Upper Quarter Screening

Question 1

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?

Answer 1

Components of a Screening Examination
0) Posture

1) Active ROM
- symmetry
- quality of motion

2) Passive ROM
- end feel

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.

Question 2

List the dermatomes and their associated areas.

Answer 2

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

Question 3

List the myotomes and their associated movements.

Answer 3

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

Question 4

There are typically three areas in the upper extremity that you can test for DTRs. What are they?

Answer 4

C5 - Biceps
C6 - Brachioradialis
C7 - Triceps

Question 5

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?

Answer 5

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.

Question 6

What is radicular pain? Why is it useful in relation to a screen?

Answer 6

Referred pain. A screen can help uncover the source of the pain.

Question 7

Inert (non-contractile) tissue like ligaments and bursa behave different than contractile tissue like muscle. Why is this import when doing a screen?

Answer 7

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.

Question 8

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

Answer 8

Finding		
Interpretation

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

Question 9

When evaluating exam findings, you can do one of the following.

1. Clear or rule out
2. Nerve root pattern
3. Peripheral nerve pattern
4. Peripheral joint pattern

Answer 9

Evaluation Of Examination Findings:

Clear or Ruled Out (R/o):
Entire Joint (Active/Passive/Resisted) not contributing to /reproducing sx
Myotome: Intact (No weakness)
Dermatome: Intact (No deficit)
Reflexes: 2+ (Normal)

Nerve Root Pattern:
AROM - Limitations in motion, if ms weakness present
PROM - No limitations or pain
RI - Weakness present
Multiple muscles affected 2° many N. Roots/muscle
Myotome: Weakness specific to N. Root
Dermatome: Deficit specific to N. Root
Reflex:  in Reflex, if specific to N. Root

Peripheral Nerve Pattern:
AROM - Limitations in motion if muscle weakness present
PROM - No limitations or pain
RI - Weakness present (no pain)
Myotome: Weakness specific to peripheral nerve
Dermatome: Deficit specific to peripheral nerve
Reflex:  in Reflex (especially seen with muscle weakness)

Peripheral Joint Pattern:
AROM - Limitations in motion 2° pain and/or stiffness (in joint)
PROM - Limitations 2° pain and/or stiffness (in joint)
RI - Strong/Weak and Painful/Painless dependent upon length of time
Myotome: Intact
Dermatome: Intact
Reflex: 2+ (Normal)