-
Yellow signs: (symptoms) (6)
- Abnormal signs and symptoms (unusual patterns of complaints)
- Autonomic Nervous System symptoms
- Bilateral symptoms
- Nuerological symptoms
- Symptoms peripheralizing
- Upper motor nueron symptoms (spinal cord)signs
-
Yellow signs:
- Abnormal sensation patterns (does not follow dermatome or peripheral nerve patterns)
- Circulatory or skin changes
- Drop attacks
- Fainting
- Multiple inflamed joints
- Multiple nerve root invovlement
- Progressive weakness
- Progressive gait disturbances
- Pyschosocial stresses
- Saddle Anesthesia
- Vertigo
-
Systematic Pain: (4)
- Constant or waves of pain or spasm
- Disturbs sleep
- Deep aching or throbbing
- Not aggravated by mechanical stresses
-
Systematic Pain: Associated with the following: (10)
- Cyclic and progressive symptoms
- Fatigue
- Jaudice
- History of infection
- Generalized weakness
- Low grade fever
- Migratory Arthralgias
- Skin rash
- Tumors
- Weight loss
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Musculoskeletal Pain:
- Aggravated by mechanical stress
- Lessens at night
- Sharp or superficial pain
- Usually decreases with cessation of activity
- Usually continues or intermittent
-
Diagnosis of shoulder pathology: External Primary Impingement 1
- Intermittent Mild Pain with overhead activities
- Over the age of 35
-
Diagnosis of shoulder pathology: External Primary Impingemet 2
Mild to moderate Pain with overhead activities or strenous Activites
-
Diagnosis of shoulder pathology: External Primary Impingment 3
- Pain at rest or with activities
- Night pain may occur
- Scapular or R.C weakness is noted
-
Diagnosis of shoulder pathology: RC tear Full thickness
- Classic night pain
- Weakness noted mostly in abduction and E.R
- loss of motion
-
Diagnosis of shoulder pathology: Adhesive capsulities (idiopathic frozen shoulder)
- Inability to perform ADL's owing to loss of motion
- Loss of motion may be percieved as weakness
-
Diagnosis of shoulder pathology: Anterior Instability (with or without external secondary impingment)
- Apprehension to mechanical shifting limits activities
- Slipping,popping, or sliding may present as suitable instability
- Apprehension usually assoc. with horizontal ABD and E.R
- Anterior or Posterior Pain may be present
- Weak scapula stabilizers
-
Diagnosis of Shoulder pathology: Posterior Instability
- Slipping or popping of the humerus out the back
- May be assoc. with forward flx and I.R while the shoulder is under a compressive load
-
Diagnosis of shoulder pathology: Multidirectional Instability
- Looseness of shoulder in all directions
- May be the most pronounced while carrying luggage or turning over while asleep
- Pain may or may not be present
-
Special Test: Instability, Anterior
- Load and shift
- Crank, Apprehension and Relocation test
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Special Test: Instability, Posterior
- Load and shift
- Posterior Apprehension
- Norwood
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Special test: Instability, Inferior (Multidirectional)
-
Special Test: Impingement
- Neer
- Hawkins-kennedy
- Posterior Internal Impingement test (PIIT)
-
Special test: Labral Lesion
- CLunk (Bankart)
- Anterior slide (Bankart/ SLAP)
- Active compression test O'Brien (SLAP)
- Bicep tension test (SLAP)
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Special test: Scapular stability
- Lateral scapular slide
- Wall/floor pushup
- Scapular retraction test
-
Special test: Muscle tendon pathology
- Speeds
- Yergusons
- Empty can
- Lift off sign
- Lag or "springy back" test (Supscapular: I.R, Infraspinatus, T.Minor: E.R)
- Trapz weakness
