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Subjective and Objective Examination for Angela

Patient Name/ Date of Birth: Female/ 1975


Reason for referral: R upper extremity pain
Medical Diagnosis/ Health Condition: R TOS
Primary Language: English
Subjective Examination/ Patient Interview
Patient Goals: Return to desk job and exercise routine without R arm pain.
Personal Factors (Nutrition, Physical Activity/ Exercise Routine, Sleep): Patient exercises with use of elliptical
trainer and lifting weights for upper extremities 4 times a week. Has continued despite pain. Unable to sleep
on left side without symptom exacerbation.
Environmental Factors: Ergonomic set up at workstation.
Body Chart: (location of symptoms, description of symptoms, relationship of symptoms, clear other areas with
a checkmark) P1: Right Upper trapezius area (ache, c, v), P2: ache to right posterior/ medial arm/ forearm P3:
occasionally experiences N/T to entire right hand
Structures that underlie area of symptoms:
P1P2Structures that refer pain to the area of symptoms or
contribute to the area of pain:
P1P2Consider non-musculoskeletal structures that refer to area of
symptoms:
STOP! A question for you: Based on the body chart what is your hypothesis/hypotheses?
Activity Limitations: (establish irritability)
Aggravating factors: Seated position working on laptop. Work out activities including doing sit-ups
and some pain with lifting weights.
Ease factors: P2 takes 1-2 days for symptom relief
Self Care (ADLs and IADLs): some upper extremity pain with putting on eye makeup.
24 hour: slight ease in the morning.

Subjective and Objective Examination for Angela

Subjective Examination/ Patient Interview


Current History: Gradual onset of P1 and P2. Symptoms began increasing after working out at the gym.
Severe exacerbation after sleeping in an airplane with head leaning and resting in left sidebend. Noticed right
hand was asleep, discolored and felt cold upon waking up. Symptoms gradually decreased over the next
several days.
Past History: In MVA 1 year ago.
Review of Systems (Body Structure/ Body Function Impairments): clear
General Health:
Malaise:
Chills/ Sweats/ Fever:
Unexplained Weight Loss/ Gain:
Cardiovascular/ Hematological:
Fatigue/ Weakness:
Paresthesia/ Numbness:
Dizziness/ lightheadedness:
Musculoskeletal
Weakness:
Cough/ Sneeze:
Neurological
Paresthesia/ Numbness:
Integumentary
Skin changes:
Gastrointestinal:
Bowel or bladder:
Nausea:
Metabolic:
Diabetes:
Medications: none
Diagnostic Tests: MRI c-spine negative`

Subjective and Objective Examination for Angela

Objective Examination Tests and Measures


Observation of Posture (Supine, Sitting, Standing):
**Static: Flat T-Spine and mild forward head posture with slight R cervical sidebend. Elevated, protracted and
anteriorly tiled R scapula with increased upper trapezius muscle tone noted.
Functional Test:
**Shoulder Elevation to simulate putting on eye make-up provokes P1
TS ROM:
**Flexion: general ROM is WNL; mod limited in T2-T5 segments
**TS Extension: max limitation (neutral), no increase in symptoms
TS Right SB: WNL
TS Left SB: WNL
Left Rotation: WNL
Right Rotation: WNL
Right Rotation with neck flexion (NT), neck rotation (negative) and **right shoulder elevation
(provoked symptoms to armP2)
Provocation Testing:
F + SB + Rot: negative bilaterally
E + SB + Rot: negative bilaterally
Special Tests:
Neurodynamic Testing
Thoracic Slump: negative
ULNT #1: P1 at 80 degrees of GH External Rotation, onset of P2 at -40 degrees of elbow extension
Rib Testing:
Lindgren Test: Positive on Right
Rib Position/ Spring Tests: posteriorly rotated rib at T3 and T4
Rib Mobility/ Spring Testing: local pain with spring testing at T3 and T4
First Rib Mobility: Right 1st rib (supine) stiff, III and IV

Subjective and Objective Examination for Angela

Objective Examination Tests and Measures


Strength Testing:
Resisted SB And Rot (isometric): clear/ no reproduction of symptoms
Lower Trapezius: right=4-/5
Muscle Length Testing:
Serratus Anterior: WNL
Pectoralis minor/ major: Mild tightness right pectoralis major sternal head. Moderate/ severe tightness R
pectoralis minor
Lattisimus Dorsi: WNL
Scalenes: Moderate tightness R in all 3 muscles
Thomas Test: Mild decrease in hip flexor length on L versus R.
Palpation:
Soft Tissue Palpation: Active trigger points and muscle spasm in R pectoralis major and minor. Trigger points in
R Upper Trapezius and Serratus Anterior. Elevated first rib noted on R.
PAIVM assessment:
1. Unilateral PAs to right C7/ T1, T1/ T2 stiff, III
2. Central PAs general stiffness from T-T5, III
Implication/ Clearing Tests:
Shoulder: Flexion, Abduction, HBH
CS: CS Rotation and SB/ appropriate provocation testing; Patient would test positive with Left SB due to tight
right scalenes. To differentiate out joint/ tightnesssupport arm and then test SB.
TOS Tests: Which tests would you perform? Adsons and Halstead
Neurological:
Segmental: WNL
Cognition: WNL