This document outlines the components and purpose of a scanning examination performed in physical therapy. The scanning exam is used to ensure issues are within the scope of physical therapy and rule out serious pathology. It involves observation of gait and posture, vital signs, functional movement testing, tissue tension testing, palpation, neurological exams, and special tests. The purpose is to detect gross loss of function and movement control in order to guide further physical therapy diagnosis and treatment.
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. 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. 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. 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. Vital Signs
• Blood pressure
• Heart rate
• Respiratory rate
• Pulse
– Central and peripheral
7. Functional Movement Testing
• Upper quadrant
– Apley’s test
– Grip strength
• Lower quadrant
– Functional squat
– Single leg stance
– Walk on heels (L4), toes (S1)
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. 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. 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. 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
Notas del editor
Article for Regional Interdependence
After observing the patient upon entering the room and during the patient interview functional movement testing can began if appropriate. Frequent repositioning should be avoided throughout the entire exam if possible to minimize patient discomfort and exacerbation. We want you to learn how to administer all applicable test per patient case that is allowed in a given position such as sitting or lying. This presentation attempts to follow a natural, comfortable positioning of the patient for the lower quadrant and upper quadrant combined. Apley’s and grip testing can be performed in sitting and initiated directly after the patient interview. The lower quadrant functional movement testing is performed in standing. Remain close to patient or have patient close to table to re-stabilize patient if loss of balance occurs. Walking on toes or heel raises can be used for S1 myotome testing and walking on heels for L4 myotome testing. Again pay attention to and note significant deviations or restricted movement during these test.
Next is the selective tissue tension testing created by Cyriax. These test involve spinal AROM with passive overpressure and then resistance. This order of testing can give you a lot of information for the orthopedic patient so you may appreciate more of the subtleties compared to the previous test. Start with the cardinal planes. Using cervical rotation in sitting for example, ask the patient to turn as far as comfortable to the right. If that position does not reproduce their pain then add overpressure. At the end of their rotation gentle add overpressure noting end feel and pain response. If appropriate (so if you assumed a muscle tear was present from the patient interview) you can then add resistance near the painful position to assess muscles for pain and weakness. So with the patient turned to the right ask them to turn to the left into your hand which blocks any movement to the left, causing an isometric contraction. If the left rotators are painful in this lengthened position you can than retest with the neck in neutral. Caution with the more acute neck patient during resistance test as quick, unguarded movement should be avoided. Once all cardinal planes are assessed quadrants can be checked by asking the patient to move in the combined movements. If the cardinal planes are significantly limited and painful quadrants may not be necessary or appropriate. The STTT can be initiated directly after the UQ functional testing in sitting or directly after the LQ functional testing in standing.
You will be assessing skin temperature, texture and feel. Is the skin warm and boggy or firm. With palpation, can you reproduce the patients pain. If so, what are you palpating – the muscle, nerve or bone ? This is where you need to know your anatomy and landmarks.
During the myotomal testing you will be assessing muscle strength or as we like to say “grade”. You want to determine if the strength is normal 5/5 or weak and then how weak with the muscle grades. Then I want you to decide why the muscle is weak, is it because it is an arthritic shoulder and pain turns off the muscle, is it painful and weak and what is painful. The joint, the muscle or another structure?Review Cyriaxtermin
You will use the grades to communicate the depth and speed of the mobilization. You can use + or ++ or +++ to be more descriptive as well as minus. You will also decide from the SINSS which grade to use.