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 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)
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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.
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Place in the Physical Therapy Examination
After Hx & Systems Review is performed; Prior to a detailed physical examination.
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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
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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
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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)
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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
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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.
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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
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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.