Midterm Flashcards
Adson’s - How long do you palpate the radial artery with this test?
10-20 seconds, enough to decide if the pulse volume has changed
What syndrome(s) might cause a positive Allen’s test?
TOS
Cervical subluxation
Raynaud’s syndrome (patency loss of the extremity arteries)
Positive Adson’s indicates ?
Scalenus anticus syndrome = pressure on the subclavian artery and brachial plexus
What diagnosis is suspected with a positive Adson’s turning away from the side being tested?
Maybe a cervical rib or Scalenus medius syndrome
Is a cervical rib that causes loss of patency….acute or chronic?
Usually an acute exacerbation, because bone will normally grow away from the artery.
What is a positive for Eden’s test?
Decreased pulse volume.
A positive Eden’s test indicates?
Costoclavicular syndrome
What constitutes a positive Wright’s test?
10-15 degrees difference in left vs. right arm abduction. You’re comparing where you lose the palpable radial pulse from one arm to the other arm
A positive Wrights test indicates?
Hyperabduction syndrome
What constitutes a positive Yergason’s?
Indicates:
Differential Diagnosis:
Positive: Tendon pops out of the groove
Indicates: Bicepital Instability
Differential Diagnosis: pain w/o slipping may be an inferior humerus
Dawburn’s:
Positive:
Indicates:
Negative:
Positive: Pain disappears on abduction
Indicates: Subacromial bursitis
Negative: Pain remaining throughout abduction may be an inferior humerus
Dugas:
Positive:
Indicates:
Positive: Patient cannot touch chest with affected arm / elbow while grasping the opposite shoulder
Indicates: Shoulder dislocation / separation
Shoulder apprehension:
Positive:
Indicates:
Positive: Look of alarm on face or patient pulling away from doctor’s pressure
Indicates: Glenohumeral instability / propensity to dislocate
Visualization: St-Cl S
Proximal end of clavicle sits higher than the opposite side
Visualization: A-C PS (posterior superior)
Distal end of the clavicle sits higher causing a visual prominence
Visualization: G-H I
Dimpling or indent of soft tissue over the joint space
Visualization: Lateral Scapula
Vertebral border of scapula has flared lateral in relation to the spine
Fluid Motion Studies: St-Cl
Place fingers at St-Cl joints and ask pt. to shrug and roll their shoulders.
Fluid Motion Studies: A-C PS
Compress humeral head into the glenoid fossa then apply S to I pressure over distal end of clavicle
Fluid Motion Studies: G-H
Block A-C and scapular spine with one hand, apply I to S pressure at elbow
Fluid Motion Studies: S-T (Scapulo-Thoracic)
Dr. places thumbs at medial inferior angle, applying M-L pressure;
then Dr. places thumbs at lateral inferior angle applying L-M pressure
Give at least (3) indications of an inferior humerus?
- Shoulder visualizes as being low w/ soft tissue dimpling/sulcus sign
- Point tenderness at the anterior aspect of the G-H joint
- Loss of fluid motion.
- Loss of Appley’s external rotation
- Anterior deltoid weakness.
Indications of a posterior humerus?
visualizes normally, no apparent visual change.
lost fluid motion
point tenderness at posterior aspect of G-H joint
Loss of internal rotation
Teres major muscle weakness
With any shoulder complaint the Dr. should routinely examine? (6 things)
St-Cl, A-C, G-H, Sc-Th, St-Co, & definitely the spine for subluxation
On Scapulo-Thoracic Lateral (S-T L) what position do we place the patient’s arm?
Behind the pts. back (side lying) with doctor reaching through the patient’s axillary/arm opening
On Scapulo-Thoracic Lateral (S-T L) where are the fingers?
Over the G-H joint
On Scapulo-Thoracic Lateral (S-T L) where is #11 of the stabilization hand?
Over the A-C joint
On Scapulo-Thoracic Lateral (S-T L) in what direction does the stabilization hand push to bring the joint to tension?
S to I
On Scapulo-Thoracic Lateral (S-T L) what’s the pain point for S-T L?
Deep to or under the scapula, in the subscapularis muscle.
How to differentiate S-T L (lateral) from S-T M (scapulo-thoracic medial)?
