We're going to be doing the costoclavicular
test for thoracic outlet syndrome.
It evaluates the neurovascular bundle
and it can compress the subclavian artery and the neurovascular bundle between
the rib and the clavicle. So what I'm going to do is
get your pulse here. Great.
I'm going to bring your arm back, externally rotate it. I'm going to have you sit up straight. Great.
And I'm looking for recreation of symptoms, loss of pulse.
If you don't get a loss of pulse but you do get symptoms, I would go to the
upper limb tension test and use those for a
peripheral nerve problem related to
the brachial plexus.
We're going to do Adson's thoracic outlet test for the neurovascular bundle. It runs
the subclavian artery and the brachial plexus.
So a person that would be having thoracic outlet may be having numbness and tingling in the hand,
coldness in the hand
and
their hand may get very cold and blotchy and white,
lack of circulation.
So some of the kinds of things
you'd find that, pins and needles, numbness
paresthesia, cold hand.
And so what you got to do is you've got to find the radial pulse.
And I've got the radial pulse there very clear.
I'm going to bring the arm back into extension and external rotation.
I'm going to put a little bit of pressure here. But what I want her to do is turn her head towards me,
extend the head back a little bit,
right there. And I want you to take a deep breath.
I want you to hold that
and that's going to affect the scalene anterior on this side.
Hold that and the pulse is fine. That's good.
You're clear. Good.
We're going to do Wright's test. It's another thoracic outlet test. And I'm going to find
Meghan's pulse,
radial pulse.
Bring the arm up, externally rotate.
I'm going to have you turn your head
to the right for me.
Good and just hold that.
And pulse has diminished a bit.
And that affects the pec minor that compresses,
it compresses the pec minor over
the neurovascular bundle. Okay.
Okay again, we're going to do
Halstead's maneuver, which is another thoracic outlet test.
Find the radial pulse.
Bring the arm back.
I'm going to rotate
your head back here and extend it back a bit.
She doesn't have to take a
deep breath this time. And this also compresses the scalenes, helps to compress
the neurovascular bundle as well, with this test.
Okay. And the pulse is good.
We're going to do Speed's test. Speed's is for a tendinitis or tendinosis of the long head of
the bicep.
So what you want to do is palpate the long head of the bicep in the bicipital groove.
You want to bring the arm out.
What I want you to do is hold that in that position.
I'm going to apply pressure and the person's hand has to be in supination
and then pronation.
I'm going to apply pressure down,
but you're going to allow me to push down, but just resist my movement, but allow me to push the
arm into extension first. Good. Great. Now I'm going to bring it back up.
We're going to pronate.
Feel the top of the
line of the bicep. Hold that there and I'm going to apply pressure down into extension.
Great. So reproduction of pain. Let your arm relax.
Reproduction of pain in the log head of the bicep or the bicipital groove
with the resisted
shoulder extension
may show signs of tendinitis or tendinosis of the long head of the bicep.
We're going to do a drop arm
test for the rotator cuff, tears in the rotator cuff.
It may also shows signs of supraspinatus or maybe infraspinatus tendinitis.
So what we're going to do is bring the arm up. You passively raise the arm up.
I'm just going to hold here. And then you let the arm go and then you ask the person to slowly lower their arm,
slowly lower their arm. And if they can't do that or they find pain and discomfort, let your am go, then
you'll just passively bring their arm back again. So it's looking for rotator cuff problems,
supraspinatus, infraspinatus
tears and it may also identify some muscles lesions related to
the supraspinatus,
infraspinatus,
in the context of tendinitis.
So we're going to do Neer's test. Neer's test tests for, it's an impingement syndrome test.
Though impingement syndrome often means that there is tendinitis of the
supraspinatus,
maybe the long head of the bicep
or bursa problems
in this region.
So what you're going to have the person do is
medially rotate their hands so their thumb
is towards them.
And you're going to bring the arm up in that position, in that plane. Bring it up, bring it up.
And if
there's pain and discomfort in this region then it would be positive for an impingement syndrome.
So that's compressing
the supraspinatus
underneath the acromion process. The long head of the bicep may also be compressed along
the acromion process,
creating pain and discomfort.
We're going to do an empty can test, which we're going to bring the arms up in neutral, just straight out
like this. And we're testing for
rotator cuff or a supraspinatus tear in the tendon or muscle belly.
And I'm going to do a little resist test here, three times for five seconds. Then I'm going to bring the arms up to
about thirty degrees or close to the plane of the scapula.
Thumbs are going to point down.
And then I'm going to resist test
here as well. So if there's weakness, pain
and inability to hold the position
it could be a tear in the supraspinatus muscle belly
or a nerve
problem as well.
We're going to do the Hawkins Kennedy. Again, Hawkins Kennedy is an impingement syndrome
test
or a test for impingement syndrome.
You're trying to compress the long head of the bicep under the acromion process or
the acromion clavicular ligament.
It may also affect the supraspinatus as well.
So bring the arm across. You adduct the arm in front of the body
and you do a little medial-lateral rotation.
And you can do it in different planes. You can do it a little lower, a little higher.
If the person is having
impingement problems of the shoulder
with those two muscles
it will often show itself with this test.