How stretch the posterior shoulder capsule

Effective stretching positions for the posterior shoulder capsule as determined by shear wave elastography

These authors sought to identify the stretching positions that specifically applied the greatest passive tension on the posterior shoulder capsule by evaluating the elastic characteristics of posterior capsules and muscles in various stretching positions using ultrasound shear wave elastography in 9 fresh-frozen cadaver shoulders without osteoarthritis or rotator cuff tears. 

All posterior shoulder tissues were preserved intact. Shear moduli of the middle and inferior posterior shoulder capsule and the posterior shoulder muscles were evaluated in combinations of glenohumeral

elevation planes and angles (frontal, sagittal, scapular; –30, 0, 30, 60, respectively). A 4-Nm torque for shoulder internal rotation or horizontal adduction was applied in each position. 

They found that the middle posterior capsule was most effectively stretch by internal rotation at 30 of elevation in the scapular plane and cross body adduction at 60 of elevation. The inferior posterior shoulder capsule was most effectively stretched by internal rotation at 30 of flexion.

Comment: Posterior capsular tightness is a common finding on careful evaluation of the painful shoulder, although it is often overlooked by the casual observer. It can be noted by (a) limited cross body adduction, (b) limited internal rotation with the arm abducted, and (c) by limited reach up the back. As found in cadavers by the authors, we have found that the posterior capsule can be effectively stretched by cross body adduction (see this link) and the sleeper stretch (see this link). 

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

"Impingement" or posterior capsular tightness?

One of our colleagues sent this question from a recent 'in training' examination.

It demonstrates the recognition that what used to be called 'impingement' is in many cases tightness of the posterior capsule which can be treated by stretching.

See more of the Rotator Cuff Book here.

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Effects of posterior capsule tightness on subacromial contact behavior during shoulder motions. JSES

JSES has recently published an article on the Effects of posterior capsule tightness on subacromial contact behavior during shoulder motions.  This article concluded that posterior capsular tightness increased contact pressure beneath the acromion when the shoulder was flexed. This result is consistent with our publication from 1990: Translation of the humeral head on the glenoid with passive glenohumeral motion as well as other publications: Effect of posterior capsule tightness on glenohumeral translation in the late-cocking phase of pitching.

The most important conclusion from these articles is that posterior capsular tightness can cause the type of symptoms that in the past were attributed to 'impingement syndrome'.  Furthermore, these symptoms almost always respond to stretching exercises including the 'sleeper stretch'.

It is reassuring that we are now moving past using the term 'impingement syndrome'.

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Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.


See from which cities our patients come.


See the countries from which our readers come on this post.