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Upper limb, Special tests Biceps Speeds Yergason's …

- - - - Non dominant shoulder
        
        40-60yrs
        
        Diabetes
        
        Primary: idiopathic
        Secondary: Immobilisation, trauma, stroke, MI, thyroid, DM, OA, RA
        
        Stage 1: Pain
        Night pain, loss of ER ROM
        (0-3mnths)
        Stage 2: Freezing
        
        Pain even at rest
        
        Restricted ROM all directions
        (3-9mnths)
        
        Stage 3: Frozen
        
        Pain only w/ mvt. Less @ night
        
        Reverse scapulohumeral rhythm
        
        Atrophy of delts, rc, biceps, triceps
        (9-15mnths)
        
        Stage 4: Thawing
        
        Minimal pain
        
        Significant capsular restriction which gradually returns
        (15-24mnths)
    - - Anterior dislocation may damage subscapularis, LHB, GH ligs (inferior), anterior capsule, labrum
        
        S&S
        
        Feeling of slippage/insecurity
        
        Apprehension
        
        Decreased ROM acutely
        
        Increased ROM chronically
        
        Fatigue
        
        Atrophy
        
        Sulcus sign
        
        Potential complications
        
        Axillary nerve/ artery injury
        
        Brachial plexus (post cord)
        
        Bankart lesion (labrum)
        
        Hill-sachs-'s lesion (HOH)
        
        Special tests
        Anterior instability
        
        Crank (apprehension)
        
        Apprehension release (surprise)
        
        Load & shift
        
        Posterior instability
        
        Jerk test
        
        Posterior apprehension test
        
        Load & shift
        
        Inferior
        
        Sulcus
        
        Feagin
      - Labral tears
        
        Bankhart
        
        3-7 o'clock
        
        Diffuse pain
        
        Worse with HBB
        
        Clicking/ popping
        
        Feeling weak & unstable
        
        Special tests
        
        Clunk
        
        Active compression (Obrien)
        
        Biceps load (Kim test 2)
        
        Cause
        
        Repetitive throwing
        
        Deceleration when throwing
        
        Direct trauma
        
        FOOSH
        
        Traction injury (inferior)
        
        SLAP
        
        10-2 o'clock
        
        GIRD
        
        Pain with overhead activities & lying on affected shoulder
        
        Clicking/popping
        
        Loss of strength & endurance of RC
        
        Dead arm syndrome in pitchers
    - - Cause
        
        Downward force on acromion
        
        FOOSH
        
        Direct hit to acromion
        
        S&S
        
        Step deformity (grd 3)
        
        Pain w/ HBB, horizontal abduction ab, elevation
        
        Painful arch 120-160 degrees
        
        Special test: Cross body horizontal ab test
        
        Rockwood classification
        Type 1: no separation
        Type 2: Subluxation, increased ACJ spacing
        Type 3: Dislocation, jt surfaces not in contact, increased ACJ & coracoclavicular
    - - Static: winging at rest, structural deformity
        Dynamic: Winging with mvt.
        
        Lesion of long thoracic nerve (serratus anterior)
        
        C7 (Serratus & rhomboids)
        
        Spinal accessory nerve C3-4 (trapezius)
      - Special tests
        
        Wall push up
        
        Scapular load
        
        Punch out test (serratus weakness)
    - - Primary (structural): Bony or soft tissue thickening
        Secondary (functional): Muscle imbalance or instability
        Calcific tendonitis
      - S&S
        
        Painful 60-120 arc
        
        Pain w/ overhead activities or laying on shoulder
        
        No pain @ rest
        
        Reverse scapulohumeral rhythm
        
        Decreased HBB, HBH ROM
        
        Anterio-superior HOH
        
        Decreased postero-inferior glide
      - Special tests
        
        Hawkings
        
        Neers
        
        Scapular assist
    - - Compression of nerves or subclavian artery/vein
        
        Diagnosis of exclusion
        
        Lower nerve roots (C8, T1) ulnar nerve
        
        Common in sports with extreme AB & ER
        
        Anterior border: Clavicle, Coracoid, pec minor
        Posterior border: UT & scap
        Lateral: axilla
        
        Neurogenic (true TOS - anatomical anomaly; cervical rib or elongated C7 TP)
        
        **Special tests:
        1. Roos (elevated arm stress test): 90/90 with hand pumps for 3 mins
        2. Shoulder girdle passive elevation (Cyriax release): arms across chest, therapist takes weight of arms to unload shoulders, if symptoms decrease = positive
        
        Radial pulse tests
        
        Adson maneuver
        
        Costoclavicular syndrome test
        
        Halstead maneuver
        
        Wright test
        
        Allen test
        
        Nonspecific symptomatic neurogenic (most common)
        
        Posture; shortening of pec minor & Scalenes
        
        Numbness
        
        Decreased grip strength
        
        Loss of dexterity
        
        Arterial TOS
        
        Aggravated by overhead activity
        
        Lack of radial pulse
        
        Cool skin
        
        Pale extremity
        
        Rapid fatigue of limb
        
        Lower BP on affected arm
        
        Venous TOS
        
        Thrombotic
        
        Painful swelling in arm
        
        Mottled, bluish discolouration
        
        Causes
        
        Congenital cervical rib
        
        Posture
        
        Muscle hypertrophy (Scalenes, subclavius, pec minor)
        
        Traumatic (#, WAD)
        
        Overhead activities
        
        Tumor
        
        Inflam/ scar tissue of structures surrounding brachial plexus
        
        Classifications
        Scalene anterior: interscalene triangle
        Costoclavicular: clavicle & first rib
        Hyperabduction: under coracoid & behind pec minor
        Cervical rib
- - - - Hand of benediction
      - Carpal tunnel
      - Ape hand
    - - Claw hand
      - Ulna tunnel
    - - Wrist drop