Download EVALUATIONS

EVALUATIONS
SUBJECTIVE QUESTIONING (HISTORY)
Chief complaint?
Date of injury/When did it happen? (acute vs. chronic)
Previous history of injury?
Mechanism of injury/How did injury happen?
Did athlete hear or feel anything?
- “snap” and/or “crack”
- “pop”
- clicking and/or catching
- grating and/or crepitus
fracture and/or dislocation
muscle/ligament injury
loose bodies
degeneration/osteoarthritic changes
Deformity present? Did it reduce spontaneously or with help?
Immediate or delayed disability or swelling?
- localized swelling = superficial structures; bursitis, contusion, strain, sprain
- diffuse swelling = severe hematoma; dislocation, fracture
- intramuscular swelling = swelling within a muscle
- intermuscular swelling = swelling between muscles
- immediate swelling = under 2 hrs; severe injury; damage to structure with rich
blood supply
- delayed swelling = 6-24 hrs; synovial irritation; capsular/ligament sprain
- delayed swelling = post-activity only; bursitis, chronic synovial irritation
What type of pain is it?
- cramping, dull, aching
- sharp, shooting
- deep, nagging, dull, localized
- sharp, bright, burning
- throbbing, diffuse, aching, poorly localized
- pain/stiffness improves with activity
- morning pain
- pain that escalates as day progresses
- night pain
- constant pain
- pain only with repeating mechanism of injury
- immediate pain
- pain of gradual onset
muscle
nerve root
bone
nerve
vasculature
chronic inflammation
acute injury
aggravating injury
pathologic problem
overuse syndrome
What does the condition currently feel like?
Any numbness and/or tingling?
When and where does it hurt? (show with 1 finger)
What is the level of pain? (0-10 scale)
Does the pain radiate? If so, where?
What makes it feel better or worse?
Are you taking any medications? Any allergies to medications?
What was functional status prior to injury? Dominant hand/leg?
PHYSICAL OBSERVATION (INSPECTION)
Athlete’s gait/movement patterns
Athlete’s posture
How athlete is carrying injured body part
Bilateral joint/body contour symmetry
Obvious deformity – malalignment, fracture/dislocation
Muscle atrophy
Swelling
Skin color/texture
Open wounds/external bleeding
Scars
Athlete’s facial expressions
Athlete’s ability and willingness to use the injured body part
PALPATION (PERFORM BILATERALLY)
Perform in a specific sequence – beginning away from pain site
Perform bony and soft tissue palpation
Note – point tenderness, crepitus, symmetry, tissue temperature
When palpating, note:
Differences in tissue tension and texture
Differences in tissue thickness
Abnormalities/deformities
Tenderness
Temperature variations
Abnormal sensation
Swelling/inflammation
Range of Motion (active, active-assisted, passive) – PERFORM BILATERALLY
Active first unless contraindicated by fractures or recently repaired tissue
Observe movement patterns, facial expressions, painful arcs
Manual Muscle Testing (PERFORM BILATERALLY)
Isometric resistive muscle testing (break test)
Resisted full range of motion testing
Special Tests (PERFORM BILATERALLY)
- Stress tests: evaluates the structural integrity of ligaments and joint
capsules; determines the amount of laxity in a specific ligament and/or
the amount of instability in a specific joint
-
Special tests: specific procedures applied to a body part to determine
the amount of damage done
Neurological tests (dermatomes, myotomes, reflexes) PERFORM BILATERALLY
- Dermatome (sensation) – area of skin innervated by a single nerve root
- Myotome (motor) – group of muscles supplied by a specific nerve root
- Deep tendon reflex – involuntary muscle contraction initiated by the
stretching of receptors within a tendon
ANKLE/LOWER LEG
PALPATIONS
_medial malleolus
_deltoid ligament
_navicular
_calcaneous
_1-5 metatarsals
_styloid process 5th metatarsal
_lateral malleolus
_ATF, CF, PTF ligaments
_tibialis anterior
_extensor digitorum
_extensor hallucis longus
_Achilles tendon
_tibialis posterior
_flexor digitorum
_flexor hallucis longus
_gastroc/soleus
_shaft of tibia
_shaft of fibula
_peroneal
LIGAMENT/SPECIAL TESTS
_Anterior Drawer
_Talar tilt
_Kleiger’s
_Navicular Drop
_Tuning fork
KNEE/THIGH
PALPATIONS
_patella
_tibial tubercle
_medial joint line
_lateral joint line
_adductor tubercle
_lateral epicondyle
_medial epicondyle
_head of the fibula
_Heel Tap
_Compression
_Metatarsal Glides
_AROM/PROM
(PF,DF,IN,EV)
_MMT
_quadriceps tendon
_Biceps Femoris tendon
_Semimembranosis/Semitendinosis
_IT band
_pes anserine insertion
_medial collateral ligament
_lateral collateral ligament
_patella tendon
LIGAMENT/SPECIAL TESTS
_AROM/PROM
_Patella tracking
_Isometric resistive muscle testing
_Valgus 0º /30º
_Varus 0º /30º
_Lachman test
_Anterior Drawer test (neutral, internal, external rotation)
_Posterior Sag test (Gravity Drawer test)
_Patellar grind test
_Patellar apprehension test for subluxation
_MMT
_Apley’s compression/distraction
SHOULDER/UPPER TRUNK EVALUATION
PALPATION
_sternoclavicular joint
_clavicle
_acromioclavicular joint
_coracoid process
_acromion
_head of the humerus
_bicipital groove
_spine of the scapula
_vertebral border of the scapula
_axillary border of the scapula
_sternoclavicular (SC) joint
_acromioclavicular (AC) joint
_coracoacromial ligament
_biceps brachii long head
_biceps brachii
_deltoid
_trapezius
_triceps brachii
_rhomboid
_latissimus dorsi
_serratus anterior
_axilla
_supraspinatus
_sternocleidomastoid
_pectoralis major
_glenohumeral ligaments
SPECIAL TESTS
_AROM/PROM
_MMT
_sulcus sign
_biceps long head (speed’s test)
_impingement (Hawkins, neers)
_bicipital tendonitis and subluxation test
_empty can test (supraspinatus)
_check movement of clavicle
_apprehension test
BACK INJURY
PALPATION
_spinous processes
_transverse processes
_L4, L5
_PSIS standing
_PSIS seated
_ASIS
_piriformis
_iliac crest
_erector spinae
_latissimus dorsi
_int./ext. oblique
_rhomboid
_iliopsoas
_sacral base
SPECIAL TESTS
_Leseque's sign (SLR)
_Bowstring Test (sciatic nerve irritation)
_Straight Leg Test (sciatic nerve irritation)
_Slump test
_Figure 4 Test (FABERs)
_SI joint testing (forward flexion, gillette’s, supine to long sit)
_reflexes
achilles, patella tendon, biceps, brachioradialis, triceps