Common Test

[Michael]

Neck, Shoulder, Elbow, Wrist, Back, Knee, Ankle,

[Michael]

Brachial Plexus Traction Test
Foraminal Comppression Test
Adson's Manoeuvre

Cervical Root Compression

Related Terms: Brachial Plexopathy, Cervical Rib Syndrome, Cervicobrachial Myofacial Pain Syndrome, Cervicobrachial Neuralgia, Cervicobrachial Neurovascular Compression Syndrome, Cervicobrachialgia, Costoclavicular Syndrome, First Thoracic Rib Syndrome, Shoulder-hand Syndrome, Thoracic Outlet Compression Syndrome, Thoracic Outlet Syndrome, TOS

Diagnosis: Cervicobrachial Syndrome
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 History: Individuals may complain of pain and fatigue of the wrist, forearm, shoulders, and neck; a swelling sensation in the hands; pins and needles; and heaviness or numbness of the upper extremity. are painful to touch, and the neck may be stiff with limited range of motion, particularly on neck extension. Individuals may have poor posture with rounded shoulders and stooped head and neck. Raising the arm (abduction) may increase pain response. Observation of possible asymmetry of the upper chest, including the clavicle, may reveal abnormalities indicative of prior fracture or anatomical defect.

Physical stress tests may be employed to reproduce symptoms, including the Adson maneuver. Hyperabduction of the arm, or elevated arm stress test (the “stick ’em up” stress test), may also produce symptoms and loss of pulse, indicating TOS.

Tests: Radiographic images are taken primarily to rule out objectively verifiable causes for the symptoms.
Plain x-rays may also identify first rib abnormalities or the presence of accessory ribs. Current or prior spinal injury or pathology (e.g., cervical root injury, herniated disc, bone spurs) may be evaluated by MRI or CT imaging, including CT myelography. Electrodiagnostic tests (EMG, NCV) are used to identify or rule out nerve damage. Vascular injury or thrombosis may be evaluated by conventional angiography, by magnetic resonance angiography (MRA), or by conventional venography. Doppler ultrasound may be used to identify interrupted blood flow to the involved arm.

Psychological testing and evaluation often reveal psychosocial stressors. Polysomnogram testing may be done to evaluate reported sleep disturbances.

In conclusion, there are no criteria for this diagnosis, since it represents a collection of symptoms for which there is no known cause. If a specific pathologic condition can be documented, this diagnosis should not be used.
 
Differential Diagnoses
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 Adhesive capsulitis of the shoulder
Cervical disc disorder
Cervical radiculopathy
Cervical spondylosis
Cervical sprain or strain
Complex regional pain syndrome
Degeneration of a cervical disc
Diabetic peripheral neuropathy
Fibromyalgia
Myofascial pain
Rheumatoid arthritis
Rotator cuff disease
Tendinitis
Thoracic outlet syndrome with proven vascular or neurologic compression
Traumatic brachial plexopathy
Tumors or masses
 
 

[Michael]

Impingment Test, Drop Arm Test

Related Terms: Internal Impingement, Rotator Cuff Impingement Syndrome, Subacromial Impingement Syndrome, Subcoracoid Impingement

Impingement syndrome is a term used to describe a disorder in which one or more soft tissues (rotator cuff tendons, bursa and biceps tendons) surrounding the ball of the shoulder joint get pinched, or impinged, on the bony surface under a portion of the shoulder blade (the acromion).

Diagnosis
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History: The hallmark symptom of impingement syndrome is shoulder pain that is most often gradual and progressive. In the early stages, individuals will experience pain only when the arm is held out from the side or in front of the body with the elbow at or above shoulder level, and the pain will be relieved with rest. There may be a "catching" sensation when the arm is lowered. As the impingement syndrome becomes more chronic, pain is felt most with shoulder activity but will not be relieved with positional change or rest. Shoulder pain may be so severe that it prevents the individual from moving his or her shoulder, which can lead to adhesive capsulitis. Pain is also frequently felt at night and may be severe enough to interfere with sleep, particularly when the individual rolls onto the affected shoulder. There may be a clicking or popping sensation felt with arm motion. The individual may have an occupation that requires repetitive arm motions. Complaints of weakness or the inability to raise the arm may indicate that the rotator cuff tendons are actually torn.

