Fix Shoulder Haikal
Fix Shoulder Haikal
Fix Shoulder Haikal
Shoulder
• The suprascapular nerve originates from the
upper trunk of the brachial plexus
scapular ligament.
What is the “Unhappy or Terrible
Triad” in regard to the shoulder?
A shoulder dislocation along with rotator cuff tear and peripheral nerve injury.
Dislocations should be considered as a clinical spectrum that includes
1) Isolated dislocations,
3) Combined injuries.
DO NOT GET CONFUSED ENTRAPMENT OF NERVE WITH ROTATOR CUFF PROBLEM!!
A) Suprascapular Nerve
Compression
Chronic or repetitive compression of the
• Weakness of shoulder
• weakness of supraspinatus
• weakness of infraspinatus
introduced.
plexus (C8 and T1) and subclavian vessels between the clavicle and
neurovascular structures in the area just above the first rib and behind
extending from the shoulder, down the ulnar aspect of the arm and
into the medial two fingers. Symptoms tend to be worse at night and
a) inspection
note specific postures, can increase loading on the brachial plexus, rounded
shoulders, increased thoracic kyphosis, downward rotation or depression of the
scapula
b) palpation
over the supraclavicular area , may reveal tenderness and/or masses and skin
temperature.
TOS Special test.
In Adson’s test the patient’s neck is extended and turned towards the
inter scalene space and may cause paraesthesia and obliteration of the
radial pulse.
TOS Special test (cont)
In Wright’s test the arms are abducted and externally rotated; again the
their head and then open and close the fingers rapidly; this may cause
Unfortunately, these tests are neither sensitive nor specific enough to clinch the diagnosis.
What diagnostic tests are helpful in
diagnosing TOS?
Klaassen describes one of the issues with TOS as a lack of a
gold standard for definitive diagnosis. Radiographs, CT scans,
and MRIs provide for detection of cervical ribs and fibrous
bands for identification of potential factors causing TOS.
What diagnostic tests are helpful in
diagnosing TOS? (Cont.)
Confirmation of a vascular abnormality is aided by the use of duplex
ultrasound, which has been found to be 92% sensitive and 95% specific.
In addition, electrophysiologic testing is valuable for differential
diagnosis and determining the presence of additional abnormalities
such as cervical nerve root or distal peripheral nerve pathology.
Treatment for TOS
By conservative treatment for TOS treatment, exercises can be done to strengthen
the shoulder girdle muscles, postural training and instruction in work practices and
ways of preventing shoulder droop and muscle fatigue. Analgesics may be needed
for pain.