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|Differential Diagnosis 6-9, 13-21 |

|Axillary Neuropathy |“Unhappy Triad” |Quadrilateral Space Syndrome (QSS) |Combination Peripheral Nerve Dysfunction |Posterior Cord of the Brachial Plexus Injury |C5-6 Radiculopathy |Parsonage-Turner Syndrome (PTS) | |Subjective History |Pain to the deep or lateral shoulder

• N/T of the lateral arm

• Feeling of instability

• History of trauma

• Weakness & fatigue |Pain to the deep or lateral shoulder

• N/T of the lateral arm

• Feeling of instability

• History of trauma

• Weakness & fatigue

• TTP at the insertion of the muscle involved |Pain to the deep or lateral shoulder

• N/T in a non-dermatomal pattern

• History of trauma OR overuse injury with overhead sports

• Weakness & fatigue

• TTP at the quadrilateral space

• Symptoms present in overhead activities

|Varies, depending on the peripheral nerve involvement, to include: axillary, suprascapular, musculocutaneous, & long thoracic nerves |Varies, depending on the site of the lesion, to include: radial, axillary, upper & lower subscapular, & thoracodorsal nerves |Insidious onset

• Symptoms RELATED to neck movements

• N/T of the lateral arm and webspace of the hand (dermatomal pattern) |Acute onset of intense pain

• No MOI

• Residual weakness/ paralysis

• Symptoms NOT related to neck movements | |Observation |Atrophy of the deltoid & teres minor muscles |Atrophy of the deltoid, and any combination of the rotator cuff muscles |Atrophy of the deltoid & teres minor muscles |Atrophy to the muscles innervated by the nerves listed above |Atrophy of the muscles innervated by the nerves listed above |Limited c-spine ROM

• Atrophy to the muscles supplied by the C5 & C6 nerve roots |Limited c-spine ROM

• Atrophy to the UE muscles supplied, usually those supplied by the C5 & C6 nerve roots | |MMT |Weakness of the deltoids & teres minor |Weakness of the deltoids, teres minor, & any combination of the rotator cuff muscles |Weakness of the deltoids & teres minor |Weakness to the muscles innervated by the nerves listed above |Weakness to the muscles innervated by the nerves listed above |Myotomal weakness to the muscles supplied by C5 & C6 |Weakness in the muscles innervated by the nerve involved

• Commonly, weakness of C5-6 muscles | |Neurologic Testing |Reflexes: Intact

• Myotomes: Weak deltoid & teres minor

• Dermatomes: decreased sensation along the lateral shoulder |Reflexes: Intact

• Myotomes: Weak deltoid & teres minor

• Dermatomes: decreased sensation along the lateral shoulder |Reflexes: Intact

• Myotomes: Weak deltoid & teres minor

• Dermatomes: decreased sensation along the lateral shoulder |Reflexes: Intact

• Myotomes: Weak muscles innervated by the nerves listed above

• Dermatomes: decreased sensation in the dermatomal pattern of the nerves listed above |Reflexes: diminished to biceps, brachioradialis, & triceps

• Peripheral nerve weakness & sensation deficits: in the dermatomal pattern of the nerves listed above |Reflexes: diminished to biceps & brachioradialis

• Myotomes: weakness- usually to the C5-6 muscles

• Dermatomes: mild sensory deficits in the C5-6 dermatomal pattern |Reflexes: diminished to biceps & brachioradialis

• Myotomes: weakness -usually to the C5-6 muscles

• Dermatomes: mild sensory deficits in the C5-6 dermatomal pattern | |Special Tests |(+) Deltoid Extension Lag |(+) Deltoid Extension Lag

(+) Painful Arc

(+) Infraspinatus test

(+) Drop arm sign |(+) Deltoid Extension Lag | | |(+) ULTT

(+) Spurling’s

(+) Rotation ................
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