- ) Fluid motion
- ) visualization of distance from spine
- ) S-T L = (lateral) Appley’s scratch in internal rotation is diminished
- ) S-T M = (medial) Appley’s scratch in external rotation is diminished
What part of the scapulo-humeral ratio would be decreased with a G-H P?
The Glenohumeral portion
G-H posterior, prone-LOC?
P-A, be careful to not get any S-I
G-H posterior where is the patient’s shoulder?
Supported on the table
G-H posterior why is the shoulder on the table?
For stabilization; we don’t want to dislocate it
Indication of Yergason’s positive?
Bicepetal tendon instability, usually caused by a shallow groove-or a tear or sprain of transverse humeral ligament
Drop Arm test: describe 3 parts least-to-most invasive and diagnosis for each
- ) Pt. lowers arm to side against gravity; if it drops fast, it’s often a severe tear of rotator cuff, grade 3. Supraspinatus muscle.
2) Apply a little pressure while they lower it; some resistance, moderate tear of rotator cuff, grade 2
3) Put an impulse in the abducted arm; fair resistance, mild tear or strain of rotator cuff, grade 1
G-H P, seated: What is most important about LOC?
Straight P-A, drop elbow so it’s level or below the wrist
G-H P, seated: What ROM’ s do you use to bring it to tension?
Abduction & extension
G-H P, seated: Where is the pain point?
Over the posterior glenohumeral joint
How to differentially diagnose a G-HP, from a G-H Inf.?
Pain point is posterior; visualizes as normal, not inferior
G-HP is decreased ROM on internal rotation, not external rotation (Appley’s Scratch ROM loss on internal rotation, not external)
X-ray shows humeral head is posterior and superior, not inferior
Teres major muscle test is weak on G-H P, not the anterior deltoid as GH I
G-H I (inferior): What is the move of choice for the G-H joint and why?
Supine traction Because you can feel the joint
What are at least three other alternatives to differentiate this diagnosis from? (9) listed
G-H posterior, Subacromial bursitis, bicipetal tendonitis,
bicipetal instability, sprain or tear of rotator cuff,
dislocation, heart attack, gall bladder, spleen
Frozen shoulder: Describe the 3 parts as you’re doing them, be sure to support arm over pillow or back of chair
1) traction, release; if ROM is gained, go on to part 2
2) traction through ROM gained, back to neutral, release
3) after a few visits if no part 2 progress, traction and take it through the ROM gained, at end-ROM put an impulse down the shaft of the humerus, bring it back to neutral, return to part 2 until no more progress. Post check with ROM and comparing L side to R side.
G-H traction, seated: Dr’s arm in Pt’s. armpit with thumb up. What are your limiting factors?
Patient tolerance & visualizing the joint space to open up
Note: it is important to be visualizing this during the practical
G-H traction, supine: Is this the move of choice for a G-H fixation?
Yes, because you can palpate the joint space rather than just visualize it.
Give at least “3” diagnoses that G-H traction, supine would work for?
Frozen shoulder Inferior humerus Posterior humerus Osteoarthritis with fixation G-H dislocation
St-Cl superior: How do you bring this joint to tension before the thrust?
Describe the thrust.
Bring the arm into abduction & extension.
Straight S-I, maybe a little torque, fingers point toward the Axillary
St-Cl traction, seated: What are we doing with our opposite arm?
Holding the opposite shoulder back
Why do we hold the shoulder back?
Isolating the st-cl joint, not rotating the thoracics
St-Cl traction, supine: What direction does the clavicle most commonly subluxate?
Superior
Is this traction move a post-check for St-Cl Superior?
NO, this is actually a procedure & should be done before St-Cl S
A-C PS: Which part of this takes care of superiority? Which part takes care of the posteriority?
Superiority Pushing down on the distal end of the clavicle
Posteriority Pushing slightly forward and externally rotating the arm
Most common muscle involved with Hyperabduction Syndrome or a positive Wright’s?
Pectoralis minor
What causes the pectoralis minor to be shortened or go into contracture?
(1. ) Cervical subluxation,
(2. ) subacromial bursitis,
(3. ) rolled shoulder posture
(4. ) other types of TOS
