Transcript Data / Information collected Pain – the cause (AROM, overpressure

Purpose & Use of Screening Exam
1. 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
2.

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)
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.
Place in the Physical Therapy
Examination
 After Hx & Systems Review is
performed; Prior to a detailed
physical examination.
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
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
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)
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
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
Extens)
Also: C4 Derm– lateral clavicle / AC
T2 Derm– medial upper arm
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.
Myotome & Dermatome Testing for LE
Disc
Root
Reflex
Myotome
Dermatome*
L1-L2
L1
--
Iliopsoas
Inguinal area
L2-L3
L2
--
Iliopsoas
Ant-sup thigh
L3-L4
L3
Patellar
Reflex
Quadriceps
Ant middle thigh
L4-L5
L4
Patellar
Reflex
Anterior Tibialis
Ant knee suprapatellar
L5-S1
L5
--
Extens Hallucis L.
1st-2nd web space
--
S1
Achilles
Reflex
Flex Hallucis L.
Lateral foot
--
S2
Achilles
Reflex
Hamstrings
Medial post thigh
& calf
* Sensory mapping varies
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.