scan exam
DESCRIPTION
Physical therapy interns will be expected to know this scan exam and be able to go through it for a skills check during the first week of the clinical rotationTRANSCRIPT
The Scanning Examination
Jake Shockley PT, OCS, COMTPhysical Therapy Central
2013
Purpose of the Scanning Exam• To ensure patient presentations are within the scope of physical therapy
practice– Ruling out “serious” pathology
• Neurological compromise – Upper and lower motor neuron lesions
• Severe ligamentous instability• Acute fracture• Any acute or sub-acute lesions with significant inflammatory response
• Briefly consider the presence of regional interdependence (Rob Wainner) or victims and culprits (Erl Pettman) within the quadrant– Cervical or thoracic spine playing a role in the development of rotator cuff tendonitis
Purpose of the Scan• To detect gross loss of function, ROM, and movement control. • The scanning examination should be negative most of the time which
means you will need further testing to determine your PT diagnosis. • The scan alone can help identify common orthopedic lesions that
present acute and or sub-acute. Below are a few…– Lumbar disc herniation– Spinal stenosis– Rotator cuff tendonitis– Cervical radiculopathy
Components of the Scan• Observation• Vital signs• Functional movement testing• Selective Tissue Tension testing• Specific palpation• Neurological exam• Dural and neural tissue tension tests• General stress tests• Special tests
Observation• Look for the obvious…
– Gait deviation• Break down cardinal planes
– Sagittal – flexion vs. extension» Loss of or significant
vertical rise– Frontal – abduction vs.
adduction» Trendelenberg sign
– Transverse – external vs. internal rotation» Excessive lumbopelvic
rotation
– Stance and swing; tolerance, quality, quantity, and position of lower extremity
– Postural deviation– Difficulty with
transitional movement– Scars, structural
deformities, skin creases
Vital Signs
• Blood pressure• Heart rate• Respiratory rate• Pulse– Central and peripheral
Functional Movement Testing
• Upper quadrant– Apley’s test– Grip strength
• Lower quadrant– Functional squat– Single leg stance– Walk on heels (L4), toes (S1)
Selective Tissue Tension Testing• AROM -> Passive overpressure -> resistance.– Cardinal planes
• Flexion• Extension• Side bending• Rotation
– Quadrants• Flexion• Extension
Specific Palpation• Specific palpation of the painful area distinguishing
structures– Muscle belly – trigger point(s)– Musculotendonous junction– Tendonoperiosteal junction– Bony landmarks– Joint line– Nerve trunks
Neurological Exam• Myotome Testing
– Upper Quadrant• C3 – Cervical lateral flexion• C4 – Shoulder elevation• C5 – Shoulder abduction and ER• C6 – Elbow flexion, forearm
supination, wrist extension• C7 – Elbow extension,
wrist/finger flexion• C8 – Thumb extension, wrist
ulnar deviation• T1 – Finger abduction or
adduction
• Myotome Testing– Lower Quadrant
• L1-2 – hip flexion• L3 – knee extension, hip adduction• L4 – ankle dorsiflexion• L5 – Great toe extension, ankle
eversion, hip abduction. • S1 – hip extension• S1-2 knee flexion
• Fatigable weakness– Neurological weakness will fatigue
quickly with repeated myotomal testing
Neurological Exam• Dermatome Testing
– Upper Quadrant• C2 – Suboccipital• C3 – Submandibular angle• C4 – Upper Trapezius• C5 – Lateral deltoid• C6 – Tip of thumb• C7 – Tip of middle finger• C8 – Fifth finger• T1 – Ulnar side forearm• T2 – Axilla
• Dermatome Testing– Lower Quadrant
• L1 – Groin• L2 – Anterior medial thigh• L3 – supra patella• L4 – Dorsum of medial leg and foot• L5 – Dorsum of middle 3 toes,
medial arch• S1 – Lateral foot, 5th toe, posterior
leg• S2 – Posterior thigh• S3 – posterior medial thigh
Neurological Exam• DTRs
– UQ • C4 - Levator scapula• C5 – Deltoid• C6 – biceps, brachiorad• C7 – Triceps• C8 – Ext Pollicis Longus• T1 – Hypothenar
– LQ• L3 – hip adductors, patella tendon• L4 – Anterior tibialis• L5 – Fibularis longus, EDM• S1 – Achilles tendon
• Upper motor neuron tests– Hoffman’s – flick middle finger,
watching for index and thumb flexion reflex.
– Babinski – scraping movement with end of reflex hammer plantar surface calcaneus to forefoot.
– Clonus – quick passive movement with hold. A positive is more than 3 beats• Wrist extension • Ankle plantar flexion.
Neural and Dural tissue testing.• Upper Quadrant
– Median– Ulnar– Radial – Slump
• Lower Quadrant– SLR– Prone knee bend– Slump
General Stress Tests
• Spine – Central P/As– Unilateral P/As
• Extremities– Valgus/varus, anterior, posterior, rotatory –
Quadrant testing
Special Tests
• Upper Quadrant– Cervical – Spurling’s, traction, figure eight– Shoulder – Empty can, O’Brians, Neers
impingement– Elbow – quadrant test, Active floor push-up sign,
Cozen’s test, Tinnel’s sign, Flexion compression test (ulnar nerve)
Special Tests• Lower Quadrant– Lumbopelvic – SI gapping/compression, lumbar traction,
prone lumbar torsion, prone instability test, SLR, treadmill test
– Hip – Standing rotation, FABERS, FADIR, Stitchfield’s (ASLR)– Knee – Thessaly’s, joint line tenderness test, Appley’s
compression test, patellar step test, Homan’s sign– Foot/ankle – talar swing, navicular drop
APPENDIX
Upper Quarter Screen
http://youtu.be/i8lJ5Tz9fvw
Lower Quarter Screen
http://youtu.be/5Co5SEteXNI
Cyriax Terminology
• Strong and painful – think minor muscle lesion • Strong and pain free – muscle is clear• Weak and painful – think major muscle lesion• Weak and pain free – neurological lesion or
full thickness tear
Maitland Mobilization Grades• Grade I - Small amplitude rhythmic oscillating mobilization in early range of
movement• Grade II - Large amplitude rhythmic oscillating mobilization in midrange of
movement• Grade III - Large amplitude rhythmic oscillating mobilization to point of limitation
in range of movement• Grade IV - Small amplitude rhythmic oscillating mobilization at end range of
movement• Grade V (Thrust Manipulation) - Small amplitude, quick thrust at end range of
movementReference: http://www.physio-pedia.com/Manual_Therapy
SINSS
• Severity – intensity of patients complaint• Irritability – the amount of activity to
aggravate/alleviate symptoms• Nature – the source of the patient’s pain• Stage – acute, sub-acute, chronic• Stability – better, same or worsening
Resources• Treatment Based Classification – Password: OUHSC • Clinical Prediction Rule – Password: OUHSC• Physical Therapy Central – Resource Page for regional
interdependence articles and more.• Subacromial Impingement Syndrome