Orthopedic Conditions of UE part 1 Flashcards
Patient was found to have an inferior trunk brachial plexopathy.
Which of the following motions would most likely show weakness?
A. Elbow flexion
B. Shoulder Adduction
C. Scapular Upward Rotation
D. Scapular Adduction
B. Shoulder Adduction
THORACIC OUTLET SYNDROME
A: _________ P: _________
M: _________ L: _________
Passage of: _________
Causes: _________
S/Sx: _________
Nn affected: _________
Sensory: _________
Motor: _________
Impaired circulation: _________
Tx:_________
THORACIC OUTLET SYNDROME
Boundaries:
A: Clavicle P: 1st rib
M: sternum L: coracoid process
Passage of: subclavian vessels & inf trunk BP (C8-T1)
Causes: trauma, congenital anomaly, hypertrophied neck ms
S/Sx: Pain at: neck & shoulder/arm pain
Nn affected: ulnar & med pectoral nn
Sensory: medial arm, FA & hand
Motor: ↓ power grip (4th & 5th finger) & Claw hand
Impaired circulation: pallor, cyanosis, pulselessness
Tx:nn mob, 1strib mob, postural reeduc, surgery for cervical
rib & fibrotic scalenes
HR jt mob: _________
To increase flexion: _________
To increase extension: _________
HR jt mob: Same
To increase flexion: volar glide
To increase extension: dorsal glide
PRU jt mob: _________
To increase supination = _________
To increase pronation = _________
PRU jt mob: opposite
To increase supination = anterior glide
To increase pronation = posterior glide
TOS: COMMON AREAS OFCOMPRESSION
1.
2.
3.
4.
- CERVICAL RIB SYNDROME
- SCALENUS ANTICUS SYNDROME
- COSTOCLAVICULAR SPACESYNDROME
- Hyperabduction Syndrome
- CERVICAL RIB SYNDROME
- _________
- Extra ___ or ___ rib
- May cause _________
- Tx: _________
- CERVICAL RIB SYNDROME
- Congenital anomaly
- Extra C6 or C7 rib
- May cause dangerous clots
- Tx: Cervical ribs surgery
removal
- SCALENUS ANTICUS SYNDROME
Aka: _________
- _________and _________ hypertrophy
Stretch: _________
R SCM: action? _________
R SCM: _________
R Scalene: _________
- SCALENUS ANTICUS SYNDROME
Aka: Scalene Triangle
- middle and ant scalenes hypertrophy
Stretch: same SCM
R SCM: A: R LF LRot
R SCM: stretch L LF, R Rot
R Scalene: stretch L LF, R Rot
- COSTOCLAVICULAR SPACESYNDROME
In between: _________ & _________
Causes: _________
- COSTOCLAVICULAR SPACESYNDROME
In between: 1st rib & clavicle
Causes:postural, tumor, callus s/p Fx,
**heavy backpack (Military position)
- Hyperabduction Syndrome
Passes under: _________
Compression in: _________
PT goals: _________
- Hyperabduction Syndrome
Passes under: Pecs Minor
Compression in: sub coracoid region
PT goals: Postural Reeducation
Identify the 3 TOS locations
1.
2.
3.
- Scalenus
- Costoclavicular
3.hyperabduction
Shoulder Girdle Passive Elevation (Relief Test)
“RELEASE PHENOMENON”
Arterial: ___________________________
Venous: ___________________________
Neurological: ___________________________
Shoulder Girdle Passive Elevation (Relief Test)
“RELEASE PHENOMENON”
Arterial: stronger pulse, skin color changes (pinker) and increased hand temperature
Venous: decreased cyanosis and venous engorgement
Neurological: numbness to pins and needles
Phases of Pitching (Muscle Activity)
Wind Up: ____________
Cocking: ____________
Acc: ____________
Dec/F-T: ____________
Phases of Pitching (Muscle Activity)
Wind Up: Conc – ER ms
Cocking: Ecc – IR ms
Acc: Conc – IR ms
Dec/F-T: Ecc – ER ms
SPECIALTESTS FOR TOS
(+): ___________________________
Indicative: ____________
(+): diminished pulse + reproduction of sx
Indicative: TOS
Adson Maneuver
❑ Palpate ____________
❑ Px rotates head to ____________
❑ PT ____________
❑ Ask the px to ____________
❑ (+):
❑ Muscle tested?
