Lower Quarter Screen: Improving Diagnoses with Thorough Examinations

For novice and experienced clinicians alike, a thorough lower quarter screen and examination is important when assessing a patient presenting with lower quarter symptoms.

Using Clinical Reasoning to Improve the Decision Making Process

Researchers have studied how clinicians become expert practitioners across medical disciplines. Results clearly indicate that prior experience improves the clinical decision making process.

Hypothetico-Deductive Reasoning

If you are familiar with the model of clinical reasoning processes, novice clinicians tend to demonstrate “hypothetico-deductive” reasoning, which includes the generation of multiple hypotheses. These clinical decision making processes include an unorganized approach that can lead to errors of omission and limited patient data recall.¹

Forward Reasoning

Experienced clinicians use a “forward reasoning” process whereby they are able to recall information in an organized fashion using selective data and pattern recognition to generate their hypotheses.¹

The Importance of a Proper Lower Quarter Screen

One thing to note is that even the experts can sometimes get overly comfortable with what appears to be a “typical pattern” and miss the underlying diagnosis without a proper lower quarter screen.

A Practical Example

Take for the example the 21-year-old female runner who complains of isolated right lateral knee pain 3 months after a lateral retinacular release. Upon initial observation, it is clear that her right leg is smaller than her left, so it is obvious her initial rehab was substandard. The assessment results seem straightforward:

• Right lateral release
• Localized knee pain
• No other complaints
• No complaints of numbness, tingling, or any other radicular symptoms

So, she is treated with normal post-operative strengthening, balance, and plyometric activities. After 3-4 months, her strength has improved and is equal on both sides, but she still complains of localized right knee pain. At this point, the clinician steps back from focusing on the knee and starts with a more global history. They find that the athlete has a history of a low back injury from around 3 years ago. Upon a proper lower quarter screen of the lumbar spine, the knee pain is reproduced and immediately eliminated with some local manual therapy techniques to the lumbar spine.

This is the perfect example where pattern recognition led to a missed diagnosis as the clinician did not perform the full lower quarter screen.

Don’t risk missing a diagnosis. If a patient presents with lower quarter symptoms, utilize a thorough lower quarter musculoskeletal screen and exam to better assess the underlying cause of their pain.