Differential Diagnoses of Scapula

thoracic outlet syndrome (TOS)

complex set of signs and sx that result from compression of brachial plexus and subclavian/axillary artery (usually caused by postural/muscular imbalances)

TOS clinical presentation

UE "heaviness", "achy" pain (from root of neck to shoulder and down arm in a diffuse fashion); possible paresthesia of arm/hand; less commonly pt c/o weakness in hand; sx of arterial compression (cold, pallor) present with numbness of entire arm

TOS tests and measures

Observation: detectable muscle atrophy, hand may be cool and pale, postural deformity of scapular protraction and forward head

Strength Tests: often normal except in severe cases

Sensory Tests: may be positive, but doesn't fit specific pattern for peripheral or nerve root distribution

Special Tests: may be positive

Flexibility Tests: pec minor is often +

TOS differential dx

cervical nerve root compression, cubital tunnel syndrome, carpal tunnel syndrome, peripheral neural tension, myofascial dysfunction, double crush syndrome

TOS special tests

Adson's test, costoclavicular test, Wright test

TOS 1st site of compression

interval between anterior and medial scalenes

TOS 2nd site of compression

between clavicle and relatively fixed 1st rib

TOS 3rd site of compression

subcoracoid region adjacent to pec minor

brachial plexopathy

occurs when there is damage to brachial plexus resulting from disease (viral infection, autoimmune disorder), direct trauma, stretch/compression of plexus (during birth, prolonged positioning, or tumor), or radiation therapy

brachial plexopathy clinical presentation

paresthesia of UE (hand and distal forearm), weakness and occasionally pain/burning down UE

brachial plexopathy tests and measures

muscle weakness (in muscles innervated by peripheral nerves), decreased sensation along peripheral nerve distribution

muscle spasm/trigger points

scapular muscles are prone to trigger points/pain related to increased muscle tension (due to constant activity during posture and UE motions); common muscles involved are traps, lev scap, and rhomboids

muscle spasm clinical presentation

localized pain in involved muscle, which may radiate into referred area

muscle spasm tests and measures

postural abnormalities, muscle imbalances (agonist weakness and antagonist tightness), pain with palpation which refers to a distal area specific to involved muscle

SICK scapula

Scapular malposition, Inferior medial scapular winging, Coracoid tenderness and scapular dysKinesis; result in an altered normal resting position of scapula and altered activation of scapulohumeral muscular force couples during shld movements (traps, rhomboids, serratus synchronization)

SICK scapula clinical presenation

h/o repetitive overhead activity, may have h/o shld (GH) injury, unbalanced wt training with emphasis on anterior muscles; may c/o arc p! or p! with end-range GH elevation

SICK scapula tests and measures

Observation: scapular winging

AROM: scapular dyskinesis with shld motions

Strength Tests: weakness in scapular stabilizers

Flexibility Test: tight pec major and/or pec minor

upper crossed syndrome

groups of muscles in neck, shlds, and chest become imbalanced (strength and flexibility) due to poor posture; agonist/antagonist muscles most affected are tightness in upper trap and lev scap "crossed" with tightness of pec major and minor; weakness of deep cervical flexors "crossed" with weakness of middle and lower traps; creates jt dysfunction (can lead to altered movement patterns and pain)

upper crossed syndrome clinical presentation

h/o ADLs that require prolonged sitting; may have h/o shld (GH) injury

upper crossed syndrome tests and measures

Observation: forward head, increased thoracic kyphosis; scapular winging

AROM: scapular dyskinesis with shld overhead motions

Strength Tests: weakness in lower and middle traps, serratus anterior

Flexibility Tests: tight pec major and/or pec mino