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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
Upper Quadrant • Outcome Measures: ○ Disabilities of the Arm Shoulder and Hand (DASH): Measures physical function/symptoms with multiple UE musculoskeletal disorders ■ MDC = 11.2 ■ MCID = 8 ○ American Shoulder and Elbow Surgeons Self-Report (ASES): Condition-specific scale that is intended to measure functional limitations and pain of the shoulder ■ MDC: Diagnosis specific ■ MCID = 6.4 points ○ Shoulder Pain and Disability Index: Measures the impact of shoulder pathology on pain and disability in an outpatient setting
• Muscle length assessment:Assessment of the flexibility of certain muscles may be warranted in patients with shoulder pain ○ Latissimus dorsi ○ Pectoralis minor/major ○ Levator scapulae ○ Scalenes: Side-bending of cervical spine and stabilize first rib ○ Upper trap: Side-bending of cervical spine and stabilize acromion • Glenohumeral joint motions ○ Internal rotation ○ External rotation ○ Abduction/adduction ○ Abduction in the plane of the scapula (scaption) ○ Elevation/depression • Manual muscle testing: Resistive testing of the scapular stabilization muscles may include upper trapezius, middle trapezius, lower trapezius, serratus anterior, rhomboids, levator scapulae • Joint mobility assessment: Assessment of the mobility of the joint may indicate hypo-/hypermobility elicit symptoms: ○ Glenohumeral ○ Horizontal adduction ○ Horizontal abduction ○ Flexion ○ Extension
■ MDC: Diagnosis specific ■ MCID: Diagnosis specific
Shoulder Examination • Cervical spine clearing tests: It is
imperative that the cervical spine be screened appropriately as it may be contributing to the patient’s clinical presentation. ○ Spurling’s test • Palpation: Key palpable structures include
○ Acromioclavicular joint ○ Sternoclavicular joint
○ Acromioclavicular ○ Sternoclavicular • Scapular dyskinesia: ○ “Winging” test ○ Dyskinesias
○ Rotator cuff muscle insertions ○ Long head of the biceps tendon
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