UQ/LQ screens

screens

• asymmetries

• “quick look”

  • comprehensive exam

  • based on anatomic and pathologic principles

screening purpose - improve efficiency

• abnormal vs normal

• identify region of pain

  • clear referral patterns

  • challenge above & below

screening purpose - improve accuracy

• examine most likely area

  • identify source of symptoms

• identify contributing factors

comparable sign

• establishes baseline

• reproduction of the patient’s specific pain

• “chief complaint”

what of the following patient presentations, would a UQ/LQ screen be most useful?

• post op TKA

• lateral elbow pain

• hip pain with insidious onset

• lateral ankle sprain

• lateral elbow pain

• hip pain with insidious onset

• both are vague

when to screen

• no history of trauma or clear MOI

• pain extending across multiple regions

• spinal cord signs

  • reports of sensory and/or motor symptoms

    • burning, aching, numbness, weakness

• radicular signs

• abnormal presentation

• challenge hypothesis

components of ortho screen

1. spine

2. nerve function

3. peripheral joints

components

• clear somatic structures in spine - muscles, ligaments, facet joints

  • ROM

  • overpressure

• challenge nerve root irritability

• assess function of nerves in spine

  • dermatomes

  • myotomes

• clear somatic structures of extremity

  • peripheral joint scan

spine - ruling in/out

• rule out somatic structures in spine

• ROM of spine

  • flex/fb

  • extension/BB

  • side bending

  • rotation

ROM sequence: AROM is pain free

• end range passive overpressure

• if both are pain free: no need to test PROM

ROM sequence: AROM is painful

• perform PROM throughout entire range (confirms contractile vs non-contractile)

• apply end range overpressure

ROM sequence: AROM is pain free but ..

• overpressure is painful

• perform full PROM and end range overpressure

• (shows there is something wrong in the chain / compensations causing pain / position pt got to through AROM put them at a disadvantage)

dermatome

area of skin supplied by a single nerve root

myotome

groups of muscles supplied by a single nerve root

reflexes

subconscious, programmed behavior

• muscle stretch reflex

nerve function assessment - dermatomes

• sensation testing

nerve function assessment - myotomes

• RROM

• muscle testing

• different than MMT

• neurogenic weakness

• takes time for weakness to become evident

• 5-6 second hold - challenge nerve at submax level

  • fatigueable weakness

peripheral joint scan sequence

• AROM

  • joint ROM

  • control

  • muscle power

  • willingness to move

• PROM

  • available anatomic ROM

• Overpressure

  • end feel

Peripheral joint scan assessment

• range (excursion)

  • how far does it move

• reactivity (pain)

  • does it hurt?

• resistance

  • end feel

  • quality of movement

Where are UE & LE screens in ICHARTS?

A