Normal values for shoulder flexion, extension, abduction and rotation, how to line up a goniometer for each one, and how to measure from a camera.
The shoulder has the largest range of any joint, and it is easy to overestimate. Trunk lean, a shrug or an arched back all add degrees the shoulder joint itself didn't produce. These are the reference values and the alignment that keep the number honest.
Normal shoulder range of motion
Reference values from the AAOS and the AMA Guides (6th edition), with the CDC average for healthy adults aged 20 to 44. Flexion and abduction both finish near 180 degrees, and both depend on the shoulder blade rotating freely.
| Motion | AAOS | AMA Guides | CDC average women / men |
|---|---|---|---|
| Flexion | 0–180° | 0–180° | 172° / 169° |
| Extension | 0–60° | 0–50° | – |
| Abduction | 0–180° | 0–170° | – |
| Internal rotation | 0–70° | 0–80° | – |
| External rotation | 0–90° | 0–60° | – |
By age and sex
From the CDC Normal Joint Range of Motion Study: more than 600 healthy people measured by physical therapists with universal goniometers. Women had more range than men in nearly every joint, and range fell with age in both.
| Motion | Women 20–44 | Men 20–44 | Women 45–69 | Men 45–69 |
|---|---|---|---|---|
| Flexion | 172.0° | 168.8° | 168.1° | 164.0° |
How to measure shoulder range of motion with a goniometer
Standard goniometric alignment. Stabilize the scapula and trunk for each motion, and record the patient position you used.
Flexion
- Position
- Supine with knees bent, palm facing the body
- Axis
- Lateral aspect of the greater tubercle
- Stationary arm
- Midaxillary line of the trunk
- Moving arm
- Lateral midline of the humerus, toward the lateral epicondyle
- Watch for
- Lumbar extension and scapular elevation
Extension
- Position
- Prone
- Axis
- Lateral aspect of the greater tubercle
- Stationary arm
- Midaxillary line of the trunk
- Moving arm
- Lateral midline of the humerus, toward the lateral epicondyle
- Watch for
- Scapular tipping and the trunk rotating
Abduction
- Position
- Supine, arm externally rotated
- Axis
- Anterior aspect of the acromion
- Stationary arm
- Parallel to the midline of the sternum
- Moving arm
- Anterior midline of the humerus
- Watch for
- Trunk side bending and shoulder elevation
Internal and external rotation
- Position
- Supine, shoulder abducted 90°, elbow flexed 90°, towel under the humerus
- Axis
- Olecranon process
- Stationary arm
- Perpendicular to the floor
- Moving arm
- Ulna, toward the ulnar styloid
- Watch for
- The scapula tilting or protracting: stop when it starts to move
Measuring shoulder range of motion with a camera
Shoulder flexion and extension read best side-on, with the camera level with the shoulder. Abduction reads best from behind or in front. Rotation is measured with the elbow at 90 degrees, so the camera needs to look along the upper arm to see the forearm arc.
- From a photo: the free online goniometer lets you tap the axis and both segments on a picture and read the angle. Nothing is uploaded.
- Live: MotionArc tracks the joints from any phone, tablet or laptop camera and measures the movement as it happens, in the clinic or on a video call.
Why two clinicians get different numbers
A goniometer reading depends on the person holding it. Finding the bony landmarks, lining up the arms and positioning the patient all add variation, and that variation is larger between two clinicians than for one clinician measuring twice.
- Small changes between two clinicians may not be real. At the shoulder, a true change measured by two different therapists needs about 15°, compared with 6° to 11° when the same therapist measures both times. Agreement between testers is weakest for shoulder extension and internal rotation.
- The instrument matters. At the knee, the smallest difference you can trust is about 6° with an inclinometer, 10° with a long-arm goniometer, 12° with a smartphone app and 14° with a short-arm goniometer or a visual estimate.
- Video can work. Shoulder angles measured over a video call with an on-screen protractor came within 0.2° to 5° of goniometer readings on average, and most smartphone apps studied show adequate reliability.
- What helps: a written protocol for patient position and landmarks, the same instrument each time, the same clinician where possible, and a note of how the measurement was taken.
Measuring from a camera takes out the hand-held step. Nobody has to line up the goniometer arms by hand, and the same view can be set up visit after visit.
Early access is limited, and we set up every account personally.
More reference values: normal range of motion chart for every joint. Other joints: Hip · Knee · Ankle · Neck · Low back.
Sources
- American Academy of Orthopaedic Surgeons. Joint Motion: Method of Measuring and Recording. Chicago: AAOS; 1965.
- AAOS values as tabulated in a Jones & Bartlett Learning clinical handbook, chapter 1 (sample chapter). Link
- Hendriks et al. Plastic and Reconstructive Surgery Global Open. 2020. Supplement: normal range of motion values according to the AAOS. Link
- American Medical Association. Guides to the Evaluation of Permanent Impairment. 6th ed. 2008, with the AMA Clarifications and Corrections. Link
- Soucie JM, Wang C, Forsyth A, et al. Range of motion measurements: reference values and a database for comparison studies. Haemophilia. 2011;17(3):500-507. Reference values from the CDC Normal Joint Range of Motion Study. Link
- Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. Philadelphia: F.A. Davis; 2016.
- University of West Alabama Athletic Training. Goniometry lab: joint measurement procedures. Link
- Mullaney MJ, et al. Physiother Theory Pract. 2010;26:327 (reliability of shoulder range of motion measurement). Link
- Riddle DL, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: shoulder measurements. Phys Ther. 1987;67:668. Link
- Hancock GE, et al. J Exp Orthop. 2018 (reliability of knee range of motion measurement methods). Link
- Sahu et al. J Shoulder Elbow Surg. 2022;31:201 (shoulder range of motion by video conference versus goniometer). Link
- Keogh JWL, et al. Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: a systematic review. PLOS ONE. 2019;14:e0215806. Link
Measure shoulder range of motion from any camera.
No goniometer, no wearables. The same movement, measured the same way, every visit.
Straight answers. If yours is not here, request access and ask us anything.
AAOS reference values are about 180° of flexion, 60° of extension, 180° of abduction, 70° of internal rotation and 90° of external rotation. The AMA Guides (6th edition) list 180°, 50°, 170°, 80° and 60°. Healthy adults in a CDC study averaged about 170° of flexion.
With the patient supine and knees bent, center the axis on the greater tubercle, align the stationary arm with the midaxillary line and the moving arm along the humerus toward the lateral epicondyle. Stop the low back from arching as the arm rises.
Usually the trunk is extending or the low back is arching at the end of range. Stabilize the trunk and remeasure.
Yes. MotionArc measures range of motion, form and balance from any phone, tablet or laptop camera, in the clinic or live on a video call. Early access is open to a small group of professionals.
Clinicians sign a business associate agreement (BAA) with us before any real patient data is entered. The free goniometer on this site runs in your browser and never uploads photos.