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

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Purpose & Use of Screening Exam 1. 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)

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Page 1: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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)

Page 2: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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.

Page 3: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

Place in the Physical Therapy Examination

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

Page 4: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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

Page 5: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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   

Page 6: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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)

Page 7: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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

Page 8: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints
Page 9: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints
Page 10: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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.

Page 11: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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

Page 12: Purpose & Use of Screening Exam 1. To determine the area to be examined in a patient with musculoskeletal impairment.  Minimal use: To "clear" the joints

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.