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Flashcards in PTE LQ screen done Deck (60):
0

When does a PT do an Lower Quadrant (LQ)screen?

• PT already has completed history
• If a patient p/w any complaints of the lowerquadrant
• Which includes the portion of the body infe-rior to T6

1

What is the purpose of a screen?

• Narrow the region of the pt’s sx’s
• Should be able to reproduce sx’s
• Identify primary contributing impairments • Establish Neurological status
• Identify red flags

2

What are the general guidelines of performing ascreen?

• Done in the beginning of every I/E
• Novices should do the entire screen, to avoid a mis-diagnosis
• Experienced clinicians should do at least one joint
above and below the involved joint
• If post op, concentrate on joint above and below
• If acute, the specific joint has top priority
• Priority is to rule out fracture and ligamentous in-stability
• Remainder of screens, can be done in the follow-

3

The LQ Exam is divided into:

Standing
•Sitting
•Supine
•Prone

4

Why does a PT do a LQ screen?

• If a patient p/w any complaints to the lower quadrant (Below T6)
• Begin with Vitals
• Same principles of the UQ Screen, however the upper half of the bodyshould not be ignored

5

What procedures are done in thestanding position?

•Posture/Inspection
•Gait
•Standing squat
•AROM of Trunk/hips
•Neurologic Screening

6

What does the PT observe for during theposture assessment?

• Looking for obvious abnormalities
• Done with no shoes or socks on

7

What is the standing squat?

• Instruct the pt to squat down as far as possible• Looking for
• Changes in pain
• Asymmetry going down
• ROM
• Compensatory motion to avoid
pain
• Progress to one leg squat if can not
cause pain or if the PT does not see
any dysfunction

8

What does the standing squat exactly test for?

• This maneuver observes ROM of lumbopelvic, knee and ankle
• Strength of the quadriceps grossly (L2 to L4)
• If difficult, have pt do unilaterally to deter-mine the side of dysfunction
• If pt performs with no dysfunction , it is un-
likely significant impairments exist at the
knee, foot, hip, and ankle
• This allows the PT to concentrate on to
other areas

9

How does the PT assess trunk/hip flexion?

• Begin trunk flexion first, keeping knees straight, fb
ext and then SB
• Look for deviation from plane, pain, speed of mo-
tion, hip vs pelvis contribution
• Apply OP, if no pain, fb MMT
• Have the pt repeat the motion to place more mechani-cal stress or combine motions

10

What is the Romberg test?

• Feet together, arms should be crossed and with eyes open
• Then compare with eyes close
• Positive finding is an increase in sway or a lost of balance
• This assesses the dorsal column’s ability to do proprio-ception
• Should not lose balance

11

Assess S1 myotome (planterflexion)

PT asks the patient to hold a wall and perform 20 planterflexion reps.
Make sure patient does not compensate by performing a knee extension thrustAbsolutely must be done if the pt pw with neuro signs (paresthesia)

12

What procedures are done in the sitting position?

•Slump Test
•Trunk ROM
•Vertical trunk compression/decompression •Neurologic Screening

All of these has the potential for the person to complain of pain and fall if standing, therefore we ask the pt. to sit and then they will have better support.

ROM, Neuro screening, slump test, and trunk vertical compression/depression.

13

Slump Test

• General test of neurodynamic mobility
• Sensitivity = 83%, Specificity = 55% for lumbar radi-culopathy (Cook and Hegedus)
• Instructions
• Sit hands behind back
• Slump the trunk
• Extend knee
• Then DF
• Then flex neck
• Positive: If there is pain, have the patient flex
their neck to see if it increases their symptom,
then extend to see if it relieves their symptom
• Negative: If there is pain, neck flexion does not
alter the patient’s symptoms
• Symptoms can be pain, tightness feeling or
paresthesia

14

How does a PT perform sitting trunk Rotation?

Make sure block the hip

15

Compression vs distractionTrunk compression !

Test wb structures !

16

Trunk distraction Tests

ligamentous system

17

(T1-T12) myotomes

Trunk flex and extension

18

(L2) myo

Hip flexion

19

(L3) myo

Knee extension

20

(L4) myo

Dorsiflexion

21

(L5) myo

Toe extension

22

(L5/S1) myo

Knee flexion

23

DTR

Patellar tendon L3•
Achilles tendon

24

How does a reflex work?

