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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