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Diagnosing upper limb somatic dysfunction

Notes

Notes

Upper limbs

Diagnosing upper limb somatic dysfunction

Please refer to the Special tests for the upper limb learn page to learn about special tests that are used in clinical practice to aid in diagnosing upper limb somatic dysfunction.

Sternoclavicular joint somatic dysfunction

Superior proximal clavicle

  • Clavicle will resist posterior and inferior glide at the sternum
  • Decreased motion of clavicle around transverse axis

Acromioclavicular joint somatic dysfunction

External rotation somatic dysfunction

  • Shoulder resists internal rotation and prefers external rotation

Internal rotation somatic dysfunction

  • Shoulder resists external rotation and prefers internal rotation

Adhesive capsulitis (“frozen shoulder”)

Adhesive capsulitis is characterized by pain and restriction of shoulder motion that progressively worsens over time. The patient experiences decreased range of motion at the shoulder joint with both active and passive movements. It is typically caused by prolonged immobility of the shoulder. The Spencer technique may be utilized to improve motion at the shoulder and help reduce adhesions.

Brachial plexus injuries

The brachial plexus is susceptible to traction injury, and many brachial plexus injuries occur during difficult childbirth.

Erb-Duchenne palsy

  • Most common form of brachial plexus injury
  • Caused by injury to C5 and C6
  • Results in paralysis of the deltoid, external rotators, biceps, and brachioradialis

Klumpke palsy

  • Much less common than Erb-Duchenne palsy
  • Caused by injury to C8 and T1
  • Results in paralysis of the intrinsic muscles of the hand

Winging of the scapula

This condition is characterized by weakness of the serratus anterior muscle due to a long thoracic nerve injury (C5–C7). The scapula will protrude posteriorly when the patient is asked to push on a wall.

Humeroulnar joint somatic dysfunction

Adduction of the ulna (varus elbow)

  • Proximal ulna (olecranon) shifts laterally
  • Distal ulna shifts medially (adduction)
  • Results in reciprocal abduction of the wrist
  • Decreased carrying angle

Abduction of the ulna (valgus elbow)

  • Proximal ulna (olecranon) shifts medially
  • Distal ulna shifts laterally (abduction)
  • Results in reciprocal adduction of the wrist
  • Increased carrying angle

Lateral epicondylitis (“tennis elbow”)

This condition is defined as a strain of the extensor muscles of the forearm at the lateral epicondyle.
  • Develops as a result of overuse (repetitive motions) of the forearm extensors and supinators (e.g., hitting a ball in racquet sports, turning a screwdriver)
  • Patients present with pain over the lateral epicondyle that worsens with wrist extension and supination against resistance

Medial epicondylitis (“golfing elbow”)

This condition is defined as a strain of the flexor muscles of the forearm at the medial epicondyle.
  • Develops as a result of overuse (repetitive motions) of the forearm flexors and pronators (e.g., swinging a golf club, throwing a baseball)
  • Patients present with pain over the medial epicondyle that worsens with wrist flexion and pronation against resistance

Radioulnar joint (radial head) somatic dysfunction

Remember that in supination the radial head moves anterior, and in pronation the radial head moves posterior (remember the mnemonic “SAPP”). Falling on an outstretched hand behind you (upper extremity is supinated) results in an anterior radial head dysfunction. Falling on an outstretched hand in front of you (upper extremity is pronated) results in a posterior radial head dysfunction. Posterior radial head dysfunctions (falling forward on an outstretched hand) are much more common.

Anterior radial head (supination)

  • Radial head (proximal radius) prefers an anterior position
  • Prefers supination
  • Restricted in pronation

Posterior radial head (pronation)

  • Radial head (proximal radius) prefers a posterior position
  • Prefers pronation
  • Restricted in supination

Radiocarpal joint (wrist) somatic dysfunction

Wrist flexion

  • Prefers wrist flexion and resists wrist extension

Wrist extension

  • Prefers wrist extension and resists wrist flexion

Wrist abduction

  • Prefers radial deviation (wrist abduction)
  • Resists ulnar deviation (wrist adduction)

Wrist adduction

  • Prefers ulnar deviation (wrist adduction)
  • Resists radial deviation (wrist abduction)