REIDER PART 171

Chaptek 2_Shoulder and Upper Arm 61

Figurę 2-77. Yergason’s test.

head biceps tendon in the intertubercular groove. This phenomenon is usually associated with a tear of the rotator cuff. To perform the test, the examiner grasps the patient s arm and brings it into abduction and external rotation (Fig. 2-78A). While palpating the bicipital groove> the examiner then internally rotates the shoulder in the scapu-lar piane. Subluxation or dislocation of the tendon pro-duces a palpable and sometimes audible snap (Fig. 2-78B).

Thoracic Outlet Syndrome

Compression of the neurovascular structures as they exit the thorax above the first rib is known as thoracic outlet syndrome. It has many origins. Compression can cause pain and paresthesias in the arm and shoulder. This syndrome is part of the differential diagnosis of shoulder pain. Its symp-toms can easily be confused with much morę common dis-orders such as rotator cuff tendinitis. Several maneuvers have been described to help diagnose this condition.

Adson’s test is the most well known of these maneu-vers. The arm of the seated or standing patient is abducted 30° at the shoulder and maximally extended. The examiner grasps the patient s wrist, positioning the examiner s fingers to palpate the radial pulse. The patient is then asked to turn the head toward the injured shoulder (Fig. 2-79A). The patient may also be asked to take a deep breath and hołd it. The examiner evaluates the qual-ity of the radial pulse in this position and compares it with the ąuality of the pulse with the arm rcsting at the patienfs side (Fig. 2-79B). Diminution or disappcarance of the pulse in the test position suggcsts the possibility of a thoracic outlet syndrome, especially if the patient s symptoms are reproduced. Some clinicians have modified this test by having the patient turn the head away from the side being tested (Fig. 2-79C). A similar test, in which the shoulder is abducted to 90° and fully externally rotated, is known as WrighTs maneuver.

In the Roos test, the patient is asked to abduct the affected shoulder 90° while flexing the elbow 90° as well. The patient is then asked to open and close the hand 15

Figurę 2-78. A and B, Biceps instability test.

B