PRA 545 Lab

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PRA 545 Lab
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Patient Interaction
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P.A.R.T.S.
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Muscle Testing

• Muscle Testing (all muscles should be tested
  bilaterally)
• Muscle strength is graded on a 5-point scale, as
  follows
• 5/5 (normal) Complete anti-gravity AROM. Full
  strength against resistance.
• 4/5 (good) Complete anti-gravity AROM. Less
  than full strength against resistance.
• 3/5 (fair) Complete anti-gravity AROM but no
  strength vs. resistance.
• 2/5 (poor) Complete AROM only with gravity
  eliminated. No strength vs. resistance.
• 1/5 (trace) Muscle contraction palpable but no
  active movement of joint.
• 0/5 (zero) No palpable or visible muscle
  contraction at all.

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Muscle Testing

• Deltoid (C5)
• Procedure Have patient abduct arm 90º and bend
  elbow 90º. Stabilize the shoulder, tell patient
  to resist pressure, and then press down just
  proximal to the elbow.
• Wrist extensors (C6)
• Procedure Have patient extend wrist and hold in
  that position. Stabilize lower forearm, and then
  tell patient to hold wrist in extended position
  while you attempt to move the wrist toward
  flexion.
• Wrist flexors (C7)
• Procedure Have patient flex wrist and hold in
  that position. Stabilize lower forearm, and then
  tell patient to hold wrist in flexion while you
  attempt to move the patients wrist into
  extension.

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Muscle Testing

• Finger Flexors (C8)
• Procedure Have patient curl 4 fingers, holding
  them close to one another. Curl your own 4
  fingers, lock them with the patients 4 fingers,
  and tell patient to resist as you seek to pull
  them out of flexion.
• Finger abductors/adductors (T1)
• Procedure Have patient hold 5 fingers of hand
  rigidly apart from one another. Tell patient to
  resist as you push 2 fingers toward each other,
  testing finger abduction. Or have patient hold
  fingers together rigidly, and attempt to separate
  two fingers, thereby testing finger adduction.

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Muscle Testing

• L4 Foot inversion
• Procedure Ask patient to resist as you push
  against the dorsal and medial aspects of the head
  of the first metatarsal bone, thereby testing
  foot inversion and dorsiflexion. The muscle being
  tested is tibialis anterior.
• L5 Great toe extension
• Procedure Place your fingers on dorsal surface
  of patients foot and ask him/her to extend the
  great toe to reach toward them. Oppose this
  motion by pressing on the nail of the great toe.
  The muscle being tested is extensor hallicus
  longus.
• S1 Foot eversion
• Procedure Have patient plantar flex and evert
  his/her foot, and oppose this motion by pushing
  against the head the 5th metatarsal bone with the
  palm of your hand. The muscles being tested are
  the peroneus longus and brevis.

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Deep Tendon Reflexes (DTRs)

• DTRs are graded as follows
• 0 absent
• 1 diminished
• 2 average/normal
• 2 slightly exaggerated
• 3 exaggerated
• 4 myoclonus

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Deep Tendon Reflexes (DTRs)

• Biceps (C5)
• Brachioradialis (C6)
• Triceps (C7)
• No reflex for C8
• Pectoralis major (T1) some texts say there is no
  T1 DTR

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Deep Tendon Reflexes (DTRs)

• Patellar (L4)
• Hamstring (L5) some texts say there is no L5 DTR
• Achilles (S1)

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Sensory

• Dermatome Testing Areas (Pinprick)
• C5 lateral brachium (upper arm)
• C6 lateral antebrachium (forearm), thumb, index
  finger
• C7 middle finger with narrow line extending to
  wrist
• C8 dorsum of hand over 4th and 5th metacarpals,
  medial antebrachium
• T1 Medial brachium

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Sensory

• Dermatome Testing (Pinprick)
• L4 medial aspect of foot near first metatarsal
• L5 middle of dorsum of foot
• S1 lateral edge of foot near 5th metatarsal

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Cervical Compression
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Cervical Distraction
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Lhermittes Sign
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Soto-Hall
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Straight Leg Raise (SLR)
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SLR
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Braggards Test
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Bowstring Test
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Kemps Test
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Valsalva Meneuver
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Femoral Nerve Stretch Test
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Sacroiliac Compression
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Gaenslens Test
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Minors Sign
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Plantar Reflex
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Hoffmans Sign
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UMN vs. LMN Lesion
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