Screening and Scan Examination Flashcards by Danielle Ennett

what is a scan exam
what is examined in a scan exam

a screening tool used in orthopaedic assessments that searches for physical signs and their interpretation
selective tissue tension testing, contractile and inert structures, capsular patterns

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what does AROM and PROM give information about
which structures are relaxed in resisted movements
resisted movements give information about what

AROM: willingness to move, ROM, muscular power
PROM: inert tissues, end feel, patterns in joint restrictions, pain
inert structures
contractile elements, strength, pain

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what is a capsular pattern
which conditions cause capsular restrictions
what is a non capsular pattern

a limitation of ROM in a fixed proportion specific to each joint (each joint has it’s own way of reacting)
inflammatory arthritis and disease
any other pattern, not the capsule of the joint that is the dominant feature

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give examples of a non capsular pattern

ligament sprain, tendon, internal derangement (disc, labrum), extra-articular limitation (bursitis), bone (fracture)

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why should we do a scan exam

to ensure patient presentations are within the scope of PT practice
to direct and streamline your assessment to specific joints
to identify orthopaedic lesions that present acute or subacute
to detect gross loss of function, ROM and movement control

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what do you need to consider when doing a scan exam
when do you use the scan exam

regional interdependence (one region influences another region), victims and culprits within the quadrant
after the subjective history, before the detailed assessment

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what is the most powerful, sensitive and versatile instrument available to a healthcare professional
why is this so useful

obtaining a history
because 60-80% of the relevant information related to the diagnosis can be obtained from a history

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what information can you attain from collecting a patient’s history

main problem, history of present illness
medical treatment and medication, general health
location/quality of symptoms, behaviour of symptoms
social history, psychological history, sleep

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what are the red flags too look out for when obtaining a history

fever, diaphoresis (unexplained perspiration)
sweats, nausea, vomiting, diarrhea
pallor, dizziness or fainting, fatigue, weight loss

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describe what a red, orange, yellow, blue and black flag mean/indicate

red: serious pathology
orange: psychiatric symptoms
yellow: beliefs, appraisals, judgements, emotional responses, pain behaviour
blue: perceptions about the relationship between work and health (work causes further injury)
black: system or contextual obstacles (conflict with staff over injury claim, no modified duties)

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describe what type 1 and type 2 thinking are
when is each type of thinking good

type 1: intuitive thinking, quick and effective, characterized by rules of thumb, clinical patterns and short cuts
type 2: slower, analytical and more resource intensive
type 1 good for when diagnosis is straightforward
type 2 good for when patient’s presentation is unusual

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what is regional interdependence
what is regional interdependence linked to

impairments in seemingly unrelated or remote anatomical region contributes to a patient’s primary concern
biomechanics, may be influenced by neurophysiological mechanisms

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what are the quick screening tests you observe in a scan exam

standing, sitting, A/P and lateral views, walking
gait assessment, walk on heels and toes, squat
twist, one leg stand, hand behind back/head

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if AROM is pain free, you should assess active movements with what
what are the characteristics of capsular, bony and elastic end feel and give an example for each

overpressure (apply pressure at the end of available ROM)
capsular: stretchable to a variable extent (knee ext)
bony: abrupt and unyielding (elbow extension)
elastic: recoil (ankle dorsiflexion with knee extended)

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what are the characteristics of springy, boggy and soft tissue interposition end feels, give an example for each

springy: rebound (no normal example, torn meniscus)
boggy: squishy (no normal example, felt with swelling around the joint)
soft tissue: no resistance (knee flexion)

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what are characteristics of pathomechanical, spasm and empty end feel, give an example for each

patho: jammed (no normal example, something has shifted and is blocking the ROM)
spasm: reactive response in the opposite direction of movement (no normal example)
empty: limited by severe pain and examiner’s reluctance to continue the test (no normal example)

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define myotome
how should you localize the segment of lesion

muscles that are supplied by a single segmental level (but most muscles are multi-segmentally innervated)
test the strength of specific key muscles which are most representative of a given segment

how should you test myotomes
T or F: deep tendon reflexes give some information to help localize lesions
if the nerve root is not working well there could be problems with what 4 things

make test, hold for 5s, repetitions if weakness suspected, test one muscle per myotome
T
pain, reflexes, myotomes, dermatomes

explain the grades of deep tendon reflexes from 0-4+

0: no response, always abnormal
1+: slight but present response, may or may not be normal
2+: brisk response, normal
3+: very brisk response, may or may not be normal
4+: repeating reflex (clonus), abnormal

T or F: dermatomes overlap and are variable from person to person
what findings on a sensation test would warrant further testing
what technique should you use when testing sensation of dermatomes

