Shoulder Flexibility Testing: Single Arm Combined Elevation Test

Shoulder elevation is important for overhead lifting, swimming, throwing, reaching, climbing, hanging, pressing and many sport or daily movement patterns. When combined elevation is limited, a client may compensate through the spine, ribs, scapula, neck or opposite side of the body.

The Single Arm Combined Elevation Test is useful because it assesses overhead mobility as a combined movement rather than an isolated shoulder angle. It captures how the shoulder, scapula and thoracic spine work together when the client moves one arm overhead.

Quick Summary

Test name: Single Arm Combined Elevation Test
Alternative names: Single Arm Shoulder Elevation Test, Single Arm Overhead Mobility Test, Unilateral Combined Elevation Test
Category: Shoulder flexibility / overhead mobility assessment
Primary score: Arm elevation angle, hand-to-floor distance or side-to-side difference
Best use: Shoulder overhead mobility baseline, side-to-side comparison and retesting
Key limitation: Results depend on test position, arm path, thoracic extension, scapular movement, elbow position, symptoms and measurement method.

What Is the Assessment?

The Single Arm Combined Elevation Test assesses unilateral overhead elevation in a standardised position.

It can be measured as:

• arm elevation angle
• hand-to-floor or thumb-to-floor distance
• side-to-side difference
• ability to reach a defined overhead position
• pain or symptom response
• movement quality and compensation

The test is often more functional than isolated shoulder flexion ROM because it reflects combined contribution from the glenohumeral joint, scapulothoracic region and thoracic spine.

Why It Is Used

The test may be used to assess:

• unilateral overhead mobility
• shoulder flexion contribution
• scapular upward rotation and posterior tilt context
• thoracic extension contribution
• left-right shoulder mobility differences
• baseline and retest change
• symptoms during overhead movement
• movement restrictions that may influence swimming, throwing, pressing, climbing or reaching tasks

It is especially useful when the goal is to monitor overhead movement quality and side-to-side change over time.

What It Measures

The test measures single-arm combined overhead elevation.

It may reflect:

• glenohumeral flexion range
• scapular upward rotation
• scapular posterior tilt
• scapular retraction where relevant
• thoracic extension
• rib and trunk control
• latissimus dorsi and posterior shoulder tissue tolerance
• pectoral and anterior shoulder tissue tolerance
• pain or symptom response
• side-to-side mobility difference
• movement confidence overhead

It does not directly diagnose shoulder pathology, identify one limiting structure, measure isolated shoulder strength or determine sport readiness on its own.

Who It Is Used For

The test may be useful for:

• swimmers
• throwers
• field and court sport athletes
• overhead athletes
• gym clients
• climbers
• CrossFit and Olympic lifting athletes
• clients with overhead mobility goals
• clients returning to pressing, reaching, throwing or hanging tasks
• professionals monitoring shoulder and thoracic ROM

It may need modification if the client cannot tolerate prone lying, overhead arm positioning, shoulder loading or end-range elevation.

Equipment Required

• Floor, mat or treatment table
• Tape measure if recording hand or thumb distance
• Optional goniometer or inclinometer if recording arm angle
• Optional Measurz inclinometer to record arm elevation angle
• Optional Measurz AR measurement to document distance or setup
• Measurz/MAT platform to record side, distance or angle, symptoms and retest comparison
• Optional video recording for scapular and trunk compensation
• Optional MAT tools such as Anker, Gripper or Muscle Meter for related shoulder or upper-limb strength testing

Measurz can store this test alongside shoulder ROM, upper-limb strength, orthopaedic tests, outcome measures, endurance tests and overhead performance assessments within the broader Measurz/MAT test library.

Step-by-Step Protocol

1. Choose the testing position

Select the position that best matches your protocol. A common version uses prone lying with the test arm overhead, although wall, floor or standing versions may also be used.

2. Prepare the surface

Use a firm, flat surface. Record whether the test is performed on a table, mat, wall or floor.

3. Position the client

For a prone version, the client lies face down with the test arm overhead. Keep the elbow straight unless the protocol states otherwise.

4. Standardise the non-test arm

Record whether the opposite arm rests by the side, under the forehead or in another position. Keep this consistent.

5. Set the head and trunk position

Keep the head, ribs, trunk and pelvis as still as possible. Record whether the forehead, chin or chest remains in contact with the surface.

6. Perform the elevation movement

Ask the client to lift or reach the test arm as high as comfortably possible while keeping the elbow straight and maintaining the agreed body position.

7. Measure the result

Measure the selected score, such as hand-to-floor distance, thumb-to-floor distance or arm elevation angle.

8. Repeat on both sides

Repeat using the same setup, instructions and measurement method.

9. Record symptoms and compensation

Record pain, stiffness, shoulder symptoms, neck symptoms, thoracic stiffness, rib flare, trunk rotation, scapular control and elbow bend.

Scoring and Interpretation

Common scoring options:

• arm elevation angle in degrees
• hand-to-floor or thumb-to-floor distance in centimetres
• left-right difference
• pain or symptom response
• movement-quality notes
• compensation notes
• active versus passive comparison if tested separately

Greater arm elevation angle or distance from the surface may indicate greater combined elevation capacity under the tested setup.

Interpretation is stronger when combined with:

• pain score
• symptom location
• side-to-side comparison
• shoulder flexion ROM
• shoulder abduction ROM
• shoulder external rotation
• thoracic extension
• scapular movement
• overhead strength
• overhead sport or gym task findings

The result does not explain the cause of reduced overhead mobility by itself. It helps guide exercise selection, monitoring and further assessment decisions.

