Clin Med UE Diff Diagnosis
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| Sign of the Buttock | Limited/painful SLR; Limited/painful passive hip flexion with knee bent; Non-capsular pattern
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| Pancoast Tumor | Men >50 with hx of smoking; Nagging pain in shoulder/vertebral scapular border; Pain progression nagging->burning & extends down arm in ulnar distribution
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| After how many visits should you refer if no improvement? | 3-4 treatments
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| S/sx of neurommskeletal impairments typically related to what? | Changes in posture or movement
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| Stoddard #1 | Back ache, having hx of malignancy during previous 2 yrs, must be assumed to have 2ndary malignant deposits in spine
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| Stoddard #2 | Onset of back pain late in life w/o any previous hx of back s/sx, it is more than likely osteoporosis or 2ndary deposits
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| Stoddard #3 | Serious loss of spinal fxn or shock or vomiting after trivial spinal injury/strain, pt likely to have pathological fx of spine
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| Stoddard #4 | Intense pain requiring morphine >48 hrs may indicate serious disease
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| Stoddard #5 | Severe pain, derofmity & mm spasm in areas of spine other than lower cervical/lower lumbar, should arouse suspicion of disease
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| Stoddard #6 | Constitutional signs like fever, loss of wt, malaise & excessive wkness suggest disease
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| Stoddard #7 | Loss of power too widespread to be accountable by single nerve root lesion suggests neurological disease
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| Stoddard #8 | Loss of sphincter control is never due to simple mechanical causes
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| Stoddard #9 | Continuous pain unrelated to posture is unlikely to be mechanical in origin
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| Stoddard #10 | Normal ESR doesn't exclude disease entirely
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| Cyriax Normal End Feels | Capsular; Bone-on-bone; Tissue approximation
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| Cyriax Abnormal End Feels | Empty; Springy Block; Spasm
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| MMT Strong & Painful | Minor Lesion
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| MMT Weak & Painless | Neurological/Rupture
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| MMT Weak & Painful | Gross Lesion
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| MMT All Painful | Psychogenic/Highly irritable
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| MMT Painful on repetition | Vascular
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| MMT Strong & Pain-free | Normal
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| DTR Biceps; Brachioradialis; Triceps | Biceps/Brachioradialis = C5-6; Triceps = C6-7
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| S/sx Cervical Radiculopathy | Neck pain, radicular pain with numbness/paresthesia in UE; Mm spasms/fasciculations; Occipital HA; Radiating pain; Wkness, lack of coordination, decreased grip strength
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| Presentation of Cervical Radiculopathy | Decreased ROM (extension/rotation reproduce radicular s/sx); Myotomes, Dermatomes, DTRs; UMN (rule out cord compression)
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| Study with ULTT, Spurling, Distraction Tests; Rotation <60 degrees | 2 s/sx = 21% have cervical radiculopathy; 3 s/sx = 65%; 4 s/sx = 90%
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| Diff Dx of Cervical Radiculopathy | Adhesive capsulitis (AROM/PROM); Demyelinating condiiton (s/sx vary); Myocardial ischemia (ECG/stress tests); Peripheral n entrapment (+ Tinel/Phalen's test); RTC (impingement/RTC s/sx); TOS (decreased radial pulse)
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| Cervical Spondylosis s/sx | Decreased ROM; Chronic neck pain; HA; Radicular s/sx; Irritability, fatigue, sleep disturbances, decreased work tolerance
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| Presentation of Cervical Spondylosis | Diffuse non-sepcific neck pain exacerbated by neck mvmts
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| Presence of joint dysfunction with cervical spondylosis | Limited ROM; Palpable tenderness; dermatomes; myotomes; reflexes
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| Diff Dx of Cervical Spondylosis | Metastatic tumor (night pain); Cervical HNP (younger population); SC tumor (diagnostic studies); Syringomyelia (loss of superficial b reflexes/insensitivity to pain); Vertebral subluxation (advanced spondylosis; RA; trauma)
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| Cervical Myelopathy s/sx | Palmar paresthesia; Decreased UE dexterity; Subtle gait disturbances; abnormal urinary fxn; Loss of vibration/position sense; UE radiculopathy; May not experience pain
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| Key Findings with Cervical Myelopathy | Long tract signs (Hoffman's; Babinski; Clonus); Gait disturbances; Decreased UE dexterity
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| RTC Tear S/sx | Recurrent shoulder pain triggered by specific injury; Night pain; Weakness; Catching; Grating