- Seratus Anterior Weakness
- Pec Major and minor Weakness
-
Special Test: Nuerological Involvement
Upper Limb tension test
-
Special test: Thoracic Outlet Syndromes
ROOS test (EAST)
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R.C Lesion: History and Observation
- History:
- 30-50 yrs of age
- Pain and weakness after eccentric load
- Observation:
- Normal bone and soft tissue outlines
- Protective shoulder hike may be present
-
R.C lesion: Active and Passive Movements
- Active:
- Weakness of ABD or Rotation, or both
- Crepitus may be present
- Passive:
- Pain if impingement occurs
-
R.C lesion: Resisted Isometric Movement
Pain and weakness on ABD and E.R
-
R.C lesion: Special Test and Palpation
- Special test:
- + Drop arm
- + Empty Can test
- Palpation:
- Tender over R.C
-
R.C lesion: Diagnostic Imaging
- Radiography: Upw. displacement of H.H
- Acromial Spurring
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Frozen Shoulder: History and Observation
- History:
- Age 45+ (isidious type)
- Insidious onset or after trauma or surgery
- Functional restriction of E.R, ABD, I.R
- Observation:
- Normal bone and soft tissue outlines
-
Frozen Shoulder: Active and Passive Movements
- Active:
- Restricted ROM
- Shoulder Hiking
- Passive:
- Limited ROM especially in:
- E.R
- ABD
- I.R (capsular pattern)
-
Frozen SHoulder: restricted Isometric movement and Special test
- Restricted Iso movement:
- Normal when arm at side
- Special test:
- None
-
Frozen shoulder: Palpation and Diagnostic Imaging
- Palpation:
- Not painful unless capsule is stretched
- Diagnostic:
- Radiography: negative
- Arthrography: decreased capsular size
-
Atraumatic Instability: History and Observation
- History:
- 10-35 yrs. of age
- Pain and instability with activity
- No history of trauma
- Observation:
- Normal bone and soft tissue outlines
-
Atraumatic Instability: Active and Passive Movements
- Active:
- Full or excessive ROM
- Passive:
- Normal or Excessive ROM
-
Atraumatic Instability: Restricted Isometric Movement and Special test
- Restricted isometric movement:
- Normal
- Special test:
- + Load and Shift
- + Apprehension
- + Relocation
- + Augmentation test
-
Atraumatic Instability: Palpation and Diagnostic Imaging
- Palpation:
- Anterior or Posterior Pain
- Diagnostic Imaging:
- NEGATIVE
-
Cervical Spondylosis: History and Palpation
- History:
- 50+ yrs.old
- Acute or chronic
- Observation:
- Minimal or no cervical spine movement
- Torticollis may be present
-
Cervical Spondylosis: Active and Passive movements
- Active:
- Limited ROM with pain
- Passive:
- Limited ROM (symptoms may be exacerbated)
-
Cervical Spondylosis: Resisted Isometric Movements and Special test
- Restricted Isometric Movement:
- Normal, except if nerve root is compressed
- Myotome may be affected
- Special test:
- + Spurling
- + Distraction
- + ULTT
- + Shoulder ABD
-
Cervical Spondylosis: Sensory function and Reflexes and Palpation:
- Sensory function/Reflexes:
- Dermatomes and Reflexes Affected
- Palpation:
- Tender over appropriate vertebrae or facet
-
Cervical Spondylosis: Diagnostic Imaging
Radiography: Narrowing Osteophytes
-
Diagnosis of Tendinosis compared to Tendinitis: Prevalence
- Overuse Tendinosis:Common
- Overuse Tendinitis: Rare
-
Diagnosis of Tendinosis compared to Tendinitis: Time for recovery, early presentation and chronic presentation
- Overuse Tendinosis:
- Early: 6-10wks
- Chronic: 3-6 months
- Overuse Tendinitis:
- Early: Several days to 2 wks
- Chronic: 4-6 wks
-
Diagnosis of Tendinosis compared to Tendinitis: Likely hood of full recovery to sport from chronic symptoms
- Overuse Tendinosis: ~80%
- Overuse Tendinitis: 99%
