Flashcards in Upper Quarter Screening Deck (9):
A patient comes in with a problem. First you take their history, then you conduct a screening examination. For the upper quarter (UQSE), what are the first 4 primary screening steps you'll take?
Components of a Screening Examination
1) Active ROM
-quality of motion
2) Passive ROM
3) Resisted Isometrics (RI)(AKA Resisted movements or RROM)
-isometric contraction in the neutral (anatomic) position (4-6 second hold)
-start slowly and bring it to 25% resistance slowly
4) Neurologic exam
Dermatome -light touch and/or pain
Myotome-isometric contraction at mid range (4-6 second hold)
-should be about 25% of their surmised max strength
-not the same as resisted isometrics because these are done through the range of movement
-stop if patient shows pain (+ reaction)
Deep tendon reflexes
Resistance for RI and myotomes needs to be done with low (25%) intensity when beginning the exam and increased according to patients’ abilities and comfort possibly up to higher intensities. Often findings will be detected with moderate or even minimum tissue recruitment. The test should be stopped if (when) positive.
List the dermatomes and their associated areas.
C1 - No skin innervation
C2 - Posterior Cranium
C3 - Posterior Neck
C4 - Acromioclavicular Joint
C5 - Lateral Upper Arm
C6 - Lateral Forearm/Tip of Thumb
C7 - Palmar Distal Phalanx (3rd)
C8 - Palmar Distal Phalanx (5th)
T1 - Medial Forearm
T2 - Medial Upper Arm
List the myotomes and their associated movements.
C1 - Cervical Rotation
C2,3,4 - Shoulder Elevation
C5 - Shoulder Abduction
C5,6 - Elbow Flexion
C6 - Wrist Extension
C7 - Elbow Extension/Wrist Flexion
C8 - Thumb Extension
T1 - Finger Adduction/5th Abduction
There are typically three areas in the upper extremity that you can test for DTRs. What are they?
C5 - Biceps
C6 - Brachioradialis
C7 - Triceps
Screening is an essential component of clinical decision making because it provides direction for more directed examination and/or referral to another provider. It also helps a PT direct further clinical examination into an unknown problem to discover its cause. Would you conduct a full screening examination for every patient?
No, because: (1) a full screening examination has been done by another clinician just prior to your care and the information is shared or (2) certain cases have been previously screened, undergone a corrective surgery
Screening can also help uncover problems that co-exist with the problem the patient is seeing you for.
What is radicular pain? Why is it useful in relation to a screen?
Referred pain. A screen can help uncover the source of the pain.
Inert (non-contractile) tissue like ligaments and bursa behave different than contractile tissue like muscle. Why is this import when doing a screen?
It signifies the importance of testing one joint at a time, but not staying there. For the shoulder, the neck and elbow should also be checked. Move proximal to distal.
Cluster of findings are useful in determining the acuity of an injury. Define each below.
1. Strong and Painless
2. Strong and Painful
3. Weak and Painless
4. Weak and Painful
5. All Movements hurt
1. Strong & Painless:
Rule out (r/o) muscle - tendon unit; no pathology
2. Strong & Painful:
Minor lesion in muscle - tendon unit; no neurologic pathology
3. Weak & Painless:
Possible Complete rupture of muscle -tendon unit
Possible Neurologic cause - either peripheral or nerve root origin
4. Weak & Painful:
Possible Partial rupture of muscle -tendon unit
Possible Pain inhibition
Possible Concurrent neurologic pathology
5. All Movements Hurt:
Medically incongruent pain; acute inflammation