Hi there,

It does sound like a tough case and it's always tough to judge a gleno-humeral limitation when you can't appreciate an end-feel because the patient doesn't let you or is unable to let you due to pain. It doesn't sound like a 'Wikipedia reference-linkfrozen shoulder' if the external rotation is full but make sure to check external rotation range both in neutral and abduction ensuring the scapula is stationary. Be sure to test horizontal flexion isolating the gleno-humeral motion only as there may be a posterior capsule restriction as it sounds like internal rotation is limited. If you haven't already, check the resting position of the humeral head in the glenoid fossa e.g. is it too anterior, and whether it translates excessively during internal rotation/external rotation i.e. it should stay centered except for mild end range movements and should not translate (nor the scapula with resisted testing). Be sure to make sure the scapula isn't depressed or downwardly rotated at rest and that it moves sufficiently with arm elevation although it sounds like her active movements are too limited to make a good judgement on that one. Hope that helps.

Cheers,

E Huner PT, FCAMT