Differential Diagnoses of Scapula

thoracic outlet syndrome

compression of inf trunk of brachial plexus C8-T1, subclavian artery, and/or subclavian vein as a result of structural abnormalities, postural dysfunction, muscular imbalances, repetitive stress, and/or trauma

clinical presentation

poorly localized UE heaviness/achey pain that extends from root of neck to shoulder and diffuse down the arm. may be accompanied by parasthesia of arm/hand in C8/T1 distribution. also could have weakness of UE, symptoms of arterial compression (cold/pale hands), or venous compression (cyanosis, edema)

observation of TOS

hand may be cool/pale/blue, pt may have postural deformity of scapula protraction and forward head

strength tests for TOS

scapular weakness common

flexibility tests for TOS

pec minor test is often positive

Adson's test

special test for TOS for compression between the anterior and middle scalenes

Costoclavicular test

special test for TOS for compression between 1st rib and clavicle

Hyperabduction test

special test for TOS for compression from pec minor

brachial plexopathy

damage to brachial plexus resulting from disease, direct trauma, stretch/compression, or radiation therapy

history of brachial plexopathy

parasthesia of hand and distal forearm, weakness and occassional pain/burning down UE

tests and measures of brachial plexopathy

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

muscle spasm/trigger points

shortened sarcomeres, common muscles involved are traps, levator scap, and rhomboids

history of muscle spasms/trigger points

localized pain in involved muscle which radiate into referred area

tests and measures of muscle spasms/trigger points

postural abnormalities, muscle imbalances (agonist weak, antagonist tight), pain w palpation which refers to distal area

SICK scapula

scapular malposition inferior medial scapular winging coracoid tenderness and scapular dyskinesis, may result in altered activation of scapulohumeral muscular force couple

history of SICK scapula

history of repetitive overhead activity/sports, may have history of GH injury, unbalanced weight training with emphasis on anterior muscles, may have joint hypermobility, may complain of arc pain, or pain/popping/snapping w end range GH elevation

observation of SICK scapula

scapular winging, scapular dyskinesis w shoulder motion, may have increased thoracic kyphosis

flexibility tests for SICK scapula

tight pec minor

upper crossed syndrome

tightness in upper traps/levator scap crossed with tightness of pec major/minor, and weakness of deep cervical flexors crossed with weakness of middle/lower traps/rhomboids, this imbalance creates joint dysfunction of cervical and thoracic vertebral joints and GH joint

Hx of upper crossed syndrome

history of ADLs that require prolonged sitting, may have history of GH injury

observation of upper crossed syndrome

forward head, inc thoracic kyphosis, scapular winging, scapular dyskinesis w shoulder overhead motions

strength tests of upper crossed syndrome

weakness in lower/middle traps, rhomboids, serratus ant, and reduced deep neck flexor muscular endurance

flexibility test of upper crossed syndrome

tight pec major and/or pec minor, suboccipitals, upper trap, lev scap