Term
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Definition
Anterior: Anterior Scalene
Posterior: Medial Scalene
Superior: Clavicle
Inferior: 1St rib
Lateral : Pectoralis Minor and Coracoid |
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Term
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Definition
Scalene Triangle
Anterior/medial scalene (medial)
1st Rib (inferior)
Subclavian Artery and brachial plexus only
Subclavian vein anterior to this space
Costoclavicular Region
Clavicle (superior)
1st Rib (inferior)
Axillary Region
Pectoralis Minor/ Coracoid Process |
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Term
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Definition
Pain/Swelling
Numbness
Tingling in hand and forearm
Pain and tingling in the neck/shoulders
Signs of poor circulation the hand/forearm
Bluish discoloration of the hand
Weaknesses of the muscles of the hand
Feeling of heaviness of the arm
Deep toothache-like pain in the neck/shoulder-worsens at night
Hand/arm easily fatigues |
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Term
| Causes: Postural Abnormalities |
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Definition
Forward Head
Cervical extensor weakness
Rounded Shoulder
Pectoralis tightness
Rhomboid weakness
Guarding Position
Shoulder evelation, cervical muscle tightness |
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Term
| Causes: Entrapment Neuropathy |
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Definition
Decreased ability of the nerve(s) to glide through surrounding tissue
Increases tension on nerve
Secondary to:
Neural fibrosis associated with cervical or shoulder trauma
Repetitive stress activities
Scarring post radiation |
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Term
Upper Limb Tension
Provacative Test |
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Definition
Pt positioned in supine
Examiner takes clients arm into abduction and external rotation behind the coronal plane at the shoulder (shoulder girdle in depression)
Elbow is extended with wrist in extension and forearm supinated
Stretch or ache or tingling in thumb and/or digits 2 and 3 = median n involvement
Lateral flexion of neck away from UE increases tension
Compare to uninvolved side |
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Term
| East test/Roos test (‘Hands Up”) |
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Definition
The patient brings their arms up in “field goal post position” (bilateral shoulders/elbow @ 90 with lateral rotation) and elbows slightly behind the head.
The patient then slowly opens and closes their hands slowly for 3 minutes
A positive test is indicated by pain, heaviness or profound arm weakness or numbness and tingling of the hand or inability to hold positition for 3 minutes |
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Term
| Adson or Scalene Maneuver |
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Definition
The examiner locates the radial pulse.
The patient rotates their head toward the tested arm and lets the head tilt backwards (extends the neck) and takes a deep breath while the examiner extends and laterally rotates the shoulder.
A positive test is indicated by a disappearance or slowing of the pulse. |
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Term
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Definition
The examiner locates the radial pulse and draws the patient's shoulder down and back as the patient lifts their chest in an exaggerated "at attention" posture.
A positive test is indicated by an absence of a pulse or reproduction of symptoms.
This test is particularly effective in patients who complain of symptoms while wearing a back-pack or a heavy jacket. |
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Term
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Definition
Arm held by clinician in fully abducted position to test for compression at pectoralis minor insertion
Note reproduction of symptoms or decreased radial pulse |
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Term
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Definition
This test is used on patients who already present with symptoms.
The patient sits with arms crossed over chest.
The examiner grasps the patient's arms from behind at the elbows (hug)
The patient is passive as the shoulders are elevated
The position is held for 30 seconds or more. This activity is evidenced by increased pulse, skin color change (more pink) and increased hand temperature.
Neurological signs go from numbness to pins and needles or tingling as well as some pain as blood flow to the nerve returns. Similar to what is felt after an arm "falls asleep" and circulation returns. |
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Term
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Definition
Progression
Stage 1: decrease pain and control symptoms, increase comfort
Postural education, avoid symptom-producing activities/postures,
Stage 2: address tissues creating structural limitations
Soft tissue mobilization, nerve gliding, stretching
Stage 3: Condition, strengthen, improve function
Postural retraining
Head and shoulders back
Distribute weight evenly on both feet
Check posture when walking, sitting, standing
Sleeping postures
Avoid lying on affected side, on stomach or hand over head
Teach to side lie on unaffected side with one pillow or cervical roll under head with another pillow to support arm
Alternate: lie on back, flat/no pillow under head, may need to support arms with pillows
Work
Pt. should not lean over when standing or sitting
At a desk there should be a forearm supporting surface that will not allow excessive shoulder elevation/depression
Should avoid over-head activities- use step stool
Avoid carrying heavy items with affected arm
Driving
Hands low and relaxed on steering wheel
Arm rest or pillow for affected side
Check seat belt over clavicle area
General
Avoid stress: affects posture and cervical tension
While standing for long periods of time put hand in pocket to avoid shoulder depression
Obesity contributes to poor posture on continuation of symptoms
Check bra straps: thick straps or strapless
Change activities or rest when symptoms occur
Wear several layers in cold weather opposed to heavy coat
Being cold creates hypontonicity of cervical muscles – keep warm
Modalities
TENS, moist heat,massage,etc.
Nerve gliding
Postural exercises
Shoulder circles, strengthen scapular adductors and cervical extensors
Stretches
Stretches
Scalene Stretch
Stand erect, arm at sides, shoulders internally rotated. Bend neck – try to touch ear to shoulder
Pectoral Stretch
Corner push-up, inhale in –exhale when pushing out
Pectoralis Minor Stretch
Lying supine, keep arms on bed surface. Slide affected arm up toward ear
Passive stetch
Diaphagmatic breathing
Progress to Strengthening and Functional Activities |
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