Neck and Shoulder Disorders

Neck and Shoulder Disorders
 The best way for a healthcare provider to obtain knowledge of job duties is through a worksite visit.
Another ways are written work description, videotape of the job tasks, picture of the employee
working at the workstation .
 The use of the splint should be reduced relatively rapidly, within weeks, in order to avoid
 Prolonged splint usage can lead to muscle atrophy, joint stiffness, or splint dependency.
Exceptions are sprains (ligament), which may require splinting for longer periods.
 Generally, splints should not be worn during work.
 Material handling performed near maximal capacity (80–100% of maximal) will increase the risk for
strain injuries due to poorly controlled movements.
 Foramen compression test → The examiner rotates the patient’s head, while at the same time
flexing it laterally to the same side. This maneuver results in narrowing of the intervertebral
cervical foramina allowing detection of a nerve root compression and irritation (cervical
radiculopathy). A positive test result occurs when the patient experiences pain or numbness in the
forearm and hand of the side to which the head is rotated and flexed.
 Arm-Lasegue test → the examiner who tilts the patient’s head to one side (lateral flexion) and, on
the other side, depresses the shoulder girdle. In this test, the nerves of the cervical brachial plexus are
stretched and abnormal irritation to these structures will result in pain or paresthesias in the
forearm and hand on the side of the depressed shoulder.
 Roos test → assessment of thoracic outlet syndrome. The patient is again in a sitting position and
elevates both the arms to 90 degrees abduction with external rotation (‘hands up’ position). The
patient is instructed to open and clench the hands at a rate of once per second for 3 minutes. The
normal experience during the test is a forearm tightness and neck and shoulder fatigue. Patients with
abnormal irritation involving the lower trunk of the brachial plexus develop progressive tingling and
pain of the ulnar side of the forearm and hand.
 Posture and force are the main risk factors for shoulder tendinitis.
 High local load on the shoulder is considered present when the hand is kept one hour per working
day at or above shoulder level, or when repetitive flexions or abductions more than 60 degrees in
the shoulder joint are performed frequently and regularly during the working day.
 Cervicobrachial pain syndromes :
Cervicobrachial pain syndrome is defined as pain in the shoulder and neck, with or without
radiation to the arm and hand, where the anatomic basis for the pain cannot be identified.
The criteria for tension neck syndrome are usually pain in the shoulder or neck in addition to
tenderness over the descending part of trapezius muscle (shoulder–neck area).
Blood test and radiographic examination are typically normal.
 Roos test positive → TOS , servical discopathy , cervicobrachial pain Sx