purpose & use of screening exam 1. to determine the area to be examined in a patient with...

Purpose & Use of Screening Exam1. To determine the area to be examined in a

patient with musculoskeletal impairment. Minimal use: To "clear" the joints above & below the

area of complaint.

2. Used on a patient in acute care or rehab setting; particularly a patient with a non-musculoskeletal problem

Example – to see how strong and mobile/functional a patient is prior to ambulation or transfer following ortho surgery. Or a patient with COPD, HIV, etc..)

3. Used as part of sports physical screening exam for athletes (requires a modified/different screen)

Data / Information collected

Pain – the cause (AROM, overpressure, or resistance) & location; if pain is always present, how does it change?

Impairments in ROM or strength Impairments in general

neurological function relative to sensation, strength, and reflexes.

Place in the Physical Therapy Examination

After Hx & Systems Review is performed; Prior to a detailed physical examination.

Components of screening exam AROM Passive Overpressure (push into the

endfeel)

Isometric Resistance - called gross muscle testing (not MMT); typically done with muscle/joint in mid-range position.

Sensory & Reflex testing

Grading scales for reflex integrityWith such a varying & subjective range of normal, a

bilateral comparison is of great importance.

Absent, Diminished (hypo), Normal, Hyperactive 

0, 1+, 2+, 3+, 4+ scale; with 1+, 2+, 3+ being normal unless asymmetric

 (0) , (-) , (+) , (++); with (+) representing the range of normal   

Key Concepts

Grade strength as painful/not painful and strong/weak;

Stabilize the patient when applying resistance & overpressure

Develop a personalized / systemic process – or you will be slow OR not do it at all

(+) signs usually warrant further examination (bilaterally)

Myotome & Dermatome Testing for UE (C5-T1)

Disc Level Root Reflex Myotome Dermatome

C4-C5 C5 Biceps Deltoid, (Biceps)Lateral upper

arm

C5-C6 C6 Brachioradialis Biceps, (Wrist Extens)

Thumb pad

C6-C7 C7 Triceps Triceps, (Wrist Flex)Middle finger

pad

C7-T1 C8 --Thumb

Extension, (Grip)5th finger pad

T1-T2 T1 -- PADS & DABS Medial arm

Also: C4 Derm– lateral clavicle / ACT2 Derm– medial upper arm

Upper Quarter Screening Examination1) AROM & Overpressure of Cervical Spine (flex-ext, LF, Rotation)

2) Resist C-spine rotation (C1)3) AROM & Overpressure Shoulder AROM (Apley's Scratch)4) Resist Scapular elevation (C2 – C4)5) Resist Shoulder abduction (C5)6) AROM & Overpressure of Elbow7) Resist Elbow flexion (C6)8) Resist Elbow extension (C7)9) AROM & Overpressure of Wrist 10) AROM Hand Open/Close; Resist Thumb Extension (C8) & Finger abduction (T1)11) Upper Extremity Dermatomes (C4 – T2)12) Mytotatic Stretch Reflexes (depends on findings in 1-11 above)

Biceps (C5) Brachioradialis (C6) Triceps (C7)

NOTE: The examination needed for detailed testing of abnormalities in sensation and/or motor function (peripheral nerve vs. spinal nerve vs. spinal cord tract vs. brain) is beyond the scope of a screening exam.

Myotome & Dermatome Testing for LE

* Sensory mapping varies

Disc Root Reflex Myotome Dermatome*

L1-L2 L1 -- Iliopsoas Inguinal area

L2-L3 L2 -- Iliopsoas Ant-sup thigh

L3-L4 L3Patellar Reflex

Quadriceps Ant middle thigh

L4-L5 L4Patellar Reflex

Anterior TibialisAnt knee -

suprapatellar

L5-S1 L5 -- Extens Hallucis L. 1st-2nd web space

-- S1Achilles Reflex

Flex Hallucis L. Lateral foot

-- S2Achilles Reflex

HamstringsMedial post thigh

& calf

Lower Quarter Screening ExaminationA: STANDING  1) AROM of Thoracolumbar Spine [flex-ext, LR, rotation (hold pelvis)] B: SITTING (tripod – lean back on hands) 2) AROM & Overpressure of Knee extension  3) Resist Hip flexion (L1, 2) 4) Resist Knee extension (L3, 4) 5) Resist Ant. Tibialis & Ext Hallucis Long. (L4, 5)  6) Resist Flex Hallucis Long (S1) 7) Resist Knee flexion (S2) C: SUPINE 8) SI Joint Compression / Distraction Stress 9) Passive SLR (Sciatic neural tension; L4,5,S1)  10) PROM & Overpressure of Hip 11) PROM & Overpressure of Knee Flexion 12) Lower Extremity Dermatomes (L2 – S2) 13) Mytotatic Stretch Reflexes (depends on findings in 1-12 above) Quadriceps Reflex (L3 - 4) Achilles Reflex (S1 - 2)NOTE: The examination needed for detailed testing of abnormalities in sensation and/or motor function (peripheral nerve vs. spinal nerve vs. spinal cord tract vs. brain) is beyond the scope of a screening exam.