❑ Palpate radial pulse
❑ Px rotates head to tested Sh c head ext
❑ PT ext & ER the Sh
❑ Ask the px to take a breath & hold
❑ (+): Diminished pulse
❑ Muscle tested: Scalene
Costoclavicular Syndrome
(Military Brace) Test
❑ Palpate ____________
❑ Head in ____________
❑ Draw the ____________
❑ **very particularly effective in px who
complains symptoms while they ____________
❑ Palpate radial pulse
❑ Head in neutral
❑ Draw the px Sh down & back
❑ **very particularly effective in px who
complains symptoms while they carry
a heavy coat or backpack
Halstead Maneuver
❑ Palpate ____________
❑ Px ____________
❑ PT applies ____________
❑ Palpate radial pulse
❑ Px hypertext head & rotate towards
opp side
❑ PT applies downward traction
Wright Test or Hyperabd Test
❑ Palpate ____________
❑ PT ____________
❑ Palpate radial pulse
❑ PT hyperabd the ER Sh
(palms facing backward)
Allen Maneuver (modified wright test)
❑ Aka: ____________
❑ Palpate ____________
❑ PT ___________________________
❑ Aka: Modified Wright Test
❑ Palpate radial pulse
❑ PT places elbow to 90 flex. Sh ext
& ER c head rotated away
Roo’s Test/EAST/Positive AER Test/
Hands Up Test
❑ Most accurate clinical test
(84% sensitivity)
❑ ____________
❑ ____________
❑ (+): ___________________________
❑ (-): ___________________________
❑ Most accurate clinical test
(84% sensitivity)
❑ Sh abd 90, ER, & flex elbow 90
❑ Open & close hands slowly for 3 mins
❑ (+): unstable to maintain position,
ischemic pain, heaviness or profound
weakness, numbness/tingling sensation
❑ (-): minor fatigue – Normal
Shoulder Girdle Passive Elevation
(Relief Test)
❑ ____________
❑ Px ____________
❑ ____________
❑ (+): ____________
❑ Perform to px who presents
c symptoms
❑ Px sitting c PT grasping
from behind, passively elevate
Sh girdle up & forward into full
elevation (passive B Sh shrug)
❑ Hold 30 secs
❑ (+): relief of sx = “Release
Phenomenon”
(Dapat my pain ang patient)
TRAUMATIC VS. ATRAUMATIC Shoulder Instabilities
TRAUMATIC
T - ____________
U - ____________
B - ____________
S - ____________
ATRAUMATIC
A - ____________
M - ____________
B - ____________
R - ____________
I – ____________
TRAUMATIC
T - Traumatic
U - Unidirectional (ant)
B - Bankart lesion (AI labrum detachment)
S - Surgery is required (Bankart repair)
ATRAUMATIC
A - Atraumatic
M - Multidirectional
B - Bilateral
R - Rehab is required but if conservative Tx fails…
I – Inf capsular shift – best alternative for surgical therapy
Anterior Shoulder Dislocation
Aka: Dead Arm Syndrome
**MC Sh dislocation
Anatomical fault: ___________________________
___________________________
MOI: ____________ (common in baseball
____________ in late ____________)
Tx: ___________________________
Anterior Shoulder Dislocation
Aka: Dead Arm Syndrome
**MC Sh dislocation
Anatomical fault: assoc c Bankart, weakness
of ant Sh capsule, absent MGH ligament
MOI: Abd + ER (common in baseball
player/pitcher in late cocking & acceleration)
Tx: strengthening of Add IR
If unreduced for >6 wks: surgery
Phases of Pitching (Muscle Activity)
Wind Up: ____________
Cocking: ____________
Acc: ____________
Dec/F-T: ____________
Wind Up: Conc – ER ms
Cocking: Ecc – IR ms
Acc: Conc – IR ms
Dec/F-T: Ecc – ER ms
Anterior Shoulder Dislocation
COMPLICATIONS:
