Physical Examination 211: Upper Body Nerve Entrapment

The examination of upper body nerve entrapment as a chiropractor performs and documents it: the consultation and the purpose of the examination; the anatomy, motor and sensory distribution and entrapment syndromes of the axillary nerve (quadrilateral space syndrome), dorsal scapular nerve, long thoracic nerve, spinal accessory nerve and suprascapular nerve (suprascapular and spinoglenoid notches), each with mechanism, symptoms and examination findings; scapular dyskinesis and its three types; the examination on video — manual muscle testing of the deltoid, teres minor, trapezius, supraspinatus and infraspinatus on the 0–5 scale, the shrug test, serratus wall test, scapular pinch test, scapular flip sign, scapular retraction test and Janda push-up movement pattern test; and chiropractic treatment on video — the seated occipital lift, the supine thoracic adjustment and the supine shoulder adjustment.

Donald Ozello, DC, CCN, CCSM — sports chiropractor, founder of Championship Chiropractic in Las Vegas and CCEDseminars faculty for the Sports Injuries, Rehabilitation and Adjusting & Manual Therapy series — teaches the 2-hour course. It is written for Doctors of Chiropractic who want to name the nerve behind a weak or winging shoulder from the examination alone: the muscle each nerve runs, the test that isolates that muscle, and the finding that separates one lesion from another.

By which muscle has failed and how the shoulder blade moves, which is what the course teaches nerve by nerve. If the inferior border of the scapula wings away from the ribs and gets worse when the arm is raised forward, or on the serratus wall test when the patient pushes against a wall, the serratus anterior has lost its long thoracic nerve. If the upper inner corner wings during abduction, the shoulder cannot shrug against resistance and the trapezius has thinned, it is the spinal accessory nerve — and the tell is that it does not wing on forward flexion, which separates it from a long thoracic lesion. A shoulder blade that sits dropped and slid outward with weak, stiff rhomboids points to the dorsal scapular nerve. Weakness or wasting of the supraspinatus and infraspinatus together, the kind seen in volleyball players, puts the suprascapular nerve at the suprascapular notch; infraspinatus alone puts it at the spinoglenoid notch. And a shoulder that cannot abduct to ninety degrees without shrugging, with a weak deltoid and teres minor and pain or tingling that appears with activity and may be absent at rest, points to the axillary nerve in the quadrilateral space. The scapular pinch, flip and retraction tests and the Janda push-up then show whether the problem is a single nerve or the broader scapular dyskinesis of Upper Cross Syndrome. The pattern across the muscle tests, not any one of them, makes the call.

Physical Examination 211 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Dr. Ozello's Physical Examination 209: Shoulder Complex and 210: Upper Extremity complete the upper quarter with this course — 209 the joint, 210 the arm, 211 the nerves — and the three together are 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). The treatment section opens onto his Adjusting & Manual Therapy 208: Cervical Spine & TMJ, 207: Thoracic Spine & Rib Cage and 203: Shoulder Treatment Techniques, and his Sports Injuries 239, 242 and 255 take upper extremity nerve entrapment from the injury side. Dr. O'Hara's Physical Examination 202: Neck and Upper Extremities approaches the same region from the injury-pattern and imaging side. New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.