Group 2d

Winter 2013

Subjective Examination

(Petty, 2011; D.G. Simons, L.S Simons, & Travell, 1999)

Body chart
Clinician should ask about any presenting symptoms. E.g. pain, paresthesia Pain or a feeling of tightness can extend over entire deltoid region Referred pain is mainly over anterior deltoid, may extend upward over subclavicular area (such as the coracoid process) and down ulnar side of arm, forearm and fingers Pain can mimic angina of myocardial ischaemia if the left pectoralis minor is affected Pain can range from superficial to deep and have different intensities depending on the area of pain

Behaviour of symptoms
Aggravating factors: Horizontal abduction e.g. reaching out to the side at shoulder height Retraction of shoulders

Special Questions
Involves finding out if individual has medical conditions which may contraindicate assessment/treatment or affect prognosis of the injury. Questions of particular importance include: Are you suffering from any comorbidities that may impact on skeletal muscle? Are you taking any medications that may affect your muscles? Do you have any allergies? E.g. may contraindicate taping for posture

Easing factors: Keeping shoulders rounded (protraction of shoulders) Forward head posture

24 hour behaviour of symptoms: Tightness is often worse in the morning and may worsen after activities where shoulders are protracted over prolonged periods of time

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History of Presenting Condition A comprehensive history of the presenting condition should be taken with particular regard to: When did symptoms begin? How did it start? How did it change? Social History Includes information on age, gender, work and social support. What is your occupation? o Note any activities that may be causative of pectoralis minor tightness o E.g. University academic would spend a lot of time hunched over at a desk or carry a large load. In this case, questions such as, What sort of bag do you carry? can also offer insight. Do you go to the gym or work out? o Pectoralis minor tightness can be due to an imbalance in muscle

Past Medical History Clinician should consider any relevant past treatment or assessment. Have you had injuries to muscles in that area? Include questions about antagonist muscles such as latissimus dorsi, serratus anterior, rhomboid major and minor as weak antagonist muscles can often be a causative factor Have you had treatment for this condition before? Was it effective? Consider other types of treatments if previous treatment was ineffective or consider the degree of the previous treatment

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Winter 2013

Physical Examination
(Petty, 2011)

Observation Can be conducted formally as well as informally. Informal o Upon first meeting o Conduct and posture can be informative about patients mood Formal o Patient sitting posture can reflect usual posture at work o Bluish discoloration and swelling in upper extremities o Patient to demonstrate typing on computer and observe movement and note any compensatory movements that might also be occurring

AMT/ PMT
Of shoulder flexion, adduction at horizontal plane Note quality of movement, range and reproduction of patients symptoms

Muscle length tests Using a tape measure to objectively measure the distance of pectoralis minor at its attachments, coracoid process and sternal edge of the 4th rib.

Neurological tests Neuro-segmental o Test myotomes of the shoulder and neck that may be affected by enlargement or excessive tightness of the pec minor resulting in superior thoracic outlet syndrome Weakening in forearm or hand in general or after activity Neuro-dynamic o Test upper limb brachial plexus nerves Tingling - parathesia

Palpation Palpate in particular corocoid process looking for tightness/ swelling

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Winter 2013

References
Brody, L. T., & Hall, C. M. (2010). Therapeutic exercise: Moving toward function (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. Lewis, J. S., & Valentine, R. E. (2007). The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms. BMC Musculoskeletal Disorders, 8(1), 64-74. doi: 10.1186/1471-2474-8-64 Nicholas, A. W. (2009). Diagnosis and management of thoracic outlet syndrome. Current sports medicine reports, 8(5), 176-183. doi: 10.1007/s11936-009-0018-4 Petty, N. J. (2011). Neuromusculoskeletal examination and assessment: A handbook for therapists (4th ed.). Edinburgh: Elsevier Churchill Livingstone. Rondeau, M. W., Padua, D. A., Thigpen, C. A., & Harrington, S. E. (2012). Precision and validity of a clinical method for pectoral minor length assessment in overhead-throwing athletes. Athletic Training & Sports Health Care, 4(2), 67-72. doi: 10.3928/19425864-20110630-01 Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Pectoralis Minor Muscle. Travell & Simons' myofascial pain and dysfunction: the trigger point manual (2nd ed., pp. 844-861). Baltimore: Williams & Wilkins.