1.Hill-Sach’s Lesion – ___________________________ **Reverse Hill-Sach – ___________________________ ___________________________
- Bankart lesion – ___________________________
**If (+) Fx = Bony Bankart - SLAP – ___________________________
- Axillary nn injury d/t ___________________________
**mm involved:
COMPLICATIONS:
1.Hill-Sach’s Lesion – compression Fx of PL aspect of HHead
**Reverse Hill-Sach – compression Fx of AM aspect of HHead 2°
posterior dislocation
- Bankart lesion – detachment of anteroinferior glenoid labrum
**If (+) Fx = Bony Bankart - SLAP – Superior Labrum from Anterior to Posterior
- Axillary nn injury d/t traction/compression ff ant dislocation
**mm involved:
Anterior Apprehension (Crank) Test
❑ ____________
❑ **PT fist under HHead
= ____________
❑ (+): ____________
❑ Indic: ____________
❑ (+): ____________
❑ Indic: ____________
❑ Abd + ER slowly
❑ **PT fist under HHead
= FULCRUM TEST
❑ (+): apprehension>pain
❑ Indic: Ant Sh dislocation
❑ (+): pain @ post HHead
❑ Indic: Post internal
impingement
*Crank Test –Test for GH ligaments
SGHL -
MGHL -
IGHL -
SGHL - Arms by the side
MGHL - 45-60 abd
IGHL - >90abd
Active Compression Test of O’BRIEN
A. ___________________________
B. ___________________________
(+): ___________________________
Indic: ___________________________
A. Px shoulder F flex, add,
and IR c elbow ext then PT
apply downward force
B. Px same position but c
shoulder ER then PT apply
downward force
(+): pain in A, ↓ or eliminated
in B
Indic: SLAP
Inferior Shoulder Dislocation
❑ Can be ____________ or d/t
____________ (____________ & ____________)
❑ Use ____________ sign
❑ FES: ____________ & ____________
❑ Can be congenital or d/t
ms weakness (post
deltoids & supraspinatus)
❑ Use Sulcus sign
❑ FES: Supraspinatus &
post deltoids
Sulcus Sign
❑ ____________: best to test for
inf instability
❑ ____________
❑ (+): ____________
+1 = ____________
+2 = ____________
+3 = ____________
❑ Indic: ____________
❑ 20-50 Abd: best to test for
inf instability
❑ PT grasp distal arm, pull
hand inferiorly
❑ (+): sulcus
+1 = <1cm
+2 = 1-2cm
+3 = >2cm
❑ Indic: Inf GH instability
Feagin Test
❑ Sh ____________ degrees
❑ PT holds hands over ____________
❑ (+): ____________
❑ Indic: ____________
❑ Sh 90 degrees
❑ PT holds hands over humerus
& pushes down
❑ (+): sulcus @ coracoid process
❑ Indic: Multidirectional instab
Posterior Shoulder Dislocation
❑ MOI: ___________________________
❑ ___________________________
❑ Assoc ____________
❑ MOI: axial loading of arm
in FADIR or direct blow
❑ Rare & occurs c
multidirectional laxity of
GH jt
❑ Assoc congenitally
Load & Shift Test
❑ ___________________________
❑ 1st = ___________________________
❑ 2nd = ___________________________
❑ Compare to the N side
❑ If Bilat affectation, use grading system
N:
I:
II & III:
❑ Grasp HHead & stabilize Sh
❑ 1st = seat the humerus on the G. fossa
❑ 2nd = push the humerus ant & post
❑ Compare to the N side
❑ If Bilat affectation, use grading system
N: <25% - c in fossa
I: 25-50% - at the rim
II & III: >50% - over the rim
Grades of Anterior glenohumeral translations
- 4.
0-25% - Mild amount of translation
25-50% - Feeling of humeral head riding up to the glenoid rim
>50% - Feeling of humeral head riding up to the glenoid rim, but spontaneously reduces.
