Friday, October 26, 2018

Upper and Lower Extremity Screening Cheat Sheet - Part 2

After assessing for active range of motion and muscle strength:

Step 3:  Assess light touch in dermatomal patterns.  Almost every nerve in your body originally branches out your spine at specific places between the spinal vertebraes. This branching of nerve or the dorsal root from the spine has a particular area of skin that is associated with it. This pattern of skin and associate nerve root is known as the Dermatomal pattern.

Step 4: Assess deep tendon reflexes.  A reflex is a motor response to a sensory stimulus and is used to assess the integrity of the nervous system at various spinal nerve root levels.  Deep tendon reflexes will elicit a muscle contraction when the muscles tendon is stimulated.

Deep Tendon Reflexes Procedure Guidelines:

  • Patient should be relaxed
  • Muscle should be placed in a slight stretch
  • Use reflex hammer to tap tendon
  • Assess both sides
  • Reflex should be graded as normal (+2), Hyper active (+3 or 4), or diminished (0-+1)
When completing an Upper Extremity Quarter Screen the therapist should test your reflexes for C5 nerve at the Brachioradialis,  C6 nerve with the bicep tendon, and C7 nerve with the triceps tendon.

When completing a Lower Extremity Quarter Screen the therapist should test your reflexes for L3 nerve with the Quadriceps (also called patellar tendon) and S1 nerve with the achilles tendon.

**Please note that while this is a 2 part blog post with a lot of information for visual aid, these tests should take no more than a couple minutes by a trained therapist/coach.  These screens are very basic tests designed to provide a rapid assessment of mobility and neurological function of the upper and lower extremities.  If a test shows any problems with AROM, Myotomes, Dermatomes, or reflexes this essentially narrows down the problem and directs further testing.  These tests can also be used as a prescreen for athletes during physical examination to establish a baseline of function.

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