Screening and Scan Examination

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Question 4

give examples of a non capsular pattern

Answer 4

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

Question 5

why should we do a scan exam

Answer 5

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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)

Question 10

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

Answer 10

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

Question 11

what is regional interdependence
what is regional interdependence linked to

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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)

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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)

Question 16

define myotome
how should you localize the segment of lesion

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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

Answer 29

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)

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

less painful side
the nerve root
passive

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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

Question 38

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

Answer 38

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

Question 39

define a mechanical issue

Answer 39

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