• Sharply tapping on tendon initiates a sensory (afferent)
• The impulse that travel along a peripheral nerve to a spinalnerve
• And then to spinal cord thru the posterior root, synapses
with a motor (efferent) neuron in the anterior horn

25

What is the Babinski's reflex?

• Used to assessed UMN function
• A positive finding suggests UMN dysfunction
• Performed by
• Firmly stroking the lateral aspect of the sole ofthe foot with a blunt object
• What is a normal finding with a Babinski’s reflex?• Normal – Toes flexion
• Abnormal – toe extension
• SN = 0 -80, SP = 0-90

26

What is clonus testing?

• Is repetitive, rhythmic contractions of a musclewhen attempting to hold it in a stretched state
Mostly done with a rapid df to the ankle
• More than three beats is positive

27

What procedures are done in the supine position?

•Neck Flexion*
•Abdominal Palpation*
•SI joint stress tests*
•Lymph node palpation*
AROM/PROM of LE’s
•Straight leg raise (SLR)
•Neuro screening
* If necessary

28

Performed only if PT suspects meningitis

What is neck dural tension testing?

• Have the pt flex their neck in supine
• This causes the dural surrounding the
nerves in the body to slide up
• If pain to the lumbar spine or posterior
thigh, it may be a sign of meningeal irrita-tion or acute lumbar radiculopathy

29

Why does a PT perform an abdominal exam?

• Rule out non-neuromusculoskeletal sources of the pt’s symptoms
• The palpation is not intended to enable the PT to dx a specific dysfunction , but contributes to the overall investigation

30

How does a PT perform an abdominal exam?

• Palpate four quadrants
• Palpate superficial, if no complaints perform
aging but go deeper
• Apply in a circular fashion
• If pain is provoked, then PT does a quick re-
lease of the tissue to evaluate for rebound ten-derness
• Pain provoked by the quick release

31

What does a positive rebound tenderness indi-cate?

• May indicate peritoneal irritation, possibly aninternal bleeding, or abscess

32

OTHER PALPATION METHODS

Middleton’s Maneuver Spleen (High Spec)
Murphy’s Sign - Gall Bladder and Liver (High Spec)
McBurney’s Point - Appendicitis (High Spec)
Kidney Percussion - Kidney

33

What Sacroiliac(SI) joint stress tests should be done?

• SI pain may not be provoked with trunk motion, so need more specific tests
• SI compression and gapping test
• Make contact just lateral to ASIS and apply pressure with both hands slowly in a medial direction (Com-pression). Also can done in side line
• Then do medial to lateral pressure (Distraction of SI)
• Useful to identify irritated SI associated with AS
• In order to rule out the SI joint, as the source of pain

34

How does a PT palpate the inguinal lymph nodes in the femoral triangle?

• Palpated the femoral triangle
• Bordered by inguinal ligament, Sartorius and ad-ductor longus muscle

35

Hip
• Flex/Ext, Abd/Add, IR/ER• Knee
• Flex/ext
• Ankle
• PF/DF, inv/ev
• Toes
• Flex/Ext

.

36

How does a PT perform a SLR test?

• Dural Test of dural system es-
pecially L4-S2 & Sciatic tract
• Pt in supine, and with knee
ext, the PT slowly flex the hip
• To r/o hamstring, df foot to
see if causes pain.
• If causes pain, have pt flex neck to see if that causes more pain.
• If that is the case it is positive for dural

37

What does a positive dural test mean?

• Normally the dural systems has no pain recep-tion
• Only becomes sensitize to pain after an injury
• Therefore a positive test indicates that there is injury to the dural system
• Can be
• Herniated disc
• Tumor

38

What does a positive dural test mean?

• Normally the dural systems has no pain reception
• Only becomes sensitize to pain after an injury
• Therefore a positive test indicates that there is injury to the dural system
• Can be
• Herniated disc
• Tumor

39

What are some variations of SLR?

• Crossover
• Pain is produced with the opposite symptomatic LE, why is the other leg feeling the pain when one leg is stretched, because the sura is being stressed.
Good indication of large medial herniated disc
• Must ask about B & B function (3,pg, 515)
• Bowstring Test
• Pressure in popliteal space
• Indicates very sensitive dura

40

Murphys’ Sign -
•Test for

cholecystitis

41

What procedures are done in the prone posi-tion?

