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Purpose & Use of Screening Exam

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Presentation on theme: "Purpose & Use of Screening Exam"— Presentation transcript:

1 Purpose & Use of Screening Exam
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. 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..) Used as part of sports physical screening exam for athletes (requires a modified/different screen)

2 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.

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

4 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

5 Grading scales for reflex integrity
With 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   

6 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)

7 Also: C4 Derm– lateral clavicle / AC T2 Derm– medial upper arm
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 / AC T2 Derm– medial upper arm

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10 Upper Quarter Screening Examination
1) 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 Elbow 7) 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.

11 Myotome & Dermatome Testing for LE
Disc Root Reflex Myotome Dermatome* L1-L2 L1 -- Iliopsoas Inguinal area L2-L3 L2 Ant-sup thigh L3-L4 L3 Patellar Reflex Quadriceps Ant middle thigh L4-L5 L4 Anterior Tibialis Ant knee - suprapatellar L5-S1 L5 Extens Hallucis L. 1st-2nd web space S1 Achilles Reflex Flex Hallucis L. Lateral foot S2 Hamstrings Medial post thigh & calf * Sensory mapping varies

12 Lower Quarter Screening Examination
A: 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.


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