55 Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
• Glenohumeral joint motions ○ 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
○ 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
○ Acromioclavicular joint ○ Sternoclavicular joint
○ Rotator cuff muscle insertions ○ Long head of the biceps tendon • 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
○ Acromioclavicular ○ Sternoclavicular • Scapular dyskinesia: ○ “Winging” test ○ Dyskinesias
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
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