Upper Quarter Screening

Question 1

Red Flags

Answer 1

Previous history of cancer

Trauma/Assault

Long term use of immunosuppressants (Crohn’s disease, sarcoidosis)

Heart Disease

Receiving anticoagulation therapy

History of acquired immunodeficiency syndrome (AIDS)

History of hematologic disease (sickle cell or hemophilia)

Past history of joint replacement

Question 2

Key assessment skills

Answer 2

Postural observation

Gait

Palpation

Balance

AROM/PROM

MMT/Myotomes

DTR

Sensation/Dermatomes

Orthopedic special test

Question 3

Standing

Answer 3

Postural observation

UE motion

Palpation/soft tissue/bony landmarks

Balance

AROM of trunk all directions

Question 4

Sitting

Answer 4

Postural observation

Respiratory pattern

CN screening

Palpation/soft tissue/bony landmarks

AROM (rotation + OP) - Cervical spine and UE joints)

Neuroscreening

DTR (biceps, brachioradialis, triceps)

Vertebrobasilar artery insufficiency (patient rotation + therapist compression/distraction)

Question 5

Supine/prone

Answer 5

Postural observation

Palpation

AROM/PROM of UE

Neuroscreening

Repeat testing with positive finding in WB postures

Neuromobility - ULTT

Question 6

Cancer

Answer 6

Leukemia - hodgkins lymphoma

Bone tumors - osteoid osteoma, chondrosarcoma, Ewings sarcoma

Cervical cord

Mets from breast, lung bone to lungs, lymph nodes, tx spine

Question 7

Cardiovascular/pulmonary

Answer 7

Arterial insufficiency

Avascular necrosis of the humeral head

Thoracic outlet syndrome

Angina/MI/ Pericarditis

Aortic aneurysm

Pancoast Tumor

TB PE Pneumonia

Question 8

Infectious/inflammatory condition

Answer 8

Osteomyelitis

Pneumonia

Cellulitis

Arthritis (RA, SLE)

Septic joint

Tuberculosis

Metabolic disease

Osteomalacia

Diabetes mellitus

Question 9

Neuromusculoskeletal

Answer 9

Cervical spine - spondylosis, spinal stenosis, herniated disc

Joint pathology - AC joint, shoulder, elbow wrist, fingers

Osteoporosis

Bursitis (subacromial)

Fasciculitis, myofascial pain

Muscle impairment - weakness, hyper/hypotonia, tear/avulsion

Tendinopathy (Tendinitis, tendinosis)

Question 10

Peptic ulcer referral pattern

Answer 10

Lateral bord R scap

Question 11

Myocardial ischemia referral pattern

Answer 11

R Shoulder, down arm

Question 12

Acute cholecystitis referral pattern

Answer 12

R shoulder, between scapula, upper traps

Question 13

Hepatic: liver disease, cancer, cirrhosis referral pattern

Answer 13

R shoulder, subscapular region

Question 14

Pulmonary: Pleurisy, pneumothorax, pancoast tumor, pneumonia referral pattern

Answer 14

ipsilateral shoulder, upper traps

Question 15

Kidney referral pattern

Answer 15

Ipsilateral shoulder

Question 16

Gynecologic: endometriosis, ectopic pregnancy referral pattern

Answer 16

Ipsilateral: possible B shoulder depending on cyst locations

Question 17

Internal bleeding, ruptured spleen referral pattern

Answer 17

L shoulder - Kehr’s sign

Question 18

Myocardial ischemia referral pattern

Answer 18

L shoulder - pectoral region

Question 19

Thoracic aortic aneurysm referral pattern

Answer 19

L shoulder - between scapula

Question 20

Pancreas referral pattern

Answer 20

L shoulder

Question 21

Infectious mononucleosis (hepatomegaly, splenomegaly)

Answer 21

L shoulder, Upper trap