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Thoracic Outlet Syndrome
Injury to the nerves/vasculature of the UE passing through the TO
Tests: Roos Test/Elevated Arm Stress Test
Hold shoulders 90 degrees abducted and externally rotated, elbows flexed for 3 minutes while opening and closing hands
┗(-_-)┛
NOT DONE IN VIDEOS
Extra Tests: Neer, Hawkins-Kennedy
Impingement Syndrome
Long head of bicep/supraspinatus tendons are compressed under the coracoacromial arch, especially under shoulder elevation
Tests: Hawkins-Kennedy test
Hold shoulders at 90 degrees Shoulder Flexion, then have the patient go into full Internal Rotation
Positive (pain, weakness) implicates impingement syndrome
NOT DONE IN VIDEOS
Neer Impingement Test
Passively Flex pt’s shoulder into end range, and then passively flex then passively flexed into end range with internal rotation to further challenge
Positive (pain, weakness) implicates impingement syndrome
NOT DONE IN VIDEOS
Rotator Cuff Tear
Tearing of one or multiple rotator cuff muscle tendons, which can be partial or full thickness
Tests: Empty Can Test
Hold shoulders at 90 degrees flexion, with some horizontal abduction, then have patients go into Internal rotation (palms facing outwards). Apply resistance
Positive (pain or weakness) implicates Supraspinatus
Full Can Test
Hold shoulders at 90 degrees Flexion, when have patients go into Internal rotation (palms facing outwards). Apply resistance
Positive (pain or weakness) implicates Supraspinatus
Lift Off Test
Have the patient put their hands on their back in a diamond shape, then have them Raise their Hands Away from their body. Apply resistance if the pt can do this.
Positive (inability to raise, pain or weakness) implicates the Subscapularis
Other Tests: Speed’s Test
Hold shoulders at 90 degrees flexion with elbow extension and supination. Apply resistance on the arm, and Palpate for the long head of the biceps tendon (lowkey next to your armpit)
Positive (not able to palpate) implicates the Long Head of the Bicep
Palpate: clavicle → AC joint → coracoid process → scapular spine → supraspinatus → medial border
Treatment: stick shit, wall climbs (abd, flex), doorway stretch (ext), TheraBand exercises (all), table slides
ROM/Strengthening: ext rot, int rot, abd
*****
Lateral Epicondylitis (Tennis Elbow)
Tendinitis of the forearm extensor musculature, primarily affecting the Extensor Carpi Radialis Brevis tendon on the Lateral Epicondyle
Cozen’s Test:
Elbow is in Extension and forearm in Pronation, have the pts Wrist in Radial deviation and Extension. Place pressure with your thumb on lateral epicondyle and apply Wrist Resistance.
Positive (pain on lateral epicondyle) implicates lateral epicondylitis
Extra Tests:
Mills’ Lateral Elbow Tendinopathy Test
NOT DONE IN VIDEOS
Varus Stress Test:
Elbow is in extension, supinated. Apply varus force to elbow (apply force medial to lateral)
Positive (pain, no firm endpoint) implicates LCL damage
NOT DONE IN VIDEOS
Treatment: wrist flexion + extension (eccentric extension), towel twists, avoid picking things up in pronation, pain management through meds, decrease repetitive activities, modify/compensate activity
Medial Epicondylitis (Golfer’s Elbow)
Damage to the common flexor tendon at the medial epicondyle of the humerus, typically involving pronator teres and Flexor Carpi Radialis
Golfer’s Elbow Test
NOT DONE IN VIDEOS
Valgus Stress Test
Elbow is in extension, supinated. Apply valgus force to elbow (apply force lateral to medial)
Positive (pain, no firm endpoint) implicates MCL damage
Thumb CMC Arthritis
Common site of arthritis in the hand, often an overuse injury
CMC Grind Test
Examiner grasps the metacarpal of the patient’s thumb and provides a slight circular movement with axial pressure into the CMC joint
Positive (pain or crepitus) implicates CMC arthritis
Extra Tests:
Eichhoff Test
Pt makes a fist with their thumb tucked within the fist. Ulnarly deviate the patient’s wrist
Positive (pain along first dorsal compartment) implicates De Quervain’s Tenosynovitis
Seme Weinstein’s?
Treatment: avoid power pinch, palmar abduction, letter Cs
De Quervain’s Tenosynovitis
Tenosynovitis of the first dorsal compartment of the thumb, involving the abductor pollicis longus and extensor pollicis breavis
Eichoff Test
Pt makes a fist with their thumb tucked within the fist. Ulnarly deviate the patient’s wrist
Positive (pain along first dorsal compartment) implicates De Quervain’s Tenosynovitis
Extra Tests:
CMC Grind Test
Examiner grasps the metacarpal of the patient’s thumb and provides a slight circular movement with axial pressure into the CMC joint
Positive (pain or crepitus) implicates CMC arthritis
Treatment: eccentric radial deviation?
Carpal Tunnel Syndrome
Compression of the median nerve at the carpal tunnel of the wrist
Phalen’s Test
The patient pushes the dorsal surfaces of their hands together and holds for 30-60 seconds.
Positive (abnormal sensation) implicates carpal tunnel syndrome
Varus/Lateral Instability
LCL fuck up
Varus Stress Test:
Elbow is in extension, supinated. Apply varus force to elbow (apply force medial to lateral)
Positive (pain, no firm endpoint) implicates LCL damage
NOT DONE IN VIDEOS
Extra Test:
Cozen’s Test:
Elbow is in Extension and forearm in Pronation, have the pts Wrist in Radial deviation and Extension. Place pressure with your thumb on lateral epicondyle and apply Wrist Resistance.
Positive (pain on lateral epicondyle) implicates lateral epicondylitis
Treatment: maintain pronation, early AROM in pronation, avoid abd and internal rot