T
hypoaesthesia, hyperaesthesia, dysaethesia (finding we wouldn’t normally expect - aching, burning)
wrap around technique to cross multiple dermatomes

what do neuromeningeal mobility tests/neurodynamics test
neurodynamic tests can be sensitized to test the mobility of what 3 things

the ability of the NS and its supporting connective tissue to passively slide/glide in response to trunk or limb movements
dura, nerve root, peripheral nerve

what nerve is the dural sleeve innervated by
pain is produced when the dura involved is ___ with no defined boundaries
describe the pain that occurs with injury to the dura

sinuvertebral nerve at it’s own and adjacent levels
multisegmental
somatic achey pain with no paresthesia

problems with the ventral nerve root produces pain where
problems with the dorsal nerve root produces what
what is the function of the dural sleeve

segmental/radicular pain (felt along the nerve root’s dermatome)
segmental paresthesia or hypoaesthesis along that nerve root’s dermatome (usually distal part)
protects the nerve

what symptoms would you see with an UMN lesion
what is the hoffman’s sign

muscle weakness, overactive reflexes, tight muscles, clonus, babinski response, hoffman’s sign
involuntary flexion movement of thumb or index finger when middle finger is flicked

what arteries should you palpate when palpating the spine what are you checking for what pressures do you exert when palpating the spine

brachial, radial, ulnar, popliteal, dorsalis pedis, posterior tibial pain provocation, how willing the segment is to move anterior/posterior or springing

what things should you look for when observing the upper quadrant in a scan exam when examining active movements for the upper quadrant in a scan exam, what movements should you examine

head position, scars, muscle atrophy, scapular position, deformities cervical flexion/extension/rotation/side flexion GH flexion, abduction, hand behind head/back flexion, extension, adduction, abduction for wrist, finger and elbow

you should not apply overpressure when examining active movements of what movement at which joint there are no reflex tests for which nerve roots what nerve roots are tested when checking reflexes of the biceps tendon, brachioradialis tendon and triceps tendon

cervical extension C8, T1 biceps: C5-C6 brachio: C6 triceps: C7

what does the slump test examine how would you position the patient for the slump test is this test performed actively or passively

the extensibility of the dura seated with feet unsupported and hands clasped behind back, add in thoracic flexion, neck flexion, knee extension actively

what is a normal response to the slump test when neck flexion is added most patients are unable to do what in the slump test what would indicate a positive slump test

central T8-T9 pain straighten the knee due to stretch in posterior thigh and knee if it reproduces their symptoms, if neck extension allows for more knee extension before symptoms are recreated

how would you assess upper cervical flexion in a passive neck flexion test how would you assess both upper and lower cervical flexion in a passive neck flexion test what is a normal and abnormal response to passive neck flexion

patient is asked to tuck their chin therapist maintains the tuck and cradles the head, gently lifting it with the patient relaxed normal: soft tissue stretching in neck abnormal: produces typical symptoms (neck or low back pain)

what does the upper limb tension test A assess how do you perform the upper limb tension test A what is one of the sensitizing maneuvers in this test

neurodynamics of the median nerve scapular elevated is prevented as the arm is brought into abduction, forearm supination, wrist and finger extension, shoulder ER and elbow extension ipsilateral cervical lateral flexion

how would you do the modified upper limb neurodynamic test what is the diagnostic criteria for the upper limb tension test

same positioning as the normal test but with the elbow fully extended and prevention of scapular elevation positive upper limb tension test 1, positive spurling A test, limited cervical rotation to affected side (<60 deg), positive distraction test

how should you test dermatomes what should you look for in your observation during a lower quadrant scan what are the screening tests for a lower quadrant scan

both sides at the same time with the patients eyes closed, ask "does this feel the same on both sides" postural type, gross deformities, scoliosis, gait squat, twist, walk on heels and toes, one leg stance

when assessing active movements, which joints should you test first which spinal root is tested when doing reflexes at the quads, medial hamstring and achilles

proximal to distal (lumbar, hip, knee, ankle) quad: L3 hamstring: L5 achilles: S1

when testing neurodynamics, which side should you test first the straight leg raise (SLR) tests tension of what structure the SLR test is a ___ test

less painful side the nerve root passive

what are the main symptom areas in the SLR test what may the patient complain of in the SLR test what degree of hip flexion is considered normal range with stretch felt

posterior thigh, posterior knee, posterior calf extending to the foot pain or deep stretch sensation 70 degrees

how can you sensitize the SLR test why would you want to sensitize the test

adding an additional movement or movements to wind up the tissues (ankle dorsiflexion, eversion, hip adduction/medial rotation, cervical flexion) to ensure that the symptoms recreated in the normal test aren't just due to a tight muscle but instead is a neurological issue

the prone knee bend checks extensibility of what is this test active or passive what would indicate that this is a positive test

upper nerve roots (L3) passive if it reproduces their typical leg complaints

what should you consider while palpating the lumbar spine after performing a scan, what are the four things we should be able to tell from the scan

gross amount of movement, level of pain, hyper/hypo mobility of joints and comparing it to levels above and below if it's mechanical or non mechanical, amenable to treatment, neurological involvement

define a mechanical issue

a specific pattern is seen or symptoms are provoked when we load a structure or tissue