Competency

Clinical Examination

Cervical AROM: Flexion values

60 degrees

Cervical AROM: extension values

45-60 degrees

Cervical AROM: side-bending values

45 degrees

Cervical AROM: rotation values

90 degrees

Shoulder AROM: flexion values

0-180 degrees

Shoulder AROM: extension values

0-60 degrees

functional: 40 degrees

Shoulder AROM: abduction values

0-180 degrees

Shoulder AROM: IR values

spinous processes.

Shoulder AROM: ER values

0-90 degree

Shoulder PROM: flexion values

0-180 degree

Shoulder PROM: extension values

0-60 degree

Shoulder PROM: IR values

0-70

Shoulder PROM: ER values

0-90

Goniometry should be done ____, unless it is a PROM

standing

MMT is graded

0-5

MMT grade 0

no palpable or observable muscle contraction (absent)

MMT grade 1

trace, no visible movement, palpable or observable tendon contraction

MMT grade 2-

poor (-) moves through partial ROM gravity eliminated.

MMT grade 2

poor, albe to move through full ORM gravity eliminated.

MMT grade 2+

poor (+) moves through partial ROM against gravity OR moves through complete ROM gravity eliminated and holds against. pressure

MMT grade 3-

(fair -), gradual release form test position

MMT grade 3

fair, hold test position against gravity

MMT grade 3+

fair (+), holds test position against slight resistance

MMT grade 4-

Good (-), hold test position against slight to moderate pressure

MMT grade 4

good, hold resistance against moderate resistance

MMT grade 4+

good +, hold test position against moderate to strong pressure

MMT grade 5

normal, hold test position against maximal resistance

C2

axis

Thoracic Spine Rotation

arms crossed sitting at the EOB, the pt is instructed to rotate trunk (twist the body). Measure the contralateral elbow in alignment with the midline

L2

hip flexion (psoas)

L3

knee extension (quads), alternative: hip adductors

L4

ankle dorsiflexion (anterior tib); alternative: posterior tib

L5

great toe extension (extensor hallucis longus), alternate: glute med, medial hamstring

S1

ankle plantar-flexion (gastroc/soleus)

alternate: peroneal, extensor digitorum longus, lateral hamstring

S2

Glute Max (hip EXT)

T1

4th & 5th digit ABD/ADD

C8

extensor pollicus longus (thumb extension) /PIP joint flexion

C7

Triceps/flexor carpi radialis

C6

ECRB/ECRL, brachialradialis, wrist extension

C5

Deltoid, biceps; alternate: infraspinatus, subscapularis

C4

levator Scapulae, diaphragm

C3

cervical side bending, diaphragm

C1/C2 cervical flexion

With Myotomes, you are looking for

fatigable weakness

Hold a myotome test for

3 sets of 5 seconds

LMN issue present with myotomes

foraminal stenosis and disc herniation

Dorsal root

afferent sensory fibers

Ventral root

efferent motor fibers

dermatome

sensory regions from a specific spinal nerve root

myotome

muscles innervated by a specific spinal nerve root

Myotome is when

muscles may be supplied by multiple nerve root

myotome can indicate

Damage to one nerve root causes a weakness in many muscles

dermatome is

an area of skin supplied by a single nerve root

Cerivcal Myelopathy CPR

1. gati deviation

2. (+) hoffman’s test

3. inverted supinator sign

4. (+) babinski

5. Age >45

babinski (+)

toe extension

Hoffman (+)

involuntary flexion of PIP in thumb or index (flick the 2-4th digit to find out)

Clonus (+)

>4 beats

UMN

issue with the brain or spinal cord

UMN issue is indicated by a ____ DTR

high number (3/4), hyper-reflexive or sustained.

UMN pathology

Multiple sclerosis, Parkinosn’s, Tumor, cervical myelopathy

LMN

issue is somewhere between spinal nerve root and innervated muscles

LMN pathology

foraminal stenosis, disc herniation

LMN problems show

atrophy, fatigable weakness

LMN issue is indicated by a ____ DTR

low number (0-1), hypo-reflexive or absent.

DTR reflexes are graded on a

0-4 scale

0: no repsonse; absent

1: feel, don’t see; trace (hypo)

2: normal; see and feel

3: brisk response (hyper)

4:extremely brisk with clonus

C7 DTR

tricep reflex

C6 DTR

brachialradialis

C5 DTR

bicep

Myotome testing

assess conduction

Which neuro component doesn’t asses UMN

myotome testing

Dermatomes assessments are best evaluated at ____ regions

distal

S1

lateral foot, 5th metatarsal pad

S2

heel, inferior gluteal

L1

inguinal area

L2

superolateral glute, anteromedial thigh

L3

distal anterior thigh, suprapatellar

L4

ppatella, proximal medial dorsum of foot

L5

dorsum of foot, ball of foot