50% - Feeling of humeral head riding up to the glenoid rim, but remains dislocated.
Jerk Test
❑ ___________________________
❑ ___________________________
❑ ___________________________
❑ Indic: ____________
❑ Can be (+) c ____________
❑ Sh flex 90 & IR
❑ PT grasps elbow & apply axial load &
then H. Add → (+) sudden jerk/clunk
❑ Return to orig position → (+) 2nd jerk
❑ Indic: Post Sh dislocation
❑ Can be (+) c PosteroInf labral tear
SURGICAL MANAGEMENT
- Bankart Repair: ___________________________ : ___________________________
- Putti-Platt: ___________________________
: ___________________________ - Capsular Shift: ___________________________
- Capsulorraphy: ___________________________
- Bankart Repair: Operation of choice for Throwing athletes (ER is not
compromised)
: tightens the labrum & capsule anteriorly - Putti-Platt: subscapularis tendon transfer
: not ideal for athletes bec ER is compromised (for sedentary) - Capsular Shift: tightening of capsule
- Capsulorraphy: altering size/features of ant capsule
POST-SURGICAL Rehabilitation
AVOID:
1.
2.
3.
AVOID:
1. Flexion and horizontal abduction to 90 degrees or greater
2. External rotation to 80 degrees
3. Activities/sports that will induced shoulder dislocations.
AC & SC Joint Disorders
AC Jt
❑ MOI: ___________________________
❑ (+) ___________________________
❑ Tx: Acute phase: ___________________________
SC Jt
❑ MOI: ___________________________
❑ Tx: ___________________________
AC Jt
❑ MOI: direct blow to Sh (Rugby)
❑ (+) Fountain sign = swelling of AC jt
❑ Tx: Acute phase: UE should be in
neutral c the use of sling & avoid sh
elevation
SC Jt
❑ MOI: fall on lat aspect of Sh c UE Add
❑ Tx: No need = little disability
Shear Test
❑ Landmark: ___________________________
❑ ___________________________
❑ (+) ___________________________
❑ Indic: ___________________________
❑ Landmark: Clavicle & spine of scapula
❑ Squeeze c both hands
❑ (+) AbN movement of AC
❑ Indic: AC jt pathology
Paxinos Sign
❑ ___________________________
❑ Thumb ____________
❑ Thumb ____________
❑ (+): ____________
❑ 2nd & 3rd finger @ clavicle
❑ Thumb @ PL acromion
❑ Thumb applies AS force @
acromion while 2nd & 3rd finger
apply post force @ clavicle
❑ (+): pain at AC jt
Total Shoulder Arthroplasty VS.
Reverse Total ShoulderArthroplasty
INDICATION: persistent or incapacitating pain; loss of shoulder
mobility or stability and/or upper extremity strength leading to
inability to perform functional tasks
Study exercise guidelines IN UR GDRIVE
Supraspinatus tendinitis
Most common cause of shoulder pain 2° to ___________________________
Patient Profile: ___________________________
: ____________
: ____________ (if young = baseball pitchers
or ____________)
: ____________, ____________, ____________
S/sx: ____________
Can lead to supraspinatus tear – less pain, nocturnal pain that can be altered c sleeping position, & full PROM
Most common cause of shoulder pain 2° to degenerative changes
Patient Profile: Overhead activities
: F>M
: 35-50 y/o (if young = baseball pitchers
or swimmers)
: Sedentary, overuse, degenerative
S/sx: weakness & painful arc (60-120 Abd)
Can lead to supraspinatus tear – less pain, nocturnal pain that can be altered c sleeping position, & full PROM
NEER’s CLASSIFICATION of RC PATHOLOGY
I – ____________
*____________
II - ____________
*____________
III – ____________
IV – ____________
I – HE (hemorrhage and edema)
*reversible & resolves c rest (<25 y/o)
II - FT (fibrosis tendinitis)
