Shoulder, Arm, Hand

History-taking for the shoulder: key diagnostic questions

• "Red flag" symptoms of urgent/serious medical conditions warranting referral to physician care: fractures, dislocations and complete tears; neuropathies; tumors
• Differentiating symptoms of muscle, tendon, ligament, labral, capsular, and nerve injuries
• Neural hypersensitization and psycho-social factors
• Functional capacity questionnaires for reporting to managed care insurance

Physical exam of the shoulder: how findings can guide treatment with acupuncture modalities

• Observation, inspection and palpation
• Joint active range-of-motion and tracking exam: taking measurements and diagnostic significance
• Assessment of joint stability through end-feel testing
• Muscle length and manual strength testing and referred pain patterns charts for 18 key muscles of the shoulder girdle
• Special orthopedic tests
• Documentation of physical exam findings
• Measuring and reporting functional capacity baselines and treatment outcomes
• Clinical flow charts to facilitate efficiency and accuracy in examination

Diagnosis, pattern identification and treatment for shoulder girdle pain, injuries and disability

• Gleno-humeral joint
  • Non-capsular patterns: AMBRI and SLAP (labral) tears
  • Capsular patterns: osteoarthorosis, capsulitis, and "frozen shoulder"
• Acromio- and sterno-clavicular joint sprains/separations and hypermobility
• Rotator cuff tendonitis/tendonosus, impingement, and bursitis
• Bicipital tendinopathies

Day 2: Arm, Wrist, and Hand

Clinical anatomy, kinesiology, and the jing-jin: 

• Elbow joints: ulnar-humeral, radio-humeral and -capitellar
• Wrist joints: ulnar-carpal, radio-carpal, and distal radio-ulnar
• Muscles and tendons of the upper- and fore- arm and hand

History-taking for the arm, wrist, and hand: key diagnostic questions

• "Red flag" symptoms of urgent/serious medical conditions potentially warranting referral to physician care: fractures, neuropathies, complex regional pain syndrome
• Differentiating symptoms of muscle, tendon, ligament, joint, and nerve injuries
• Neural hypersensitization and psycho-social factors
• Functional capacity questionnaires for reporting to managed care insurance

Physical exam of the arm, wrist and hand

• Observation, inspection and palpation
• Active and passive range-of-motion examination of the elbow, wrist, and finger joints: measurements and diagnostic significance
• Assessment of joint stability through end-feel testing of the elbow, wrist and finger
• Peripheral nerve sensory and motor exams
• Manual and dynamometer strength testing, muscle length testing, and referred pain pattern charts for 20 key muscles of the arm, wrist and hand
• Special orthopedic, neurologic and vascular tests
• Documentation of physical exam findings
• Measuring and reporting functional capacity baselines and treatment outcomes
• Algorithmic flow charts to facilitate efficiency and accuracy in examination

Diagnosis, pattern identification and treatment for arm, wrist and hand pain, injuries and disability

Posterior & radial tracts: yangming and shaoyang

• Tennis elbow, extensor strains, tendinosus, radial tunnel compression neuritis and palsy
• Radial styloid stenosing tenosynovitis
• Radial collateral ligament sprains and hypermobility

Ulnar tract: taiyang and shaoyin

• Ulnar neuritis/neuropathy
  • Ulnar groove compression
  • Canal of Guyon compression
• Acute sprains and chronic laxity of the ulnar-carpal joint
• Acute tendonitis and chronic tendonosus
  • Golfer’s elbow & “medial epicondylitis”
  • Extensor carpi ulnaris
  • Flexor carpi ulnaris
  • Abductor digiti minimi
  • Ulnar collateral ligament laxity & “Little league elbow”

Anterior tract: taiyin, shaoyin, jueyin

• Biceps, supinator and forearm flexor tendonitis and tendonosus
• Median neuritis/neuropathy
  • Pronator teres syndrome
  • Carpal tunnel syndrome

Intrinsic wrist conditions

• 1st CMC joint pain: sprains, DJD
• Triangular fibrocartilage complex tears

Intrinsic hand conditions

• MCP and inter-phalangeal joints
  • Sprains and laxity of finger collateral ligaments
  • Degenerative joint disease
• Finger extensor tendonitis

Ergonomics, postural correction and exercise therapy for shoulder, arm and hand conditions:

• Scapular stabilization
• Rotator cuff strengthening
• Forearm exercises
• Wrist stabilization
• Keyboard ergonomics

Build on your skills with the Review/Practicum Lab