Normative Data, Benchmarks or Reference Values

Exact universal norms for the Single Arm Combined Elevation Test are limited.

Combined elevation results depend on:

• test position
• arm path
• elbow position
• thoracic extension
• scapular movement
• body size
• arm length
• measurement method
• symptoms
• sport background
• whether the test is single-arm or bilateral

Practical field guidance:

• compare left and right sides
• compare baseline to retest
• track distance or angle consistently
• track pain and symptom response
• track rib flare, trunk rotation and scapular compensation
• compare with bilateral Combined Elevation Test
• combine with shoulder flexion, thoracic extension and shoulder strength tests

For bilateral Combined Elevation Test protocols in swimming-related contexts, a practical angle range of approximately 5–15 degrees relative to horizontal has been described. This should not be applied directly to every single-arm variation unless the protocol is comparable.

Reliability and Validity

Combined elevation testing can be useful when the protocol is standardised.

Research on the Combined Elevation Test supports it as a practical measure of shoulder and thoracic mobility in swimming-related and youth assessment contexts. The test reflects combined movement across the shoulder, scapula and thoracic spine rather than one isolated joint.

Reliability improves when the same:

• testing position
• arm path
• elbow position
• head and trunk position
• measurement landmark
• measurement tool
• instructions
• number of trials
• endpoint definition
• symptom scale

are used each time.

Small changes should be interpreted cautiously unless they are repeated, exceed likely measurement variation and align with symptoms, function or related testing.

Common Errors and Limitations

Common errors include:

• changing from prone to standing testing
• comparing single-arm and bilateral scores directly
• allowing elbow bend
• allowing rib flare or lumbar extension
• allowing trunk rotation
• not recording head or chest position
• measuring from inconsistent landmarks
• not recording pain or symptoms
• using a bilateral benchmark for a single-arm variation without caution
• assuming the result identifies the exact limiting structure

Limitations include:

• values are protocol-specific
• thoracic extension strongly affects the result
• scapular movement affects the result
• arm length and body size influence distance measures
• pain may reduce performance
• active control may differ from passive capacity
• single-arm norms are limited
• the test does not diagnose shoulder pathology
• the test does not determine sport or work readiness on its own

Practical Applications

The Single Arm Combined Elevation Test can help professionals:

• monitor overhead mobility progress
• compare sides
• track shoulder and thoracic movement changes
• support overhead mobility programming
• add context to swimming, throwing, pressing, hanging and reaching assessment
• monitor symptoms during overhead movement
• combine shoulder ROM findings with strength, trunk and performance tests

It is most useful when paired with:

• Combined Elevation Test
• Shoulder Flexion Test
• Shoulder Abduction Test
• Shoulder External Rotation Test
• Shoulder Internal Rotation Test
• Thoracic Extension Test
• Wall Slide Test
• Push Up Test
• Chin Up Test
• Dead Hang
• Upper-limb strength testing

How to Record This in Measurz/MAT

Record:

• test name: Single Arm Combined Elevation Test
• side tested
• testing position
• distance or angle
• measurement method
• arm path
• elbow position
• head and trunk position
• pain or symptoms
• scapular movement
• rib flare
• trunk rotation
• compensation notes
• retest date

Use the Measurz inclinometer for arm elevation angle, Measurz AR measurement for distance or setup, and notes for symptoms and compensations.

A useful Measurz note may read:

“Single Arm Combined Elevation Test, prone on plinth, elbow straight, forehead down. Right thumb-to-floor height 18 cm, left 22 cm. Mild right anterior shoulder tightness, no pain. Slight rib flare on right. Retest same setup.”

FAQs

What does the Single Arm Combined Elevation Test measure?

It measures how far one arm can elevate overhead in a combined shoulder, scapular and thoracic movement pattern.

Is this the same as shoulder flexion ROM?

No. Shoulder flexion ROM is more isolated. The Single Arm Combined Elevation Test includes shoulder, scapular and thoracic contribution.

Should both sides be tested?

Yes. Side-to-side comparison is one of the most useful parts of the test.

What is a good score?

There are limited universal norms for single-arm versions. Baseline, side-to-side comparison and retest change are usually most useful.

Can it diagnose shoulder pain?

No. It measures overhead mobility and symptom response but does not diagnose the cause of shoulder pain.

Should pain and compensation be recorded?

Yes. Pain, stiffness, rib flare, trunk rotation, scapular movement and elbow bend all change interpretation.

Key Takeaways

• The Single Arm Combined Elevation Test measures unilateral overhead mobility.
• It reflects combined shoulder, scapular and thoracic contribution.
• Side-to-side and baseline comparison are often more useful than universal norms.
• Test position, arm path, elbow position and measurement method must be standardised.
• Pain and compensation should always be recorded.
• Measurz can record angle, distance, side, symptoms, setup and progress.

References

Blanch, P. (2004). Conservative management of shoulder pain in swimming. Physical Therapy in Sport, 5(3), 109–124. https://doi.org/10.1016/j.ptsp.2004.05.002

Hill, L., Collins, M., Posthumus, M., & Botha, A. (2018). The Combined Elevation Test in adolescent school children: A reliability study. South African Journal of Sports Medicine, 30(1), 1–5. https://doi.org/10.17159/2078-516X/2018/v30i1a4914

Movement Assessment Technologies. (n.d.). Combined Elevation Test. https://www.matassessment.com/

Physiopedia. (n.d.). Combined Elevation Test. https://www.physio-pedia.com/Combined_Elevation_Test

Swimming Australia. (2021). Pathways testing protocols. Swimming Australia.