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When are screening exams performed?
when the patient's primary subjective complaint is related to an extremity or a part of the spine
what should be examined if there is an UE complaint? What if there is a LE complaint?
if UE complaint: cervical and thoracic spine should be examined
if LE complaint: lumbar spine and pelvis should be examined
what are components of the lower quarter screening exam in standing?
PATHS
1. Postural assessment
2. Active forward, backward, and lateral bending of lumbar spine
3.Standing flexion test/ Gillet's test
4. Toe Raises (S1, tibial nn)
5. Heel walking (L4, L5 deep fibular nerve)
what are the components of the lower quarter screening exam in sitting?
5 SAP RD
1. Sitting flexion test
2. Active rotation of the lumbar spine
3. Passive OP if symptom free
4. resisted hip flexion (L1, L2, femoral nn)
5. resisted knee ext (L3, L4, femoral nn)
6. Resisted ankle DF (L4, L5 deep fibular nn)
7. resisted big toe ext (L5 deep fibular nn)
8. resisted ankle eversion (L5, S1 superficial peroneal nn)
9. DTR: patellar (L3, L4) and Achilles tendon (S1, S2)
What are the components of the lower quarter screening exam in supine?
RNDS
1. Passive ROM of hip
2. Sciatic nn tension test
3. dermatome sensory testing
4. SLR (L4, L5; S1)
1. dermatome sensory testing
2. SLR (L4, L5; S1)
3. Passive ROM of hip
4. Sciatic nn tension test (SLR w/ variations for tibial nn [DF/eversion], peroneal nn [PF/inversion], sural [Df/inversions]
What are the components of the lower quarter screening exam in prone?
BF
1. Femoral nn tension test
2. Babinski reflex test (UMN)
What are the components of the upper quarter screening exam?
PAP VAQ BAR9
Passive OP if symptom free
AROM cervical spine
Postural assessment
Vertebral artery test
Active shoulder flexion, abduction, IR, ER
Quadrant test
Babinski Reflex test (UMN)
AROM of elbow
Resisted:
1-2 elbow flexion (C6) ext (C7)
3-4 wrist flexion (C7) ext (C6)
5 -thumb ext (C8)
6- finger abduction (T1)
7- cervical spine rotation (C1)
8-9 shoulder elevation (C2, C3, C4) and abduction (C5)
What is the accessory mobility scale?
-complete joint play/ testing of joint mobility when the joint capsule is most relaxed or in the loose packed position
0 Ankylosed joint
1 considerable limitation/hypomobility
2 slight limitation/hypomobility
3 Normal
4 slight hypermobility
5 considerable hypermobility
6 Pathologically Unstable
What are the 4 possible findings of resisted mm testing? and what does each indicate?
1. strong and painless: no pathology in contractile tissue
2. Strong and painful: minor structural lesion of the muscle-tendon unit
3. Weak and Painless: complete rupture of muscle-tendon unit or neuro deficit present. Further testing is needed
4. Weak and painful: partial disruption of muscle-tendon unit. Pain response due to serious pathology or concurrent neurological deficit
How can you differentiate the action of a one-joint muscle from that of a multi-joint muscle?
place the multi-joint mm at a disadvantage
-if a muscle that crosses two or more joints produces simultaneous movement at all of the joints it crosses, it soon reaches a length at which it cannot generate full mm force = active insufficiency
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