Examination of the upper quadrant or upper limb in physiotherapy is a comprehensive process that involves assessing the shoulder, elbow, wrist, and hand, as well as associated muscles, tendons, and nerves. The goal is to identify any impairments, dysfunctions, or conditions that may be affecting the patient’s function or causing pain. Here is a step-by-step approach to upper quadrant/upper limb examination in physiotherapy:
1. Subjective Assessment
History Taking
- Chief Complaint: Determine the main issue (e.g., pain, weakness, numbness).
- History of Present Illness: Onset, duration, and progression of symptoms.
- Pain Assessment: Location, quality, intensity, frequency, and factors that aggravate or relieve pain.
- Functional Limitations: Activities of daily living affected.
- Past Medical History: Previous injuries, surgeries, or conditions affecting the upper limb.
- Occupation and Lifestyle: Work-related activities and recreational activities that may impact the upper limb.
- Medications: Current medications that might influence the condition.
2. Observation
- Posture: Observe overall posture and alignment, including head, neck, and shoulder positions.
- Symmetry: Compare both sides for any asymmetry or deformities.
- Muscle Atrophy: Look for any signs of muscle wasting.
- Skin Changes: Note any discoloration, swelling, or scars.
3. Palpation
- Temperature: Check for warmth indicating inflammation.
- Tenderness: Identify any tender points or trigger points.
- Swelling: Assess for edema or effusion.
- Muscle Tone: Evaluate muscle tone and consistency.
4. Range of Motion (ROM)
Active ROM
- Shoulder: Flexion, extension, abduction, adduction, internal rotation, and external rotation.
- Elbow: Flexion, extension, supination, and pronation.
- Wrist: Flexion, extension, radial deviation, and ulnar deviation.
- Hand and Fingers: Flexion, extension, abduction, adduction, and opposition of the thumb.
Passive ROM
- Perform the same movements passively, noting any restrictions or pain that differ from active ROM.
5. Strength Testing
- Manual Muscle Testing (MMT): Assess the strength of individual muscles or muscle groups using a grading system from 0 to 5.
- Shoulder: Deltoids, rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis).
- Elbow: Biceps, triceps, brachioradialis.
- Wrist: Flexor and extensor groups.
- Hand: Intrinsic and extrinsic muscles.
6. Special Tests
Shoulder
- Neer’s Test: For impingement.
- Hawkins-Kennedy Test: For impingement.
- Apprehension Test: For shoulder instability.
- Empty Can Test: For supraspinatus pathology.
- Speed’s Test: For biceps tendinitis.
Elbow
- Lateral Epicondylitis Test (Cozen’s Test): For tennis elbow.
- Medial Epicondylitis Test: For golfer’s elbow.
- Tinel’s Sign: For ulnar nerve compression.
Wrist and Hand
- Phalen’s Test: For carpal tunnel syndrome.
- Tinel’s Sign: For median nerve compression.
- Finkelstein’s Test: For De Quervain’s tenosynovitis.
7. Neurological Examination
- Sensation Testing: Assess dermatomes for any sensory loss.
- Reflex Testing: Check biceps (C5-C6), brachioradialis (C6), and triceps (C7) reflexes.
- Motor Testing: Evaluate myotomes to identify any muscle weakness.
- Nerve Tension Tests: Upper limb tension tests for nerve irritation or compression.
8. Functional Assessment
- ADL Assessment: Observe the patient performing tasks of daily living.
- Special Functional Tests: For athletes or specific activities, simulate movements to assess performance.
9. Diagnostic Imaging and Reports (if available)
- X-rays, MRI, CT Scans: Review any available imaging for structural abnormalities.
- EMG/NCV: Evaluate any nerve conduction studies if nerve injury is suspected.
10. Documentation and Goal Setting
- Document Findings: Record all subjective and objective findings comprehensively.
- Set Goals: Establish short-term and long-term goals based on the assessment findings and patient’s functional needs.
Conclusion
A thorough examination of the upper quadrant or upper limb involves a detailed subjective assessment, careful observation, precise palpation, systematic range of motion and strength testing, special tests, and neurological examination. The results of this comprehensive evaluation guide the development of an effective treatment plan tailored to the individual patient’s needs.