-
Diagnosis of tendinosis compared to tendinitis: Conservative Therapy
- Overuse Tendinosis: Encouragement of Collagen synthesis maturation and strength
- Overuse Tendinitis: Anti-inflammatory modalities and drugs
-
Diagnosis of Tendinosis compared to Tendinitis: Role of surgery, Prognosis, time of recovery from surgery
- Overuse Tendinosis:
- Surgery: Exercise abnormal tissue
- Prognosis: 70-85%
- Recovery: 4-6 mo
- Overuse Tendinitis:
- Surgery: Not known
- Prognosis: 95%
- Recovery: 3-4 wks
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Signs and Symptoms of Peripheral Nerve Involvement: Spinal Accessory nerve
- Inability to abduct arm beyond 90 degrees
- Pain in shoulder on ABD
-
Signs and Symptoms of Peripheral nerve Involvement: Long Thoracic Nerve
- Pain on flexing fully extended arm
- Inability to flex fully extended arm
- Winging starts at 90 degrees of forward flexion
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Signs and symptoms of Peripheral Nerve involvement: Suprascapular Nerve
- Increased pain on forward shoulder flexion
- Shoulder weakness (partial loss of humeral control)
- Pain increases with scapular ABD
- Pain increases with Cervical rotation to opposite side
-
Signs and symptoms of peripheral nerve involvement: Axillary (circumflex)nerve
Inability to abduct arm with nuetral rotation
-
Signs and symptoms of peripheral nerve involvement: Musculocutaneous Nerve
Weak elbow flexion with forearm supinated
-
Classification of GH painful arcs: Night Pain
- Anterior: Yes
- Posterior: Yes
- Superior: Maybe
-
Classification of GH painful arcs: Age
- Anterior: 50+
- Posterior: 50+
- Superior: 40+
-
Classification of GH painful arcs: Sex Ratio
- Anterior: F>M
- Posterior: F>M
- Superior: M>F
-
Classification of GH painful arcs: Aggravated by:
- Anterior: E.R and ABD
- Posterior: I.R and ABD
- Superior: ABD
-
Classification of GH painful arcs: Tenderness
- Anterior: Lesser tuberosity
- Posterior: Posterior Aspect of G. tuberosity
- Superior: G. Tuberosity
-
Classification of GH painful arcs: AC joint involvement
- Anterior: No
- Posterior: No
- Superior: Often
-
Classification of GH painful arcs: Calcification (if present)
- Anterior:
- Supraspinatus
- Infraspinatus
- and/or Subscapularis
- Posterior:
- Supraspinatus
- and/or Infraspinatus
- Superior:
- Supraspinatus
- and/or Subscapularis
-
Classification of GH painful arcs: Third-degree strain biceps brachii (long head)
- Anterior: No
- Posterior: No
- Superior: Occasional
-
Classification of GH painful arcs: Prognosis
- Anterior: Good
- Posterior: Good
- Superior: Poor (without surgery)
-
Levator Scapulae: Referral Pattern
Over muscle to posterior shoulder and along medial border of scapula
-
Latissimus Dorsi: Referral Pattern
- Inferior angle of Scapula up to posterior and anterior shoulder into posterior arm
- May refer to area above iliac crest
-
Rhomboids: Referral pattern
Medial border of scapula
-
Supraspinatus: Referral Pattern
- Over shoulder cap and above spine of scapula
- Sometimes down lateral aspect of arm to proximal forearm
-
Infraspinatus: Referral Pattern
- Anterolateral shoulder and medial border of scapula
- May refer down lateral aspect of arm
-
Teres Minor: Referral Pattern
Near deltiod insertion, up to shoulder cap, and down lateral arm to elbow
-
Subscapularis: Referral Pattern
Posterior shoulder to scapulaand down posteromedial and anteromedial aspect of arm to elbow
-
Teres Major: Referral Pattern
Shoulder cap down lateral aspect of arm to elbow
-
Deltoid: Referral Pattern
Over muscle and posterior gleniod area of shoulder
-
Coracobrachialis: Referral Pattern
Anterior shoulder and down posterior arm