AROM/PROM of LE’s and trunk• Myotomes
• knee flexion = L5/S1
• Hip extension = S2

42

PostAnt (PA) Pressures

• Applied over the spinous, mammillary, and tp
• Apply the PA force in a slow and gentle fashion using the index and middle fingers of one hand,
while monitoring the paravertebrals with the
other hand
• Although these maneuvers are capable of elicit-
ing pain, restricted movement, or muscle spasm, or a combination, they are fairly nonspecific in determining the exact level involved, or the exactcause of the symptoms
• Poor interrater reliability

43

Wadell’s S&S is for?

•  Behavioral response to pain
•  5 nonorganic signs, and 7 non anatomic sx

44

Meningitis displays with?

•  Kernig sign
•  Brudzinski sign

45

Rib Expansion indicates?

•  Suspect •  A/S

46

Testing for
Appendicitis

•  Iliopsoas Test
•  Obturator Test

47

What are Waddell’s nonorganic signs?

• Wadell et al identified 5 nonorganic signs
• A score of 3 or more places, is categorized as a non movement dysfunction
• Have a non mechanical, pain focused behavior• Predictive of a poor outcome, and is associated with a delay in return to work
• Less than 2, is a good indicator of returning pack
to work

48

What are the 5 nonorganic Waddell’s signs?

• Tenderness = tender to light touch over wide area
of lumbar skin, unable to localize to one structure
• Stimulation tests = (+) pain to lumbar region, with
light cervical axial loading.   (+) lumbosacral pain
with acetabular rotation in the first 30 degrees
• Distraction tests = SLR discrepancy with distraction or SS vs LS.  More pain with (b) SLR, when usually
less in somatic pain2,pg164
• Regional disturbances = weakens (cogwheeling or
giving way),  weak with MMT testing, but can per-
form fnl task.  Sensory disturbance = diminished
sensation over a stocking, as oppose to a der-
matome pattern
• Overreaction = disproportionate behaviors to
pain

49

What is meningitis?

• Inflammation of the meninges and underlying
subarachnoid cerebrospinal fluid (CSF).
• May be bacterial or viral
• 2-3 per 100,000, Median age 25 y/o
• Patients may decompensate quickly and requireER

50

What are S & S of meningitis?

• Headache
• Nuchal rigidity (generally not present in children <1 y or in pa-
tients with altered mental status)
• Fever and chills
• Photophobia
• Vomiting
• Prodromal upper respiratory infection (URI) symptoms (viral
and bacterial)
• Seizures (30-40% in children, 20-30% in adults)
• Focal neurologic symptoms (including focal seizures)
• Altered sensorium (confusion may be sole presenting complaint,especially in elderly)

51

What are objective findings of meningitis?

• Nuchal rigidity or discomfort on neck flexion
• Kernig sign: Passive knee extension in supine patient elicits neck pain and hamstring resistance.• Brudzinski sign: Passive neck is accompanied by involuntary flexion of both hips.
• Isolated cranial nerve abnormalities (principally III, IV, VI, VII) in 10-20% of patients
• Altered mental status, from irritability to somnolence, delirium, and coma

52

Appendicitis is found where?

Positive McBurney’s point or rebound tender-ness (supine)

53

Appendicitis happens most likely to whome?

Younger people.

54

S&S’s of apendicitis

RLQ pain, right thigh/groin pain, abd ms rigidity, Mc Burney’s point, N&V, (+) hop
test, low grade fever, coated tongue and bad
breath, epi gastric pain

55

What is the obturator test?

• Also for infl peritoneum or inflamed appendix
• Test: pt supine, flex hip and knee, and passively IR/ERhip
• Positive: is pain to the RLQ

56

Iliopsoas test

• Done when ant hip pain can be from abdomen due to a abscess or appendix that has spread
• Test: Resist active SLR
• Positive: pain to ant hip and/or abd
• Alternative = passive hip extension in sideline

57

How does a PT assess Rib cage excursion?

• Assess rib cage excursion
• Note asymmetry
• Palpate lateral rib cage as the pt inhales and exhales
• Diminished if have AS
• Detecting abnormalities will lead the PT do a more ex-
tensive assessment in this region in the recumbent posi-tions

58

How would you distinguish if a patient had a weak kneeextension is due to a weak quads or it is due to dysfunction of the L3 Nerve root level?

Test out the dermatome of the L3 it is in the inner tigh above the knee.

59

If the weakness is due to L3 Nerve root level, is a UMN le-sion or an LMN lesion?

Clonus, babinksi can be done to determine this.