out to the side with the palms facing the floor. Raise the arm as high as it will go. Ideal abduction is 150 degrees.

• Cross-body Adduction: Cross one arm over the trunk as if you are reaching for the opposite shoulder. Move the arms as far across the body as they can go. The ideal cross-body abduction is 30-50 degrees.

• External Rotation: With the palm facing up, bend the arm at the elbow until the lower arm is at a 90-degree angle to the upper arm. Rotate the lower arm away from the body. The ideal external rotation is 90 degrees.

• Internal Rotation: Flex both elbows at approximately 45 degrees. Reach the lower arms across the front of the body at the waist level. Ideal internal rotation should be 70-90 degrees.

Potential Causes for Range of Motion Issues

• Rotator Cuff Tear: Any injury to the connective tissue around the shoulder joint can cause weakness, pain, and limited range of movement. Depending on the damage, a rotator cuff tear may not be reparable.

• Shoulder Bursitis: Bursitis is caused by inflammation of the shoulder joint’s fluid-filled sac.

• Shoulder Dislocation: If the upper arm bone pops out of the socket in the shoulder blade, it is called a dislocated shoulder. It can lead to swelling, bruising, and pain. A dislocated shoulder may require treatment to reset it. Once a shoulder dislocates, there is an increased risk for repeat dislocations in the future.

• Shoulder Replacement: Irreparable damage to the shoulder may necessitate surgery to replace the joint with artificial parts. Shoulder replacement can lead to a limited range of motion or loss of strength.

• Shoulder Separation: A shoulder separation means that the ligaments that attach the collarbone to the shoulder become stretched or torn, causing pain, weakness, bruising, swelling, and limited movement. The injury may require surgery to repair.

• Shoulder Tendonitis: Tendonitis is inflammation of the tendons in the rotator cuff or biceps. Symptoms include pain and limited mobility.

How the VA Rates Disability for Shoulders

To file for disability through the VA, veterans need to establish a link between military service and the current disability. To prove service connection, a veteran must satisfy three basic criteria. The first is medical evidence of a current disability. Veterans will need to be able to show that a condition is impacting their well-being and ability to work. For example, a veteran would need to show diagnosis and treatment records for a medical condition, such as a shoulder disability. Veterans should provide copies of medical records detailing symptoms, treatment, and results. Any test results or medical imaging records will be important, as well.

Second, the veteran must be able to show that something happened in service There must be an in-service occurrence of something that led to the shoulder disability. Veterans need to have evidence establishing that a disabling disease or injury was “incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein.”

Finally, veterans must show a connection between in-service injury or disease and the present disability.

Relevant disabilities should be documented in military service treatment records. Going back to the example, if a shoulder disability started after service, the veteran’s current doctor should confirm that service-related activities contributed to the current disability.

The VA rates shoulder conditions based on how they affect the use of shoulders and arms. They use the rules of the VASRD to determine that rating. Veterans may be eligible to receive as much as 50% disability compensation.

The VA assigns a percentage rating for disabilities stemming from limited use of shoulder muscles according to severity. For shoulder disabilities that result from bone, tendon, or ligament issues, the VA assigns a percentage based on the severity of the range of motion limitation (see tables below).

The rating number correlates with the monthly payment amount veterans are entitled to receive. Payment amounts vary depending on factors like the number of dependents.

Raising Arm Forward

5301 Group I. Function: Upward rotation of scapula; elevation of the arm above shoulder level. Extrinsic muscles of shoulder girdle: (1) Trapezius; (2) levator scapulae; (3) serratus magnus

Lowering Arm

5302 Group II. Function: Depression of the arm from vertical overhead to hanging at the side (1, 2); downward rotation of scapula (3, 4); 1 and 2 act with Group III in forward and backward swing of the arm. Extrinsic muscles of the shoulder girdle: (1) Pectoralis major II (costosternal); (2) latissimus dorsi and teres major (teres major, although technically an intrinsic muscle, is included with latissimus dorsi); (3) pectoralis minor; (4) rhomboid

Raising Arm to the Side

5303 Group III. Function: Elevation and abduction of arm to the level of the shoulder; act with 1 and 2 of Group II in forward and backward swing of the arm. Intrinsic muscles of shoulder girdle: (1) Pectoralis major I (clavicular); (2) deltoid

Shoulder Rotation

5304 Group IV. Function: Stabilization of shoulder against injury in strong movements, holding the head of the humerus in the socket; abduction; outward rotation and inward rotation of the arm. Intrinsic muscles of shoulder girdle: (1) Supraspinatus; (2) infraspinatus and teres minor; (3) subscapularis; (4) coracobrachialis

Use of Bicep for Elbow + Shoulder Movement

5305 Group V. Function: Elbow supination (1) (long head of biceps is the stabilizer of shoulder joint); flexion of the elbow (1, 2, 3). Flexor muscles of elbow: (1) Biceps; (2) brachialis; (3) brachioradialis

Use of Tricep for Elbow + Shoulder Movement

5306 Group VI. Function: Extension of the elbow (long head of triceps is the stabilizer of shoulder joint). Extensor muscles of the elbow: (1) Triceps; (2) anconeus.