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| Presentation of RTC Tear | Supra/infra atrophy; Limited AROM; Drop arm; Tenderness over greater tuberosity
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| Diff Dx of RTC Tear | AC jt arthritis (localized pain/tenderness, normal ROM); C-spondylosis (neck stiff, myo/dermatomes/DTRs); GH jt arthritis (radiographs); Adh Caps (AROM/PROM); Impingement; Pancoast tumor; TOS (ulnar n distribution; worse with TOS testing)
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| What is TOS? | Compression of brachial plexus &/or subclavian vessels as they exit b/t shoulder girdle & 1st rib; may be due to congenital anomalies; Fibromuscular bands in thoracic outlet; Post-traumatic fibrosis of scalenes
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| TOS s/sx | Vague & variable; Aching pain/paresthesias from neck to shoulder, arm, medial forearm, fingers; Intermittent swelling/discoloration of arm, decreased radial pulse, coldness; Aching, fatigue & wkness exacerbated by overhead activity
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| Presentation of TOS | Female, late teens to 40s; Must reproduce neuro/vascular s/sx; Fwd head, rounded shoulders; (+) ANTT; Motor/sensory intact
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| TOS Diff Dx | Brachial neuritis (sudden onset, pain, prox wkness); CTS (radial s/sx; Phalen); HNP (neck involvement; radicular pattern); Impingement (+ tests with localized pain); Pancoast tumor (venous congestion; radiographs); Ulnar n entrapment (Tinel, no prox s/sx)
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| Medial/Lateral Epicondylitis S/sx | 35-50 yo; gradual onset in lateral elbow/forearm during wrist ext; medial presents with medial pain exacerbated with wrist flexion/pronation
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| Presentation of Med/Lat Epicondylitis | Local tenderness 1 cm distal to lat epicondyle (common extensor origin); Medial epicondylitis tender just distal to med epicondyle
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| Diff Dx of Med/Lat Epicondylitis | Cubital tunnel sx (ulnar n compression with parasthesias in 4th/5th fingers); Radial tunnel sx (PIN compression; tender 5 cm distal to lat epicondyle)
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| What nerve compression is the 2nd most common nerve entrapment? | Ulnar nerve compression
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| Where is ulnar n usually compressed? | Cubital Tunnel
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| PIN Compression | No sensory, innervates wrist, thumb, fingers extensors
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| Which nerve is compressed in pronator syndrome? | Median Nerve
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| S/sx of ulnar n compression | Medial elbow aches w/ N/T in 4th/5th fingers; Rdiate proximal into shoulder/neck; Mm wasting in late stages
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| S/sx of Radial n compression | Pain 4-5 cm distal to lateral epicondyle; No N/T; Mm weakness in late stages
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| S/sx of Median n compression | Forearm pain that can radiate proximally into arm; Numbness may affect all/part of median n distribution
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| Diff Dx of elbow compression syndromes | CTS (numb thumb, index, middle fingers; thenar wasting); HNP; Med/Lat epicondylitis; TOS; Ulnar n entrapment at wrist
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| Ulnar Nerve supply | FCU; FDP; Superficial sensory; Deep motor; Ulnar lumbricals; IO; Adductor pollicis; FPB
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| What is the most common compression neuropathy in the UE? | CTS
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| What occurs most in middle-aged/pregnant females? | CTS
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| CTS S/Sx | Vague aching radiating into thenar area; Presthesia/numbness in median distribution; Worse at night; Dropping objects/wkness; Need to shake/rub hands
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| Presentation of CTS | Thenar atrophy; decreased sensory; Phalen test; Tinel sign; Carpal compression; ULTT; Opposition strength
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| Diff Dx of CTS | CMC arthritis (pain w/ motion); Cervical radiculopathy of C6 (neck pain; C6 dist); Diabetes; Hypothyroid; Median n compression at elbow; Ulnar neuropathy
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| Median N. supply | FCR; PT; PL; FDS; AI branch = FPL; Radial 1/2 of FDP; PQ; Superficial sensory; Terminal = APB; OP; FPB; Radial lumbricals; Sensory
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| DeQuervain Tenosynovitis is what? | Swelling/stenosis of sheath surrounding APL & EPB
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| DeQuervain's is common in what population? | Middle-aged women
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| S/sx of DeQuervain's | Pain, swelling, triggering resulting in locking/sticking of tendon with thumb motion; Swelling over radial styloid & pain aggravated by moving thumb/making fist
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| DeQuervain's Presentation | Swelling/tenderness over tendons of 1st dorsal compartment; Crepitus with thumb flex/ext; (+) Finkelstein
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| Diff Dx of DeQuervain's | CMC arthritis (painful compression); Dorsal wrist ganglion (palpable mass); Scaphoid fx (snuffbox tender); Superficial radial n (cheralgia paresthetic; dog handler's sx)
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