Download the nervous system

Kinesiology Lab
Bilateral Upper and Lower Quarter Screening Exam: "Screen" means to broadly check,
examine or test; it implies something that is done before a detailed examination.
Purpose & Use

To determine the area to be examined in a patient with musculoskeletal impairment. Minimal use of
the screen in this type of patient is to "clear" the joints above & below the area of complaint - - to
avoid missing something (ie. hip pathology often refers pain to the knee)
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The screen can be the neuromusculoskeletal exam on a patient in acute care or rehab setting;
particularly a patient with a non-musculoskeletal problem (example – see how strong and mobile a
patient is prior to ambulation or transfer following surgery; a patient with COPD, HIV, etc..)
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Revised/modified and used as a specific pre-participation screening exam for athletes
Data / Information collected
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Pain – the cause (AROM, overpressure, or resistance) & location; if pain is always present, how
does it change?
Impairments in ROM or strength
Impairments in general neurological function relative to sensation, strength, and reflexes.
Place in the Physical Therapy Examination

After Hx & Systems Review is performed; Prior to a detailed physical examination.
Components of screening exam
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AROM
Passive Overpressure
Isometric Resistance - called gross muscle testing (not MMT); typically done with muscle in mid to
shortened position. (mid to end of joint ROM)
Sensory & Reflex testing
Key Concepts
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Grade strength as painful/not painful and strong/weak;
Only apply overpressure if AROM is painfree
Stabilize the patient when applying resistance & overpressure
Develop a personalized / systemic process – or you will be slow OR not do it at all
(+) signs usually warrant further examination (bilaterally)
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Neurological Aspect of the Screening Examination:
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Dermatome light-touch testing
Grading: Normal, Impaired, or Absent
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Gross Muscle and Myotome testing
Grading: judge gross strength/weakness & pain (eg. “strong-painless”, “weak-painful”, “weakpainless”, “strong-painful”)
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Testing Reflex (DTR) Integrity
Grading scales for reflex integrity: (with such a wide, subjective range of normal; a bilateral comparison is
of great importance)
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0, 1+, 2+, 3+, 4+ scale; with 1+, 2+, 3+ being normal unless asymmetric
(0) , (-) , (+) , (++); with (+) representing the range of normal
absent, diminished (hypo), normal, hyperactive
Myotome, Dermatome, DTR Chart for UE (C4 – T2 spinal nerves)
Disc
Root
Reflex
Myotome
C4-C5
C5
Biceps
Deltoid, (Biceps)
C5-C6
C6
Brachioradialis
Biceps, (Wrist Extens)
C6-C7
C7
Triceps
Triceps, (Wrist Flex)
C7-T1
C8
--
Thumb Extension, (Grip)
T1-T2
T1
--
PADS & DABS
Add: C4 Derm– lateral clavicle / AC
Dermatome
Lateral upper arm
(humeral head area)
Thumb pad
Middle finger pad
5th finger pad
Medial arm
AND T2 Derm– medial upper arm
Myotome, Dermatome, DTR Chart for LE (L1 - S2 spinal nerves)
Disc
Root
Reflex
Myotome
Dermatome
L1-L2
L2-L3
L3-L4
L4-L5
L5-S1
--
L1
L2
L3
L4
L5
S1
--Patellar Reflex
Patellar Reflex
-Achilles Reflex
Iliopsoas
Iliopsoas
Quadriceps
Anterior Tibialis
Extens Hallucis L.
Flex Hallucis L.
Inguinal area
Ant-sup thigh
Ant middle thigh
Ant knee - suprapatellar
1st-2nd web space
Lateral foot
--
S2
Achilles Reflex
Hamstrings
Medial post thigh & calf
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Upper Quarter Screening Examination
1) AROM & Overpressure of Cervical Spine (flexion,
extension, sidebending, rotation)
Lower Quarter Screening Examination
A: STANDING
2) Resist C-spine rotation (C1)
1) AROM of Thoracolumbar Spine [flexion, extension,
sidebending, rotation (hold pelvis)]
3) AROM & Overpressure Shoulder flexion & rotation
(Apley's Scratch)
B: SITTING (tripod – lean back on hands)
4) Resist Scapular elevation (C2 – C4)
2) AROM & Overpressure of Knee extension
5) Resist Shoulder abduction (C5)
3) Resist Hip flexion (L1, 2)
6) AROM & Overpressure of Elbow
4) Resist Knee extension (L3, 4)
7) Resist Elbow flexion (C6)
5) Resist Ant. Tibialis & Ext Hallucis Long. (L4, 5)
8) Resist Elbow extension (C7)
6) Resist Flex Hallucis Long (S1)
9) AROM & Overpressure of Wrist
7) Resist Knee flexion (S2)
10) AROM Hand Open/Close;
Resist Thumb Extension (C8) (or grip strength) &
Finger abduction (T1)
C: SUPINE
8) SI Joint Compression / Distraction Stress
11) Upper Extremity Dermatomes (C4 – T2)
9) Passive SLR (Sciatic neural tension; L4,5,S1)
12) Mytotatic Stretch Reflexes (depends on findings in
1-11 above)
 Biceps (C5)
 Brachioradialis (C6)
 Triceps (C7)
NOTE: The examination needed for detailed testing of
abnormalities in sensation and/or motor function
(peripheral nerve vs. spinal nerve vs. spinal cord tract
vs. brain) is beyond the scope of a screening exam.
10) PROM & Overpressure of Hip
11) PROM & Overpressure of Knee Flexion
12) Lower Extremity Dermatomes (L2 – S2)
13) Mytotatic Stretch Reflexes (depends on findings in
1-12 above)
 Quadriceps Reflex (L3 - 4)
 Achilles Reflex (S1 - 2)
NOTE: The examination needed for detailed testing of
abnormalities in sensation and/or motor function
(peripheral nerve vs. spinal nerve vs. spinal cord tract
vs. brain) is beyond the scope of a screening exam.
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