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* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Assessment and Evaluation Mazyad Alotaibi Assessment and Evaluation • Good assessment is dependent upon: – Knowledge of functional anatomy – History – Complete examination Evaluation • Structure governs function – Anatomy is the structure – Biomechanics/physiology are the function Evaluation Purpose • Develop database to establish Patient’s level of function • Plan a treatment program and establish outcomes • Evaluate results of treatment program • Modify treatment program Clinical Evaluation Sequence • • • • History Inspection Palpation Functional Testing • A/P/ROM • Ligamentous Testing • Special Tests • Neurological Testing History • Most important portion of exam – Any special test should confirm what is learned in the history • Key questions(identify forces on the body) – Acute Injury= What is the mechanism – Chronic Injury= Are there changes in treatment routines/equipment/posture History • Mechanism – How did injury occur • Macrotrauma (single traumatic force) • Microtrauma (accumulation of repeated forces) • Relevant Sounds or sensations – Pop – “Giving Way” • Location of symptoms – Localized – Referred(pain from another source) – Isolated vs. diffuse • Onset and duration of symptoms – Immediate pain v. chronic – Classification for overuse injuries • Stage 1 – Pain after activity • Stage 2 – Pain during/after activity • Stage 3 – Constant pain • Description of symptoms – – – – – Sharp/dull/achy Intermittent v. constant Weakness Paresthesia (numbness/tingling) Dysfunction/ inability to perform activity • Change in symptoms – Intensity change with specific motions, postures, treatment, modalities, medications • Previous history – – – – – – Previous injury When did previous episode occur Who evaluated and treated injury Diagnosis Course of treatment/rehab/surgery performed Did previous treatment plan decrease symptoms • Related history to opposite body part – Previous history of injury to uninvolved side • General health status – congenital abnormality/disease Inspection • Gait • Gross Deformity fracture/discoloration/serious bleeding • Swelling (localized v. diffuse) • Bilateral Symmetry • Discoloration • Keloids (surgical scars) • Infection – Redness/warmth/pus/swelling/red streaks/lymph nodes Girth Measurements • Swelling – Identify joint line using bony landmarks • Atrophy – Make incremental marks (2,4,6 inch) from jt. line • Lay tape symmetrically around body • Take 3 measurement and record average • Repeat and record for uninjured limb Palpation • Detect tissue damage – – – – Bones (rule out fracture) Ligaments/tendons Soft tissue Pulses • Point tenderness – Visualize structure which lie beneath fingers – Compare bilaterally • Trigger Points – Palpated points in muscle which refer pain to another body area • Change in tissue density (or feel of tissue) may indicate: – – – – – Muscle spasm Hemorrhage Edema Scarring Myositis ossificans • Crepitus- repeated crackling sensations or sound emanating from the joint or tissue • Symmetry – Compare muscle tone, bony prominence • Increased tissue temperature – Indicates active inflammatory process Range of Motion (ROM) • Helps to assess functional status • Compare bilaterally • Test joints proximal and distal to injured area Functional Testing AROM Contraindications: immature fracture sites newly repaired Cardinal Planes (test all planes of ROM) Painful ARC compression within range Functional Testing PROM • Quantity of available movement • “End feel” reach limit of available ROM • Most accurate method is with goniometry measurements Normal End Feel Physiological Hard Soft Firm Bone contacting bone elbow extension Soft tissue approximation elbow flexion Capsule stretch(ext of MCP jt) Ligament Stretch (forearm supination) Muscle Stretch (hip flexion with knee extended) Abnormal End Feel Pathological Soft Firm Hard Empty Soft tissue edema synovitis Capsular,muscular, ligamentous shortening osteoarthritis Fracture Bursitis, Joint inflammation Functional Testing RROM • Two types of testing – Manual muscle testing – Break test • Contraindications for RROM – Patient is unable to voluntarily contract injured muscle – Patient is unable to perform AROM – Underlying fracture site is not healed – Involved tissues are not yet healed • Manual Resistance – Stabilize limb proximally – Resistance provided distally on bone to which muscle attaches – Watch for compensation Grading system for Manual Muscle Testing • 0/5 • 1/5 Zero Trace • 2/5 Poor • 3/5 Fair • 4/5 • 5/5 Good Normal No contraction Palpable contraction No muscle movement Able to move body part through gravity eliminated Move against gravity throughout ROM Moderate resistance Maximal resistance Clinical Significance • Strength Pain Finding – Good – Good None Present – Weak – Weak Present None Normal Minor soft tissue injury Major injury Neurological or Rupture or Chronic Ligamentous and Capsular Testing Ligamentous testing compare bilaterally compare with baseline measures correct positioning (if incorrect positioning may lead to false results) Special Tests • Specific procedures applied to joint to determine presence of injury • Unique to each structure • Bilateral comparison Neurological (Referred Pain) • Involves Upper/lower quarter screen of: – Sensory (dermatome) – Motor (myotome) – DTR (Deep Tendon Reflex) Sensory Testing – Bilateral – Dermatone • Area of skin innervated by a single nerve root – Slight stroke over area/pin prick – Sharp v. dull – Hot v. cold Motor Testing Manuel Muscle Testing