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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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