1:Acrmionclavicular joint

2:Thoracic outlet syndrome

SPECIAL TEST
Shoulder Joint
 Introduction
 Shoulder complex composed of
clavicle ,scapula ,& humerus which
form three joints that links upper
extremity to the thorax.
 Structures of shoulder complex are
designed primarily for mobility,
allowing us to move & position the
hand through a wide range of space.
Introduction
 The shoulder consists of a ball and
socket joint formed by humerus
and scapula and their surrounding
structures-
ligaments,muscles,tendons which
supports the joint to maintain in
position.
Movements of Shoulder Joint

 Flexion and Extension

 Abduction and Adduction
 Medial and Lateral Rotation
 Circumduction
Shoulder joint
 Introduction
 1:Sternoclavicular joint (SC)
 2:Acromioclavicular joint(AC)
 3:Glenohumeral joint (GH)
 4:Scapulothoracic joint (ST)
2:Acromioclavicular joint(AC)

The acromioclavicular joint is a joint at the

Top of shoulder. It is between the acromion
and the clavicle.
 The joint is stabilized by three ligaments:
 1:Acromioclavicular Ligament
 a)superior Acromioclavicular Ligament.
 b) Inferior Acromioclavicular Ligament
 2:Coracoacromial ligament
 3: Coracoclavicular ligament
ligaments
 1)Acromioclavicular ligament,which
attaches the clavicle to the acrmion of the
scapula.
 2)Coracoacromial ligament which runs
from the coracoid process to the
acromion.
 3)coracoclavicular ligament,which consist
of two ligaments,the conoid and the
trapezoid ligaments.
 Connects clavicle with coracoid process of
scapula.
Function
 The acromioclavicular joint
provides the ability to raise the
arm above the head.
 It helps with movement of scapula
resulting in a greater degree of
arm rotation.
Injury(AC)
 Acrmioclavicular joint dislocation is
particularly common in collision
sports such as ice hockey,
football ,judo ,rugby .
 The most common mechanism of
injury is a fall on the tip of
shoulder or “FOOSH”.(FALL ON
OUTSTRETCHED HAND)
Special Test of Acromioclavicular
joint

1: Horizontal
Adduction Test
2:Paxions Test
1:Horizontal Adduction Test
 Horizontal Adduction Test

Test Position: Sitting or standing.

Performing the Test: The examiner should stand

behind the patient on the side being tested. Grasp
the patient’s arm to the elbow and passively flex the
patient’s shoulder to 90 degrees. Then maximally
adduct the patient’s shoulder . A positive test is
considered if the patient reports pain during the
adduction motion or localized pain in the AC joint.
Purpose of Test:To test for presence of AC joint
dysfunction
2:Paxinos sign
Paxinos Technique

 With the patient sitting and the arm by the

side, the examiner's thumb is placed under
the posterolateral aspect of the acromion and
the index and middle fingers of the same
hand are placed superior to the mid-clavicle
 The examiner provides pressure to the
acromion in an anterosuperior direction with
the thumb, while also applying pressure an
inferior direction to the mid-clavicle with the
index and middle fingers .
Paxinos Technique(con)
 If pain is elicited or increased in
the region of the acromioclavicular
joint, the test is considered
positive.
Thoracic outlet syndrome

 Introduction :
 Thoracic outlet syndrome is a
condition where by symptoms are
produced from compression of nerves
or blood vessels, or both, because of
an inadequate passageway through
an area (thoracic outlet).

Cause
 Common cause of TOS include
physical trauma from car accident,
repetitive injuries from job or
sports related activities .
 Poor posture : Drooping your
shoulders or holding your head in
forward position can cause
compression in the thoracic outlet
area.
Thoracic outlet syndrome symptoms
include

 Thoracic outlet syndrome symptoms

include
 neck pain,
 shoulder pain,
 arm pain,
 numbness and tingling of the fingers,
and
 impaired circulation to the extremities
(causing discoloration).
 Discoloration of your hand .
 Arm pain and swelling.
 Blood clot in veins or arteries .
 Weak or no pulse in affected arm
Diagnosis & Treatment.
 Diagnosis of thoracic outlet syndrome
is suggested by the symptoms and
physical findings and is sometimes
supported by nerve conduction
and/or radiology tests.
 Treatment of thoracic outlet
syndrome usually involves physical-
therapy exercises and avoiding
certain prolonged positions of the
shoulder.
What is thoracic outlet syndrome?

 Thoracic outlet syndrome (TOS) is

a condition whereby symptoms are
produced (such as numbness in
fingers, pain in shoulder, arm, and
neck) due to compression of
nerves and/or blood vessels in the
upper chest.
What is thoracic outlet syndrome?
(con.)

 Any condition that results in

enlargement or movement of these
tissues of or near the thoracic outlet can
cause the thoracic outlet syndrome.
These conditions include muscle
enlargement (such as from weight lifting
), injuries, an extra rib extending from
the neck (cervical rib), weight gain, and
rare tumors at the top of the lung. Often
no specific cause is detectable.
Thoracic outlets Syndrome(TEST)

1:Roos Test
2:Adsons maneuver
Test
1: Roos Test
Roos Test (con)
 Roos Test is a common test included
in the examination of the shoulder,
specifically for the presence of Thoracic
Outlet Syndrome (TOS). The test is
very easy to carry out. It is also knows
as the EAST (Elevated Arm Stress
Test) Test or the Hands Up Test.
 Involved Structures
 subclavian artery
 brachial plexus
Roos Test(con)
 Starting Position
 In this test, the patient raises their arms to 90
degrees of abduction in the frontal plane of the
body with the arms fully externally rotated and the
elbows at 90 degrees of flexion.
 Test Movement
 The patient opens and closes their hands for up to
3 minutes.
 Positive Test
 The test is considered positive if the patient is
unable to hold the arms up for the 3 minutes, or if
the patient experiences pain, heaviness or
parasthesia in the shoulder, arm or hands.
Roos Test
2) Adsons Test

 Adson's test is a provocative test for

Thoracic Outlet Syndrome

 Technique
 Patient in upright position.
 Passively extend, abduct and externally rotate
affected arm while palpating the radial pulse.
 Ask patient to take a deep breath and hold it
in.
 Ask patient to extend neck and rotate the head
towards affected side.
Adsons Test(con)
 The test is positive if there is a
marked decrease, or
disappearance, of the radial pulse.
It is important to check the
patient's radial pulse on the other
arm to recognize the patient's
normal pulse.
  
THANK
YOU