to lift their hand off their back and maintain this position. A weakness of the subscapularis is indicated if the client is unable to lift their hand off their back. An accompanying pain deep in the axillary is typically indicative of an injury to the muscle belly or origin, while pain near the lesser tubercle of the humerus may indicate a tear at the muscle’s insertion. Working in the axillary with trigger point therapy can be effective, though challenging due to client sensitivity in this area and the nearby presence of the brachial nerve plexus (Cleland et al., 2020). Analysis: Since the client is complaining of pain during abduction of the shoulder, the orthopedic tests should be limited to the muscles involved in shoulder abduction, namely, the deltoid and supraspinatus. This would limit the tests to the adhesive capsulitis abduction test, the drop arm test, the Hawkins- Kennedy impingement test, and the painful arc test. The AC joint shear test might also be employed in the event there are no indicators during the tests previously mentioned. Self-Assessment Quiz Question #2 The drop arm test tests for the weakness or dysfunction of which muscles?
indicated by pain along the superior-lateral border of the scapula high in the axillary. A weakness of teres minor is indicated by an inability of the client to maintain strength against the therapist’s resistance. When pain is present in these muscles, trigger point therapy is highly effective This tests for a dysfunction of the subscapularis muscle. The client can be seated, standing, or lying prone on a table with their arm beside them, elbow slightly flexed, with their hand placed on their lower back. The client is asked Case study A male client whose work often includes working with his arms overhead is complaining of pain at the head of the humerus during abduction of the shoulder before reaching 90 degrees. Questions: 1. What muscles are most likely involved? 2. What special tests would be most appropriate to assess the cause of pain? (Cleland et al., 2020). Gerber’s lift-off test Reflection : Many muscles are involved in movement at the glenohumeral joint, so it may be the case that many orthopedic tests will need to be conducted to narrow the nature of the problem. The client is providing clues, though, indicating pain under certain circumstances. Speed’s test This tests for tendonitis of the biceps brachii muscle. The client can be seated or standing. The client fully extends their arm and supinates their forearm so that the palm of their hand is facing the floor. The client is then asked to flex their elbow to 90 degrees while the therapist stands behind the client and resists the client’s attempt at flexion. Tendonitis of the bicep brachii is indicated by pain at either the muscle’s origins near the shoulder or insertions near the anterior elbow. Cross-fiber friction on the tendons may be helpful, as well as directional massage and/or myofascial release along the length of the muscle (Manske & Magee, 2018). Golfer’s elbow test This tests for medial epicondylitis of the humerus. The client should be seated with their arm over a therapy table with their fingers flexed into a fist. The therapist should sit across from the client and support their elbow with one hand while maintaining a grip on the client’s wrist and hand with their other. The therapist then passively supinates the client’s forearm while extending the elbow, wrist, and fingers. A positive result is indicated by pain or discomfort in the area of the medial epicondyle. Cross-fiber friction at the medial epicondyle is an effective treatment. In cases where hypertonicity of the wrist flexors is also present, directional massage, myofascial release, and trigger point therapy are also effective (Manske & Magee, 2018). Tennis elbow test This tests for lateral epicondylitis of the humerus. The client may be seated or standing and should flex their elbow to 90 degrees with their palm face down. Their fingers should be flexed into a fist. The therapist palpates the lateral epicondyle with one hand while maintaining a grip on the back of the client’s hand. The therapist first resists the client’s attempt to place their wrist in extension and
a. Infraspinatus and teres minor. b. Latissimus dorsi and teres major.
c. Pectoralis major and minor. d. Deltoid and supraspinatus. SECTION III: ORTHOPEDIC TESTS FOR THE ARM, ELBOW, AND WRIST
second, then resists the client moving their wrist into radial deviation. A positive result is indicated by pain or discomfort in the area of the lateral epicondyle during either of these movements, or during the movements simultaneously. Cross-fiber friction at the lateral epicondyle is an effective treatment. In cases where hypertonicity of the wrist extensors is also present, directional massage, myofascial release, and trigger point therapy are also effective (Manske & Magee, 2018). Flick test This tests for carpal tunnel syndrome. This simple test involves the therapist asking the client what they do when they feel carpal tunnel syndrome symptoms (i.e., tingling, numbness, burning, and/or pain in the palm, thumb, index, and/or middle fingers). If the client flicks their wrist, this is considered a positive indicator of the pathology. The therapist should start with light myofascial release of the flexors of the wrist before addressing hypertonicity in the forearm with other techniques (Manske & Magee, 2018). Healthcare Consideration: Carpal tunnel syndrome may be caused by multiple factors, particularly due to inflammation of the flexor retinaculum which is itself often caused by hypertonic flexors of the wrist and/ or compression of the wrist on hard surfaces over long periods of time. As always, icing for inflammation may be a treatment option. In the event that manual therapy does not relieve the symptoms of carpal tunnel syndrome, a client should consult a physician for alternative treatment options (Manske & Magee, 2018). Phalen’s test This tests for carpal tunnel syndrome. With their arms in front of them, the client is asked to place the back of their hands together and, keeping them together, raise their
EliteLearning.com/Massage-Therapy
Book Code: MTX1326
Page 28
Powered by FlippingBook