Week 2- Upper Quarter Screening Examination Flashcards
How to test CN I
Assess ability to smell common scents
How to test CN II
Have patient read an eye chart
How to test CN III
Assess pupil constriction as a reaction to light
How to test CN IV
Ask patient to follow finger moving downward and inward
How to test CN V
- Test sensation of face and cheeks as well as corneal reflex
- Clench teeth
How to test CN VI
Ask patient to follow finger moving away from midline
How to test CN VII
- Assess symmetry and smoothness of facial expression
- Test taste on anterior 2/3 of tongue
How to test CN VIII
- Rub fingers by each ear (should hear both equally)
- Balance test
How to test CN IX
Assess gag reflex and taste on posterior tongue
How to test CN X
Ask patient to say “ah” and watch for elevation of soft palate
How to test CN XI
Muscle test trapezius
How to test CN XII
- Ask patient to stick tongue out
- Tongue will deviate toward injured side
Arteries used in vascular screen
- Carotid
- Brachial
- Radial
Clearing tests for shoulder
- Hand behind back (w/ overpressure)
- Hand behind head (w/ overpressure)
Clearing tests for neck
- Flexion
- Extension
- Sidebending
- Observe eyes
- Rotation
- Quadrant (combined)
- ALL WITH OR WITHOUT OVERPRESSURE
Purpose of upper rib cage clearing tests
Test for presence of 1st rib hypomobility in patients with brachialgia
Describe the upper rib cage clearing test
- Cervical Rotation-Latereal Flexion (CRLF) test is performed sitting
- C-spine is passively and maximally rotated away from the side being tested
- While in this position, spine is gently flexed, moving the ear toward the test
What is a positive upper rib cage clearing test?
Lateral flexion movement is blocked
Thoracic region clearing tests
- Flexion
- Extension
- Rotation
- Sidebending
- WITH OR WITHOUT OVERPRESSURE
When is a upper quarter neuro screen required?
For patients who:
- Exhibit upper quarter pain w/ symptoms extending into the scapula or upper extremity past acromion
- Patient w/ upper quarter symptoms of questionable origin
Upper quarter myotomes
- Cervical flexion or rotation: C1
- Cervical extension: C2
- Cervical lateral flexion: C3
- Shoulder shrug: C4
- Shoulder abduction; *elbow flexion: C5
- Elbow flexion; *Wrist extension: C6
- Elbow extension: C7
- Thumb extension or finger flexors; *Long Finger flexion: C8
- Finger abduction; *5th digit abduction: T1
Upper quarter dermatomes
- C2: Occiput
- C3: Lateral neck
- C4: Shoulder
- C5: Lateral epicondyle
- C6: Dorsum of thumb
- C7: Dorsum of middle finger
- C8: Dorsum of pinky
- T1: Medial epicondyle
Upper quarter DTRs
- Biceps
- Brachioradialis
- Triceps
Biceps reflex
- C5
- Musculocutaneous n.
Brachioradialis reflex
- C6
- Radial n.
Triceps reflex
- C7
- Radial n.
Grading for reflexes
- 4+ : Very brisk response; associated w/ clonus
- 3+ : Brisk response; possibly hyperreflexive
- 2+ : Normal, average response
- 1+ : Low, normal response
- 0 : No response
- 1+(R) : Absent response which appears with reinforcement
- 0(R): No response even with reinforcement
Upper motor neuron signs
2/3:
- Babinski sign
- Hoffman’s reflex
- IVS
