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The Scanning Examination
Jake Shockley PT, OCS, COMT
Physical Therapy Central
2013
Purpose of the Scanning Exam
• To ensure patient presentations are within the scope of physical
therapy practice
– Ruling ...
Purpose of the Scan
• To detect gross loss of function, ROM, and movement control.
• The scanning examination should be ne...
Components of the Scan
• Observation
• Vital signs
• Functional movement testing
• Selective Tissue Tension testing
• Spec...
Observation
• Look for the obvious…
– Gait deviation
• Break down cardinal planes
– Sagittal – flexion vs.
extension
» Los...
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 l...
Selective Tissue Tension Testing
• AROM -> Passive overpressure -> resistance.
– Cardinal planes
• Flexion
• Extension
• S...
Specific Palpation
• Specific palpation of the painful area
distinguishing structures
– Muscle belly – trigger point(s)
– ...
Neurological Exam
• Myotome Testing
– Upper Quadrant
• C3 – Cervical lateral flexion
• C4 – Shoulder elevation
• C5 – Shou...
Neurological Exam
• Dermatome Testing
– Upper Quadrant
• C2 – Suboccipital
• C3 – Submandibular angle
• C4 – Upper Trapezi...
Neurological Exam
• DTRs
– UQ
• C4 - Levator scapula
• C5 – Deltoid
• C6 – biceps, brachiorad
• C7 – Triceps
• C8 – Ext Po...
Neural and Dural tissue testing.
• Upper Quadrant
– Median
– Ulnar
– Radial
– Slump
• Lower Quadrant
– SLR
– Prone knee be...
General Stress Tests
• Spine
– Central P/As
– Unilateral P/As
• Extremities
– Valgus/varus, anterior, posterior, rotatory ...
Special Tests
• Upper Quadrant
– Cervical – Spurling’s, traction, figure eight
– Shoulder – Empty can, O’Brians, Neers
imp...
Special Tests
• Lower Quadrant
– Lumbopelvic – SI gapping/compression, lumbar
traction, prone lumbar torsion, prone instab...
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 pa...
Maitland Mobilization Grades
• Grade I - Small amplitude rhythmic oscillating mobilization in early
range of movement
• Gr...
SINSS
• Severity – intensity of patients complaint
• Irritability – the amount of activity to
aggravate/alleviate symptoms...
Resources
• Treatment Based Classification – Password: OUHSC
• Clinical Prediction Rule – Password: OUHSC
• Physical Thera...
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Scan exam

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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 rotation

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Scan exam

  1. 1. The Scanning Examination Jake Shockley PT, OCS, COMT Physical Therapy Central 2013
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Vital Signs • Blood pressure • Heart rate • Respiratory rate • Pulse – Central and peripheral
  7. 7. Functional Movement Testing • Upper quadrant – Apley’s test – Grip strength • Lower quadrant – Functional squat – Single leg stance – Walk on heels (L4), toes (S1)
  8. 8. Selective Tissue Tension Testing • AROM -> Passive overpressure -> resistance. – Cardinal planes • Flexion • Extension • Side bending • Rotation – Quadrants • Flexion • Extension
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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.
  13. 13. Neural and Dural tissue testing. • Upper Quadrant – Median – Ulnar – Radial – Slump • Lower Quadrant – SLR – Prone knee bend – Slump
  14. 14. General Stress Tests • Spine – Central P/As – Unilateral P/As • Extremities – Valgus/varus, anterior, posterior, rotatory – Quadrant testing
  15. 15. 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)
  16. 16. 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
  17. 17. APPENDIX
  18. 18. Upper Quarter Screen http://youtu.be/i8lJ5Tz9fvw
  19. 19. Lower Quarter Screen http://youtu.be/5Co5SEteXNI
  20. 20. 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
  21. 21. 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 movement Reference: http://www.physio-pedia.com/Manual_Therapy
  22. 22. 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
  23. 23. 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

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