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Thumbs Up or Down on Shoulder Pain?


The patient’s reach with his thumb helps distinguish between frozen shoulder and osteoarthritis. How high is enough to tell?

Pain is often severe in patients with adhesive capsulitis, or frozen shoulder, and motion is restricted. Distinguishing between frozen shoulder and osteoarthritis may be difficult. Internal rotation of the shoulder is measured by the highest vertebral level that the tip of the thumb may reach with the arm behind the back.

Normal range of motion is indicated if the thumb reaches which of the following?

A. Top of the thoracic spine (T1)
B. Midthoracic level (T7)
C. Top of the lumbar spine (L1)
D. Bottom of the thoracic spine (T12)
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