*recurrent pain c activity (25-40 y/o)
III – BSTR (bone spurr, tendon rupture)
(>40 y/o)
IV – RCTear rotator cuff
(>60 y/o)
S/P ROTATOR CUFF REPAIR REHABILITATION
6 – 8 wks: ___________________________
10 – 12 wks: ___________________________
12 – 14 wks: ___________________________
24 – 28 wks: ___________________________
36 – 40 wks: ___________________________
6 – 8 wks: passive ROM, endurance, neuromuscular control and maintaining ROM, no CKC
10 – 12 wks: strengthening, no vigorous stretching
12 – 14 wks: task specific strengthening; activities in a controlled environment
24 – 28 wks: return to recreational activities; (80% regained)
36 – 40 wks:90% of strength is regained
Acute Calcific Tendinitis
Aka: Peritendinitis Calcarea
* Deposition of ____________ in ____________
* S/Sx: ____________
: pain affecting sleep
: Sh LOM d/t pain
: No Abd & Rot
- Iontophoresis:Acetic Acid
- Tx:Immob
: Aspiration (most effective)
Aka: Peritendinitis Calcarea
* Deposition of Ca phosphate in tendon
* S/Sx: severe localized intolerable pain
that radiates to deltoid insertion
: pain affecting sleep
: Sh LOM d/t pain
: No Abd & Rot
- Iontophoresis:Acetic Acid
- Tx:Immob
: Aspiration (most effective)
Subacromial Bursitis
❑ Acute phase:
❑ hard to distinguish bet
supraspinatus tendinitis
❑ Both (+) pain c resist
❑ Chronic phase:
❑ (+) pain c resist =
❑ (-) pain c resist =
❑ Acute phase:
❑ hard to distinguish bet supraspinatus tendinitis
❑ Both (+) pain c resist
❑ Chronic phase:
❑ (+) pain c resist = supraspinatous tendinitis
❑ (-) pain c resist = subachromial bursitis
Bicipital Tendinitis
Caused by: ____________
Pain at: ____________, ____________, ____________
Special Test:
SPEED’S vs YERGASON’S TEST
Caused by: inadequate depth of
bicipital groove
Pain at: anteromed Sh, biceps
belly, Delts insertion
Special Test:
SPEED’S vs YERGASON’S TEST
Speed’s Test
aka: Biceps or Straight-Arm Test
Procedure
(+):
Indic
❑ Maybe (+) in px c __________
❑ Resist F Flex while elbow ext &
FA supinated 1st
❑ then pronated
❑ (+): tenderness in bicipital
groove (esp. supination)
❑ Indic: Bicipital
Paratenonitis/tendinosis
❑ Maybe (+) in px c SLAP Type 2
lesion
LBC - Labral Biceps Complex
most painful during supination
Yergason’s
❑ 1° tests the ability of _____ to hold the _______
❑ Palpate: _________
❑ 1st =
❑ 2nd =
❑ (+):
❑ (+): tenderness =
❑ 1° tests the ability of THL to hold the biceps tendon
❑ Palpate: bicipital groove
❑ 1st = Elbow flex 90, FA pronated, Sh IR (used to give way to step 2)
❑ 2nd = Px ER & supination c PT resist
❑ (+): popping out of biceps tendon from groove = Torn THL
❑ (+): tenderness = Bicipital paratenonitis
(+) = THL pathology
Biceps Tendon Rupture
❑ may progress to ____________ tear:
❑ may be ____________;
❑ MOI: ____________
❑ S/Sx: ____________
Popeye’s sign
Heuter’s sign
❑ Tx:
Young: ____________
Adults: non-op = ____________
❑ Special Test:
❑ may progress to biceps tendon tear:
❑ may be avulsed anywhere in the mm;
❑ MOI: sudden indirect violence c a tendon that
has already degen changes
❑ S/Sx: sharp pain c audible snap
Popeye’s sign
Heuter’s sign
❑ Tx:Young: surgery (tendon transfer to coracoid
or bicipital floor)
Adults: non-op = regain ms strength 4-6 mos
❑ Special Test: Ludington’s Test
Ludington’s Test
Procedure
(+):
Indic
❑ Alternate contxn of biceps
❑ (+): no palpable contxn
❑ Indic: Long head biceps
tendon rupture
Impingment Syndrome
Characterized by soft tissue
inflammation of the shoulder
against the acromion with
repetitive overhead AROM.
