Shoulder Mobility: Distance Says 2, Pain Says 0
A 19-year-old female competitive swimmer (six pool sessions and two dryland sessions per week) has no current shoulder pain at rest or during swimming. She is right-hand dominant and has been doing extra pulling sets. You measure her hand length from the wrist crease to the tip of the middle finger as 17 cm. In the shoulder mobility screen, her right fist-to-fist distance is 10 cm; her left is 24 cm. The left shoulder clearing test reproduces sharp anterior shoulder pain; the right clearing test is negative. She says the left pain 'only happens when you push it like that' and asks to continue because she has a championship meet in three weeks. She has no history of dislocation or surgery.
1. Assign the left and right shoulder mobility scores and show the hand-length math.
Read the worked answer
Right = 3; left = 0. Hand length = 17 cm. For a 3, the fists must be within one hand length: right 10 cm is less than 17 cm, so the right side is 3. For the left, 24 cm is greater than 17 cm but less than 25.5 cm (1.5 hand lengths), so the distance alone would be 2. However, the left clearing test is positive for sharp anterior shoulder pain. A positive clearing test overrides the distance and scores the test 0. The final recorded scores are left 0 and right 3.
2. Explain why the left score is not 2 and what the positive clearing test means.
Read the worked answer
The left score is 0, not 2, because pain is the highest-priority finding in the FMS. The clearing test is designed to provoke symptoms that might not appear during the mobility motion itself. Sharp anterior pain at end range is a red flag for the screen, not a flexibility score. It does not diagnose impingement or labral pathology, but it means the left shoulder cannot be scored as a mobility limitation only. The distance of 24 cm tells you she has limited range on that side, but the pain tells you not to treat that range as a simple stretching target.
3. What do you do next regarding training and rescreening?
Read the worked answer
Refer her for medical assessment before continuing aggressive overhead training. Do not aggressively stretch the left shoulder into pain or use the 24 cm distance as a target to force. Communicate with her coach that she has a positive pain provocation, not a diagnosis. Modify training only within your scope and in consultation with her medical provider; keep pain-free ranges and avoid provocative end-range positions. Re-screen only after she is pain-free and cleared. The right side can be recorded as 3 but does not cancel the left 0, and the total score will use the lower shoulder score.