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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
Screening the Shoulder and Upper Extremity: Shoulder Pain Mechanism Injury to Shoulder Fall on outstretched arm
Proximal humerus fx, rotator cuff tear, SLAP lesion AC separation, rotator cuff tear, fracture, SLAP lesion
Fall onto shoulder
Arm abducted & externally rotated
Anterior instability, subscapularis tendon tear
Traction injury SLAP lesion Fall into hyperabducted arm Inferior dislocation Falling onto point
AC lesion w/arm adducted, great tuberosity fx
NO TRAUMA: Insidious onset pain
DJD, tendonitis, frozen shoulder
Insidious onset severe pain
Branchial neuritis, shingles
Night pain
Tumor
Weakness w/out pain
Nerve injury, muscle disease, chronic rotator cuff tear
Shoulder Special Tests Impingement Syndrome • Age 40 – 60
Biceps Tendon Involvement • Yergason’s: Biceps tendon instability or tendonitis ○ Sensitivity = 74%; specificity = 58% Instability/Labrum Issues • Apprehension: Possible torn labrum or anterior instability problem ○ Sensitivity = 30–53%; specificity = 63–99% Adhesive Capsulitis 1. Acute/freezing/painful phase (typically lasts 3–9 months): Gradual onset pain at rest with sharp pain at extremes ROM, and pain at night 2. Adhesive/frozen/stiffening phase (occurs at ~4 months; lasts ~12 months): Pain starts to subside, progressive loss of glenohumeral motion in capsular pattern. Pain is apparent only at extremes ROM 3. Resolution/thawing phase (last ~1–3.5
• Pain during elevation in anterior/ lateral shoulder; worse with overhead activities, does not radiate below elbow • Painful arc: between 60-120 degrees • Weakness • Hawkins–Kennedy: Supraspinatus tendon impingement: ○ Sensitivity = 72%; specificity = 66% • Neer impingement test: Subacromial impingement: ○ Sensitivity = 79%; specificity = 53% Rotator Cuff Injury • Empty can—integrity supraspinatu: ○ Sensitivity = 41–89%; specificity = 50–90% • Drop arm sign: Rotator cuff tear ○ Sensitivity = 27%; specificity = 88% • Apley scratch test: The patient attempts to touch the opposite scapula to test range of motion of the shoulder ○ Loss of range of motion = rotator cuff problem
years): Spontaneous, progressive improvement in functional range of motion
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