PRIMARY
SECONDARY
POSTERIOR (INTERNAL) IMPINGEMENT
A. PRIMARY Impingment Syndrome
* Inflammation at the
subacromial space
* Rotatorcuff tendon degeneration
* Osteophytes under AC joint
* Hooked acromion
B. SECONDARY Impingment Syndrome
* Abnormal glenohumeral/scapul
othoracic arthrokinematics
* Slouched posture
* Poking chin
* Muscle hypomobility
* Capsule tightness
(especially posterior)
* Adhesions
(especially inferiorly)
C. Posterior Internal Impingement
- MC in: overhead athletes (throwers, swimmers, tennis players)
- Manifests at: late cocking/early acceleration
- RC (supraspinatus) impinges against the PS edge of the G. fossa
- occurs when the arm is in: EXABER
- Dx Test:Arthrogram or MRI
PRIMARY Impingment Syndrome
A. PRIMARY Impingment Syndrome
* Inflammation at the
subacromial space
* Rotatorcuff tendon degeneration
* Osteophytes under AC joint
* Hooked acromion
SECONDARY Impingment Syndrome
B. SECONDARY Impingment Syndrome
* Abnormal glenohumeral/scapul
othoracic arthrokinematics
* Slouched posture
* Poking chin
* Muscle hypomobility
* Capsule tightness
(especially posterior)
* Adhesions
(especially inferiorly)
Posterior Internal Impingement
C. Posterior Internal Impingement
- MC in: overhead athletes (throwers, swimmers, tennis players)
- Manifests at: late cocking/early acceleration
- RC (supraspinatus) impinges against the PS edge of the G. fossa
- occurs when the arm is in: EXABER
- Dx Test:Arthrogram or MRI
Neer Impingement Test
Procedure
(+):
Indic
❑ Sitting
❑ PT depress scapula while other hand IR
❑ Max forced full arm elevation
❑ (+): apprehension – “when px face
shows pain”
❑ But if (+) pain on ER = AC jt patho
Hawkins-Kennedy test
Procedure
(+):
Indic
❑ Sitting
❑ F Flex 90
❑ Perform passive IR
❑ (+): pain
Yocum’s Test
Procedure
(+):
Indic
❑ Px hand is placed on opp Sh
❑ PT elevate elbow – Passive
❑ (+): pain = Sh impingement
Dugas Test
Procedure
(+):
Indic
❑ Px hand is placed on opp Sh
❑ Px lowers elbow to chest – Active
❑ (+): inability = ant Sh disloc s reduction
Posterior Internal Impingement Test
Procedure
(+):
Indic
❑ Supine
❑ PT Abd 90-110 c 15-20 Ext & full ER
❑ (+): pain at post aspect of Sh
Impingement tests?
1.
2.
3.
4.
5.
Neer Impingement Test
Hawkins-Kennedy test
Yocum’s Test
Dugas Test
Posterior Internal Impingement Test
Adhesive Capsulitis
Aka: ____________, ____________, ____________
Characterized by a restriction in Sh motion as a result of
____________ usually d/t ____________ or ____________.
Sex affected? ; age affected?
Capsular pattern of limitation:
Trick motions: to ↑ Sh Abd =
: to ↑ Sh Flex =
Reverse Scapulohumeral rhythm
Self-limiting (up to 2 years)
Aka: Frozen Sh, Obliterative Arthritis, Diffused
RC tendinitis
Characterized by a restriction in Sh motion as a result of
inflammation and fibrosis of the Sh capsule usually d/t
disuse ff injury or repetitive micro trauma.
F>M; 40-60 y/o
Capsular pattern of limitation: ER>AB>IR
DM pt.