-
Peripheral Nerve injury: Suprascapular C5-6: Affected Muscle,sensory,reflex
- Muscle Weakness:
- Supraspinatus, Infraspinatus
- Sensory Alteration:
- Top of shoulder from clavicle to scapula spine
- Pain in posterior shoulder radiating into arm
- Reflexes Affected:
- None
-
Peripheral Nerve Injury: Suprascapular: Mechanism of Injury
- Compression in suprascapular notch
- Compression in spinogleniod notch
- Stretch into scapular protraction plus horizontal ADD
- Direct blow
- Space occupying lesion (ex.ganglion)
-
Peripheral nerve Injury: Axillary (circumflex) nerve (posterior cord C5-6): Affected muscles,sensory,reflex
- Muscle weaknes:
- Deltiod, T. Minor (arm ABD)
- Sensory Alteration:
- Deltoid area
- Anterior shoulder pain
- Reflexes: None
-
Peripheral nerve injury: Axillary nerve: Mechanism of Injury
- Anterior GH dislocation or fx of surgical neck of humerus
- Forced ABD
- Surgery for Instability
-
Peripheral Nerve Injury: Radial Nerve C5-8, T1: Affected muscle,sensory, reflex
- Muscle weakness:
- Shoulder, wrist, and hand extensors
- Sensory alteration:
- Dorsum of hand
- Reflexes:
- Triceps
-
Peripheral nerve injury: Radial nerve: Mechanism of injury
- Fracture Humeral shaft
- Pressure (ex. crutch palsy)
-
Peripheral nerve injury: Long thoracic nerve C5-7: Affected muscles,sensory, reflex
- Muscle weakness:
- Serratus Anterior (scapular control)
- -No sensory and reflex alteration
-
Peripheral nerve injury: Long thoracic nerve: Mechanism of injury
- Direct blow
- Traction
- Compression against internal chest wall (backpack injury)
- Heavy effort above shoulder height
- Repititive strain
-
Peripheral Nerve injury: Musculocutaneous Nerve C5-7: affected muscles, sensory, reflex
- Muscle weakness:
- Bicep brachii, Coracobrachialis, brachialis (elbow flexion)
- Sensory Alteration:
- Lateral aspect of the forearm
- Reflex:
- Bicep
-
Peripheral Nerve injury: Musculocutaneous nerve: Mechanism of injury
- Compression
- Muscle Hypertrophy
- Direct blow
- Fx (clavicle and humerus)
- Dislocation (anterior)
- Surgery (Putti-Platt, Bankart)
-
Peripheral Nerve Injury: Spinal Accessory Nerve XI C3-4: affected muscles,sensory,reflex
- Muscle weakness:
- Trapz (shoulder elevation)
- Sensory alteration:
- Brachial Plexus symptoms b/c of drooping of shoulder
- shoulder aching
- Reflex: none
-
Peripheral Nerve Injury: Spinal Accessory: Mechanism of injury:
- Direct Blow
- Traction (shoulder depression and neck rotation to opposite side
- Biopsy
-
Peripheral nerve Injury: Subscapular Nerve Posterior Cord C5-6: affected muscles,sensory,reflex
- Muscle weakness:
- Subscapular, T. Major (I.R)
- - No sensory or reflex alteration
-
Peripheral Nerve Injury: Subscapular Nerve: Mechanism of injury
-
Peripheral nerve injury: Dorsal Scapular C5: affected muscle,sensory,reflex
- Muscle weakness:
- Rhomboids, Levator Scapulae (Scapular retraction and elevation)
- -No Sensory Alteration or reflex
-
Peripheral nerve injury: Dorsal Scapular: Mechanism of Injury
-
Peripheral Nerve injury: Lateral Pectoral nerve C5-6: affected muscles,sensory,reflex
- Muscle weakness:
- Pec major and minor
- -No Sensory or reflex alteration
-
Peripheral nerve injury: Lateral Pectoral Nerve: Mechanism of Injury
Direct blow
-
Peripheral Nerve injury: Thoracodorsal C6-8: affected muscles,sensory,reflex
- Muscle weakness:
- Lats
- No sensory or reflex alteration
-
Peripheral nerve injury: Thoracodorsal
-
Peripheral nerve injury: Supraclavicular nerve: Sensory and Mechanism of Injury Only!
- Sensory:
- Mild clavicular pain
- Sensory loss over anterior shoulder
- Mechanism:
- Compression
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