Tests: Routine shoulder x-rays, including special views of the acromial arch, are used to evaluate the shape of the arch and rule out other diagnoses. For most individuals, MRI is the imaging study of choice for shoulder pathology (DeBerardino). It is noninvasive and can be used to measure the amount of room for the rotator cuff, determine whether tendinitis is present in the cuff tendons (increased signal), determine whether osteophytes or acromioclavicular joint hypertrophy are producing impingement, detect rotator cuff tears, and detect other pathology (biceps tendinitis or rupture, labrum tear, etc.). Diagnostic ultrasound or shoulder joint arthrography (x-rays obtained after injecting a contrast medium, such as iodine solution) are alternatives that examine the integrity of the rotator cuff.

Differential Diagnoses
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Acromioclavicular osteoarthritis
Acromioclavicular separation or injury
Adhesive capsulitis
Biceps tendinitis
Biceps tendon rupture
Brachial plexus injury
Bursitis
Cervical disc disorders
Cervical spine sprain and strain injuries
Clavicle trauma
Myofascial pain
Rheumatoid arthritis
Rotator cuff tear
Rotator cuff tendinitis
Septic arthritis
Shoulder arthritis
Shoulder contusion
Shoulder dislocation
Thoracic disc injury
Thoracic discogenic pain syndrome
 

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Rotator cuff tear occurs when the tendons that form the rotator cuff weaken and tear.

Rotator cuff impingement syndrome is divided into three stages of severity. In stage I, swelling (edema) and/or bleeding (hemorrhage) occurs. Stage I is frequently associated with an overuse injury. At this stage, the syndrome can either be reversed or it can progress.
In stage II, there is inflammation of the tendon (tendinitis) and development of scar tissue (fibrosis).
Stage III frequently involves a tendon rupture or muscle tear and often represents years of fibrosis and tendinitis.
 


Tests: X-rays (Anteroposterior view, axillary view, supraspinatus view) are an essential component of evaluation to rule out calcium deposits in the joint, and bone or joint diseases. If symptoms do not improve following 3 to 6 weeks of conservative therapy, other advanced imaging modalities may prove helpful, especially in diagnosing suspected rotator cuff tears. MRI detects a wide spectrum of rotator cuff disease, including degeneration and partial to complete tears. It can also reveal soft tissue abnormalities, and proves especially valuable in tracking postoperative healing. Ultrasonography proves useful in diagnosing moderately large rotator cuff tears and evaluating other cuff disease. Widespread use of arthrography has decreased with the advent of MRI, but it remains useful in individuals for whom MRI is contraindicated (e.g., those with a pacemaker, cerebral aneurysm clip, or recent cardiac stent). Arthrography involves injection of contrast media into the glenohumeral joint followed by plain x-rays. Observed leakage of contrast material into the subacromial or subdeltoid spaces following injection indicates a full-thickness rotator cuff tear. Other diagnostic tests for rotator cuff syndrome are bone scintigraphy and CT scan, often with contrast media (CT-arthrography). Electromyography (EMG) and nerve conduction velocity studies (NCVs) may be helpful if neurologic involvement is suspected.

[Michael]

Golfer's Elbow Test, Tennis Elbow

Epicondylitis, Medial and Lateral

Definition
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Epicondylitis occurs when tendons in the elbow develop microscopic tears and degeneration, sometimes referred to as tendinopathy or tendinosis.
 
Often epicondylitis is the result of overuse or overexertion of the forearm and wrist muscles. Improper training, poor technique, or improperly sized equipment often contributes to the disorder. Some cases have been described after acute trauma from a blow to the elbow or a sudden maximal muscle contraction.

Tests: The diagnosis generally is made based upon the history and exam. In cases of medial epicondylitis, a Tinel test may be administered over the ulnar nerve to rule out ulnar neuropathy. Injection tests can help differentiate lateral epicondylitis from radial tunnel syndrome. When the diagnosis is in doubt or if an individual fails to respond to treatment, x-ray done to rule out fractures or bony abnormalities including arthritis about the joint. MRI may reveal abnormalities in the medial or lateral epicondyle consistent with tendinopathy or tear, but MRI imaging usually is not necessary.

Differential Diagnoses
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Calcium deposits (calcification)
Cervical radiculopathy
Compartment syndrome
Humeral (elbow) fracture
Infection
Irritation of the radial or ulnar nerve around the elbow (e.g., nerve entrapment)
Ligament injuries
Loose bodies with pain and locking
Medial (ulnar) collateral ligament instability or injury
Osteoarthritis
Osteochondritis dissecans
Radial neuropathy
Rheumatoid arthritis
Stress fracture
Synovitis
Triceps tendonitis
Ulnar neuropathy