Shoulder

Question 1

How long do you palpate the radial artery when performing ADSON’S

Answer 1

from 10-20s, enough to decide if the pulse VOLUME has changed

Question 2

What does a positive Adson’s indicate?

Answer 2

TOS -Scalenus Anticus Syndrome –pressure on the Subclavian artery and brachial plexus.

Question 3

Scalenus Anticus Syndrome is usually caused by

Answer 3

subluxation

Question 4

What do you do for a patient with Scalenus Anticus Syndrome?

Answer 4

Adjust the subluxation, use moist heat to relax the muscles, and stretch.

Question 5

What diagnosis is suspected with a positive Adson’s when the head is turned away from the side being palpated (Reverse Adson’s)?

Answer 5

It maybe Scalenus Medius Syndrome or a cervical rib.

Question 6

Is a cervical rib that causes loss of patency acute or chronic?

Answer 6

It’s usually an acute exacerbation, because bone will normally modify away from the artery.

Question 7

What syndrome(s) might cause a positive Allen’s Test

Answer 7

TOS, Cervical subluxation, Reynaud’s syndrome (loss of patency in the arteries of the extremities).

Question 8

Positive Dawburn’s is when

Answer 8

pain over subacromial bursitis disappears on abduction of the arm

Question 9

Disappearance of pain w/ Dawburn’s indicates ____

Answer 9

subacromial bursitis

Question 10

Pain remaining throughout abduction w/ Dawburn’s may be due to ____

Answer 10

Inferior Humerus

Question 11

Part 1 drop arm; procedure and Dx

Answer 11

Pt. attempts to raise arm, if unable, dr. does it for them. Pt. then lowers arm to their side against gravity.
If it drops fast it is a Grade 3 tear of rotator cuff. Most likely supraspinatus

Question 12

part 2 drop arm; procedure and Dx

Answer 12

pt’s arm at 90° abduction, dr. applies 2 finger resistance while pt. lowers arm to their side.
If arm fails grade 2 tear of rotator cuff

Question 13

part 3 drop arm; procedure and Dx

Answer 13

pt’s arm at 90° abduction. dr. applies impulse to the arm. Grade 1 strain of rotator cuff

Question 14

Dugas Procedure, Dx

Answer 14

pt. can’t touch chest wall with affected arm/elbow while holding the opposite shoulder.
shoulder dislocation/separation.

Question 15

What is a positive for Eden’s Test?

Answer 15

Decreased radial pulse volume

Question 16

What does a positive Eden’s Test indicate?

Answer 16

TOS - Costoclavicular syndrome.

Question 17

How to treat for a positive Eden’s Test?

Answer 17

Determine if it is due to muscle guarding, often a hypertonic pectoralis major, which needs to be stretched out.

It may also be a cervical, thoracic or rib that is subluxated and can be helped by adjusting

Question 18

What questions might you ask a patient that has this test positive?

Answer 18

Do they carry: a backpack or heavy objects in front of them at work?

Have they ever: had an accident with the seatbelt on; fractured or dislocated their clavicle; or had a shoulder problem.

Have they ever fallen on their shoulder or with an outstretched arm/hand (FOOSH)?

Question 19

Shoulder apprehension test positive and Dx

Answer 19

A positive is a look of alarm on the face or the patient pulls away from the pressure.

This indicates that the glenohumeral joint is unstable, or has a propensity to dislocate.

Question 20

What constitutes a positive Wright’s Test? Dx?

Answer 20

A 10°-15° difference in left vs. right arm abduction. You’re comparing where you lose the palpable radial pulse from one arm to the other arm.
TOS - Hyperabduction syndrome.

Question 21

What is the most common muscle involved with a positive Wright’s?

Answer 21

The pectoralis minor.

Question 22

What causes the pectoralis minor to be shortened or go into contracture?

Answer 22

Cervical subluxation, subacromial bursitis, rolled shoulder posture, other types of TOS.

Question 23

What constitutes a positive Yergason’s?

Answer 23

The bicepital tendon pops out of the groove.
The popping that is felt/heard indicates Bicepital instability.
The instability may be due to a shallow groove or a lax/tear/sprain of the transverse humeral ligament.

Question 24

DDx for pain on yergason’s w/o instability

Answer 24

inferior humerus.

Question 25

Visualization of shoulder A-C PS

Answer 25

Distal end of the clavicle sits higher (posterior superior) causing a visual prominence. Compare the trapezius muscles on each side to see if there is a smooth transition over the distal clavicle.

Question 26

Visualization of G-H I

Answer 26

Will see a (dimpling or indent of the soft tissue along the G-H joint space (sulcus sign).

Question 27

Visualization of S-T L

Answer 27

The medial (vertebral) border of the scapula has flared lateral in relation to the spine.

Question 28

Visualization of St-Cl S

Answer 28

The proximal end of the clavicle sits higher than the opposite side.

Question 29

Fluid Motion A-C PS

Answer 29

Stabilize the humeral head into the glenoid fossa, then apply S to I pressure over the distal end of the clavicle. (Don’t confuse w/ G-H I)

Question 30

Fluid Motion G-H

Answer 30

Stabilize the A-C joint and the scapular spine with the hand closest to the patient. The other hand will hold the elbow and draw the humerus I-S.

Question 31

Fluid Motion S-T

Answer 31

To check for a medial scapula – the Dr. will place their thumb at the medial inferior angle of the scapula and press from M-L. To check for a lateral scapula – the Dr. will place their thumb at the lateral inferior angle of the scapula and press from L-M.

Question 32

Fluid Motion St-Cl

Answer 32

Dr. stands behind the patient and places their 2nd & 3rd digits at the St-Cl joints and asks the patient to shrug their shoulders up and roll them backward/forward.