Differential Diagnosis 6-9, 13-21

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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 <60 degrees
(+) Distraction Test