lecture 3 assessment
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Transcript lecture 3 assessment
Lecture 3
Assessment Protocols
History,
Observation,
ROM/Resisted,
Special tests and
Palpations
History
Provides valuable information about the athletes condition
- Listening to the patient / athlete
- Questions – try not to lead the athlete
- Repetition – taken in an orderly sequence
- Try to keep patient focused on relevant information
-
Relevant past history and or treatments received
Surgeries, allergies, major illnesses
Relevant family history
X-rays , or any other test results
Medications
- Age, occupation (student/ sport) , life style
(recreational pursuits)
- Chief complaint- what is the major problem
- What was the trauma – Mechanism of injury (MOI)
- Direction , magnitude, force applied
- Predisposing factors ( old injuries, braces , field
conditions)
- Onset – sudden (acute) or slow (insidious)
- Pain – during day or night - when is it better ( what
makes it feel better) or when is it worse
- Symptoms – what bothers the athlete- can they point
to one area – specific / general
- Pain – has it changed since it first started
- Trigger points ( points that are hyperirritable) tender
to compression
- Referred pain – is the pain felt somewhere other that
the injured site ( referred pain is usually referred
segmentally – does not cross midline)
- What causes the pain
Functionally pain is seen in seven levels
pain after specific activity
pain after specific activity resolving after a warm up
pain during and after specific activity which does not
effect performance
pain during and after specific activity which does
effect performance
pain with all activity of daily living
constant dull aching pain at rest which does not
disturb sleep
constant dull aching pain at rest which does disturb
sleep
- How long has problem existed – duration /frequency
- Have they had this problem before – did it get better
– how – how long
-
Type of pain
Nerve – sharp , bright , burning
Bone – deep , boring , very localized
Vascular – diffuse , aching poorly localized
Muscle – hard to localize, dull and achy
-
Sensations - pins and needles - numbness
Locking – joint can not be fully extended
Giving way – joint buckles
Other problems – fainting , bladder , neurological
problems etc..
- Stress levels of athlete
Red Flags
Cancer
- persistent night pain
- unexplained weight loss ( 10 – 15 lbs in 2 weeks or
less)
- loss of appetite
- lumps or growths
Cardiovascular
-
shortness of breath
dizziness
pain / heaviness in chest
pulsating pain in body
Gastrointestinal
-
frequent and sever abdominal pain
heartburn and or indigestion
nausea and vomiting
bladder problems
Neurological
-
changes in hearing /speech or vision
frequent and or severe headaches
problems with balance
fainting spells
weakness
Miscellaneous
-
fever or night sweats
emotional disturbances – depression
swelling with no apparent history
severe unremitting pain
severe pain with no obvious history
severe spasms
All Red Flags Refer to Doctor immediately
Observations
- observations start right away when athlete
walks into clinic – limping .. etc
- looking and or inspecting an area
- gain information on visible defects or
abnormalities
- posture
- gait
Dominant Eye
Normal alignment
Obvious deformities
Obvious deviations
Muscle wasting
Limb position – equal / symmetrical
Skin colour and temperature
Scars
Crepitus, snapping or abnormal sounds
Swelling / redness
Willingness to move
Active Movement
Test joint range, muscle control and
willingness of athlete to move.
Things to note
- When and where during each movement
the onset of pain occurs
- Does it increase intensity and quality of
pain
- Observe restrictions
- Observe pattern of movements
- Observe rhythm and quality of movement
- Willingness to move what are their
limitations
Passive Movements
- Athlete is relaxed, movement is through
the full ROM of the joint as possible.
- Normal movement is relative – ie.
gymnasts as compared to football.
(Hyper/hypo)
End Feels
Normal
Bone to bone – hard and unyielding –
elbow extension
Soft tissue approximation – yielding
compression stops further movement –
knee flexion
Tissue stretch – hard or firm (springy)
type of movement with slight give – ankle
dorsiflexion – shoulder lateral rotation
Abnormal
Muscular spasm - sudden and hard – quad
contusion
Capsular – similar to tissue stretch – but occurs
when not expected – frozen shoulder
Bone to bone – ends meet before normal –
osteophyte formation
Empty – considerable pain – no end feel - MCL
rupture – bursea
Springy block – similar to tissue stretch but
again where not suspected – meniscus
Resisted Movement
-
Tested last
Strong static (isometric)contraction
Voluntary muscle contraction
Amount of pain and weakness is related to
degree of injury
- Athlete resists applied pressure
- Keep movement to a minimal
Muscle Grading
5 – Normal – Complete max resistance
4 – Good – Moderate resistance
3 – Fair – ROM with gravity
2 – Poor – Rom with gravity eliminated
1 – Trace – Minimal contraction
0 – None – No contraction
Examination Principles
test normal side first
Active before passive
Passive before resisted
Most painful test done last
Resisted – joint is in neutral and isometric –
stress on inert tissue is minimal
Passive ROM – not only degree of movement
but end feel
Ligament stress – gentle / repeat and increase
stress but not beyond point of pain
Special Tests
Are available for all joints and most
muscles to determine injury
Uses of special tests
- To confirm tentative diagnosis
- Make a differential diagnosis
- Differentiate between structure
Reflexes
Biceps
Triceps
Patella
Achilles
C5-C6
C7-C8
L3-L4
S1-S2
Palpations
To palpate the area should be as relaxed
as possible
discriminate the difference in tissue
tension , ie rigidity and or flaccidity
discriminate the difference in tissue texture
– fibrous band
detect abnormalities or deformities
(myositis ossificans)
determine tissue thickness
- obvious swelling , intra or extra articular
- blood swelling - rapid (2-4 hours) – hard
thick gel like
- fluid swelling – slow (8- 24 hours) – softer
more mobile
Joint tenderness
Temperature
Abnormal sensations
– hyperesthesia – increased sensations
– dysesthesia – diminishing sensations
– anethesia – absence of sensations
– crepitus etc.