Shoulder Flashcards
How long do you palpate the radial artery when performing ADSON’S
from 10-20s, enough to decide if the pulse VOLUME has changed
What does a positive Adson’s indicate?
TOS -Scalenus Anticus Syndrome –pressure on the Subclavian artery and brachial plexus.
Scalenus Anticus Syndrome is usually caused by
subluxation
What do you do for a patient with Scalenus Anticus Syndrome?
Adjust the subluxation, use moist heat to relax the muscles, and stretch.
What diagnosis is suspected with a positive Adson’s when the head is turned away from the side being palpated (Reverse Adson’s)?
It maybe Scalenus Medius Syndrome or a cervical rib.
Is a cervical rib that causes loss of patency acute or chronic?
It’s usually an acute exacerbation, because bone will normally modify away from the artery.
What syndrome(s) might cause a positive Allen’s Test
TOS, Cervical subluxation, Reynaud’s syndrome (loss of patency in the arteries of the extremities).
Positive Dawburn’s is when
pain over subacromial bursitis disappears on abduction of the arm
Disappearance of pain w/ Dawburn’s indicates ____
subacromial bursitis
Pain remaining throughout abduction w/ Dawburn’s may be due to ____
Inferior Humerus
Part 1 drop arm; procedure and Dx
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
part 2 drop arm; procedure and Dx
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
part 3 drop arm; procedure and Dx
pt’s arm at 90° abduction. dr. applies impulse to the arm. Grade 1 strain of rotator cuff
Dugas Procedure, Dx
pt. can’t touch chest wall with affected arm/elbow while holding the opposite shoulder.
shoulder dislocation/separation.
What is a positive for Eden’s Test?
Decreased radial pulse volume
What does a positive Eden’s Test indicate?
TOS - Costoclavicular syndrome.
How to treat for a positive Eden’s Test?
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
What questions might you ask a patient that has this test positive?
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)?
Shoulder apprehension test positive and Dx
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.
What constitutes a positive Wright’s Test? Dx?
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.
What is the most common muscle involved with a positive Wright’s?
The pectoralis minor.
What causes the pectoralis minor to be shortened or go into contracture?
Cervical subluxation, subacromial bursitis, rolled shoulder posture, other types of TOS.
What constitutes a positive Yergason’s?
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.
DDx for pain on yergason’s w/o instability
inferior humerus.
Visualization of shoulder A-C PS
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.
Visualization of G-H I
Will see a (dimpling or indent of the soft tissue along the G-H joint space (sulcus sign).
Visualization of S-T L
The medial (vertebral) border of the scapula has flared lateral in relation to the spine.
Visualization of St-Cl S
The proximal end of the clavicle sits higher than the opposite side.
Fluid Motion A-C PS
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)
Fluid Motion G-H
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.
Fluid Motion S-T
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.
Fluid Motion St-Cl
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.
