Upper Extremity Functional Assessment  
 
The upper extremity functional assessment is designed to test the upper extremity following surgery or injury to 
determine the patient’s readiness to return to sport. The assessment addresses ROM, proprioception, strength, 
endurance, motor control and functional testing. Descriptions of each test with recommended standards is found in the 
back. The assessment should be utilized once patient has completed the appropriate rehab and has been cleared by 
physician.  
 
Patient Name:__________________________________________________  
 
MRN:_________________________________
Injury/Surgery:________________________________________________ 
 
Date of Injury/Surgery:_________________
Concomitant Injuries/Procedures:_________________________________________________________
 
Operative Limb 
Non-operative 
limb 
Limb Symmetry 
Index 
Passive Range of Motion: ER-0-IR at 90° ABD 
-  0  - 
-  0  -  
- 
Joint Position Sense – Mid range (Avg 3 trials each 
limb) 
 
 
 
Joint Position Sense – end range (Avg. 3 trials each 
limb) 
 
 
 
External Rotation Strength (Avg of 3 trials) 
Handheld Dynamometer 
 
In scapular plane  
 
 
 
In 90° ABD 
 
  
 
Eccentric ER in scapular plane 
 
 
 
Internal Rotation strength (Avg/3 trials) 
Handheld dynamometer 
 
 
In scapular Plane  
 
 
 
In 90° ABD 
 
 
 
Ratio of ER/IR in scapular plane 
 
 
 
Ratio of ER/IR in 90° ABD  
 
 
 
Periscapular Strength (Avg/3 trials) 
 
Middle Trapezius 
 
 
 
Lower Trapezius 
 
 
 
Motor Control 
 
Scapular Dyskinesis Test 
Symmetry:        Yes      or        No 
Functional Performance Tests (Avg/3 trials) 
 
Upper Quarter Y-Balance 
 
 
 
Closed Kinetic Chain Upper Extremity Stability  
Males: > 21   Yes   or   No       Females > 23  Yes  or  No 
 
Massachusetts General Brigham Sports Medicine  
 
2 Single arm seated shot-put test 
 
 
 
Shoulder Endurance  
 
Posterior shoulder endurance test 
 
 
 
 
 
Cleared for sport activities:  
  Yes 
 
No 
Recommendations: 
__________________________________________________________________________________________________ 
Examiner: _________________________________________________________________________________________ 
 
 
Joint Position Sense: Patient in supine. Arm ABD to 90 degrees with elbow flexed 90 degrees. Patient’s eyes closed, 
move the patient’s arm passively to an angle of either ER or IR, measure that angle. Then passively move the shoulder 
through ER and IR, then ask patient to actively reproduce the angle measured. Repeat at various angles for 3 trials and 
record for both mid-range and end range.  
• A > 5 degrees error is considered abnormal 
 
Strength Testing 
 
External rotation strength: Using a handheld dynamometer(HHD). Patient is supine and instructed to apply maximal 
isometric force against the HHD positioned just proximal to the wrist. Measured in both the scapular plane and in 90 
degrees ABD. Average of 3 trials for each limb, in each position.  
• Limb Symmetry: Involved > 90% of uninvolved 
 
Internal rotation strength: Using an HHD. Patient is supine and instruct them to apply a maximal isometric force against 
the HHD positioned just proximal to the wrist. Measured in both scapular plane and in 90 degrees ABD. Average of 3 
trials for each limb, in each position. 
• Limb Symmetry: Involved > 90% of uninvolved 
 
Eccentric external rotation strength: Measured with the HUMAC system. Patient is seated and it is measured in both 
scapular plane and 90 degrees ABD.  Average of 3 trials for each limb, in each limb. 
• Limb Symmetry: Involved > 90% of uninvolved  
 
ER/IR Ratio: Calculated for each limb based on the average of 3 trials. The average external rotation isometric strength is 
divided by the average internal rotation isometric strength.  
• Limb Symmetry: involved arm > 90% of uninvolved arm 
 
Middle Trapezius: Measured with HHD. Patient in prone with arm ABD 90 degrees. Instruct patient to apply maximal 
isometric force against the HHD that is proximal to the elbow in the horizontal abduction direction. Average of 3 trials 
for each limb. 
• Limb Symmetry: Involved > 90% of uninvolved  
 
Lower Trapezius: Measured with HHD. Patient in prone with arm elevated to 120 degrees. Instruct patient to apply 
maximal isometric force applied against the HHD that is just proximal to the elbow in the elevation direction. Average of 
3 trials for each limb. 
• Limb Symmetry: Involved > 90% of uninvolved  
 
 
Massachusetts General Brigham Sports Medicine  
 
3 Motor Control 
 
Scapular dyskinesis test: Patient is standing facing away from clinician. Patient’s arms at the sides in neutral rotation. 
Bilateral shoulder flexion and ABD performed through the full range of motion. Arms elevated at a cadence of 25 bpm 
for 5 repetitions. Patients that weigh < 150lb use 3 lbs., patients weighing > 150lb use 5lbs. The clinician is determining if 
there is symmetry or asymmetry in scapulohumeral motion. Document the quality of motion.  
 
Functional Performance tests 
 
Upper Quarter Y-balance Test: Patient in push-up position, with feet < 12 inches apart. Patient performs a maximal 
effort reach with the free hand in 3 directions: medial, superolateral and inferolateral (named in relation to stationary 
arm). Distance reached is recorded for each hand. Average the 3 trials for each direction. The sum of the 3 directions is 
calculated for total excursion score.   
• Limb Symmetry: Involved > 90% of uninvolved  
 
Closed Kinetic Chain Upper Extremity Stability test (CKCUEST): Place 2 strips of 1.5-inch athletic tape on the ground 
parallel to each other 36-inches apart. Starting Position: push-up position with one hand on each piece of tape. Males 
have knees off the ground, females may have knees on the ground in modified position. Move one hand across their 
body and touch the piece of tape on the opposite side, then return to starting position. Then perform with the opposite 
arm. Back should remain straight and hands and shoulders in a perpendicular position. Test is 15 seconds. Each tape 
touch is 1 repetition. Average of 3 trials.   
 
Single arm seated shot-put test: Patient is long sitting with back against a wall/backrest. 2kg medicine ball is in their 
hand with elbow tucked against their torso as far back into the backrest/wall as possible. Opposite arm is on the 
patient’s lap. Instruct patient to shot-put the medicine ball as hard as they can to throw the greatest distance. Patient’s 
knees cannot bend. Test is repeated if the patient’s test arm crosses midline, torso moved away from wall/backrest, 
knees bent, or preloaded before putting the ball. Average of 3 trials.  
• Limb Symmetry: Involved > 90% of uninvolved  
 
Shoulder Endurance 
 
Posterior shoulder endurance test: Patient in prone with test shoulder off the table and arm perpendicular to the floor 
with elbow extended. Patient holds a weight that is 2% of bodyweight. Patient horizontally abducts the arm to 90 
degrees at a cadence of 30 bpm. There is a 1 second hold at the top of the arc of motion. Repeat until patient fatigues 
indicated by inability to hold arm at top of the arc of motion (1 second), compensation with elevation of entire upper 
torso, verbal report of inability to continue. Total repetitions are counted for each side.   
• Limb Symmetry: Involved > 90% of uninvolved  