Dominant: IR = ER > AB > EXT
Non-dominant: Hyperext = ER > ABD > IR
: trick motions: for increase sh abd (lat bend trunk)
increase sh flex (trunk ext)
Trick motions:
: to ↑ Sh Abd =
: to ↑ Sh Flex =
Reverse Scapulohumeral rhythm
Self-limiting (up to 2 years)
Stages of Adhesive Capsulitis check on Gdrive
Claim RPT!
Brachial Plexus Injuries
1.
2.
- ERB-DUCHENNE PARALYSIS
- DEJERINE-KLUMPKE’S PARALYSIS
ERB-DUCHENNE PARALYSIS
Nn root: ____________
MOI: ____________
Strong mm: ____________
Weak mm: ____________
Prognosis: ____________ (____________& ____________)
Nn root: C5-C6
MOI:Overstretched upper trunk of BP
Strong mm: Mm that asume waiters tip (adducted and IR)
Weak mm: Sh. ER, AD, F, FA SUPINATOR, WRIST EXTENSION
Prognosis: GOOD (hands & fingers
not affected)
DEJERINE-KLUMPKE’S PARALYSIS
Nerve root: ____________
Affects: ____________, ____________,
____________
____________ prognosis
Nerve root: C8-T1
Affects: FA pronators, Wrist flexors,
Intrinsic ms of the hands
POOR prognosis
Long Thoracic Nerve Injury
Can be injured by blows or pressure on the ____________ trunk or during the surgical procedure of ____________.
Aka: ____________
Weakness: ____________
- ____________
- ____________
Occurs on: ____________
Difficulty in: ____________
Tx: Strengthen: ____________
Can be injured by blows or pressure on the posterior trunk or during the
surgical procedure of radical mastectomy.
Aka: Open Book Paralysis
Weakness:SA
- Medial winging
- Scapula elevated & moves medially,
Inf angle moves medially
Occurs on: Abd & F Flex ≥90
Difficulty in: combing hair
Tx: Strengthen: Push up c a Plus
Wall Push-ups
❑ 15-20 reps
❑ Winging observed @ 5-10 reps
Spinal Accessory Nerve Injury
Causes the scapula to ____________ and move
____________, with the inferior angle rotated
____________.
____________
Aka: ____________
Weakness: CN XI = ____________
Occurs on: ____________
Causes the scapula to depress and move
laterally, with the inferior angle rotated
laterally.
Radical neck dissection
Aka: Sliding Door paralysis
Weakness: CN XI = Trapz
Occurs on: Lateral winging <90
Punch out Test
Procedure:
(+):
Indication:
Apley’s Scatch Test
R problematic: ____________
R problematic: difficulty in hooking bra
Sprengel’s Deformity
____________
MC ____________
Presentation: Scapula is congenitally ____________
& ____________
LOM: ____________
Scapula & its muscles are poorly developed
Scapula is smaller than normal and is
medially rotated/placed
Sprengel’s Deformity
MCcongenital deformity in the Shcomplex
Presentation: Scapula is congenitally high
& undescended
Sprengel’s Deformity
Complex Regional Pain Syndrome
Previously known as ____________
* Usually occurs after ____________ (esp. ____________)
* SEX? at ____________
* laterality?
* S/sx: ____________
CRPSI – ____________
STAGEI STAGEII STAGEIII
CRPSII – Causalgia – develop after trauma c nerve lesion
Previously known as Shoulder Hand Syndrome
* Usually occurs after trauma (esp. Fracture)
* F>M at 5th decade
* Bilateral or unilateral at first
* S/sx: pain, tenderness, stiffness, trophic skin changes, non pitting edema (impaired venous & lymphatic return)
CRPSI – RSD (Reflex Sympathetic Dystrophy) – without nerve involvement
STAGEI STAGEII STAGEIII
CRPSII – Causalgia – develop after trauma c nerve lesion
Complex Regional Pain Syndrome
STAGES?
CRPS I – RSD (Reflex Sympathetic Dystrophy)
Stage 1 – acute/reversible
Stage 2 – dystrophic/vasoconstriction/ischemic
Stage 3 - atrophic
