Download 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.