Post on 03-Jun-2015
Systematic Evaluation Process
Systematic Evaluation Process
• What need to know for successful evaluation and impression?– ANATOMY– Pathomechanics– Biomechanics of
Sport– Pathologies
Systematic Evaluation Process
• Many different ways• Must be Sequential Process• Types of Evaluations
– Clinical– On-field
Systematic Evaluation Process
• History– Most important part of
evaluation– Communication skills– Simple Open-ended
Questions• Mechanism• Sounds • Pain Location• Onset of Symptoms• Description of Symptoms
– When– Joint Position– How
• Previous Injury
Systematic Evaluation ProcessTips for taking a
good history– LISTEN– Verbal vs
Nonverbal Communication
– Avoid slang and jargon language
– Maintain eye contact
– Be Calm and reassuring
Systematic Evaluation Process
• Inspection (Observation)– Really begins when
patient enters athletic training room
• Gait • Posture• Functional movement
Systematic Evaluation Process
• Inspection cont.– Deformities
Systematic Evaluation Process
• Inspection cont.– Deformities
Systematic Evaluation Process
• Inspection cont.– Deformities– Ecchymosis
Systematic Evaluation Process
• Inspection cont.– Deformities– Ecchymosis – Swelling
• Effusion vs edema• Localized vs
diffuse
Systematic Evaluation Process
• Inspection cont.– Deformities– Ecchymosis – Swelling
• Effusion vs edema• Localized vs
diffuse
– Bilateral Symmetry
Systematic Evaluation Process• Inspection cont.
– Deformities– Ecchymosis – Swelling
• Effusion vs edema• Localized vs diffuse
– Bilateral Symmetry– Skin
• Scars, ecchymosis, temp, color
Systematic Evaluation Process
• Palpation– Feeling for:
• Point tenderness• Deformities• Crepitus • Gapping• Muscle tension/spasm• Temperature• Swelling
(edema/effusion)
Systematic Evaluation Process
• Palpation Procedures– Injured vs non-
injured side– Start away from
injured part– Bony Tissue First
Systematic Evaluation Process
• Palpation Procedures– Injured vs non-
injured side– Start away from
injured part– Bony Tissue First– Ligament Structures
Second
Systematic Evaluation Process
• Palpation Procedures– Injured vs non-
injured side– Start away from
injured part– Bony Tissue First– Ligament Structures
Second– Muscle Tissue Third
Systematic Evaluation Process
• Range-of-Motion (ROM)– Active ROM (AROM)
• Contraindications• Willingness to move
Systematic Evaluation Process
• Range-of-Motion (ROM)– Active ROM (AROM)
• Contraindications• Willingness to move
– Passive ROM (PROM)• Quantity of movement• Endfeels
– Normal vs abnormal
Endfeels (Normal vs Abnormal)
Normal
Soft Soft Tissue approximation
Firm Muscle, capsular, ligament stretch
Hard Bone-on-bone
Abnormal
Soft Boggy feeling, Ex edema
Firm Spasm, soft tissue shortening
Hard Loose bodies, fracture
Empty No endfeel, Ex fracture, severe sprain, acute inflammation
Systematic Evaluation Process• Range-of-Motion (ROM)
– Active ROM (AROM)• Contraindications• Willingness to move
– Passive ROM (PROM)• Quantity of movement• Endfeels
– Normal vs abnormal
– Resistive ROM (RROM)• Break test vs manual
muscle test• Grading System
Grading Scale for RROM
Normal (5/5) Resist against maximal pressure
Good (4/5) Resist against moderate pressure
Fair (3/5) Move through full ROM against gravity
Poor (2/5) Move through full ROM in gravity eliminated position
Trace (1/5) Cannot prodce movement, but feel muscle contration
Gone (0/5) No contraction felt
Systematic Evaluation Process
• Ligament and Capsular Tests– Structural
integrity of non-contractile tissue
– Bilateral comparison
Systematic Evaluation Process
• Special Tests– Bilateral
comparison– Specific to a
structure, joint or body part
Systematic Evaluation Process
• Neurological Tests– Sensory
• Dermatome • Myotome• Reflex Testing
Systematic Evaluation Process
• Neurological Tests– Sensory
• Dermatome • Myotome• Reflex Testing
Systematic Evaluation Process
• Neurological Tests– Sensory
• Dermatome • Myotome• Reflex Testing
Systematic Evaluation Process
• Functional Tests– Coordinated
movements specific to sport or position
On-field Evaluation
On-field EvaluationMust rule out
– Cardiovascular or respiratory failure
– Life-threatening head or spinal injury
– Profuse bleeding– Fractures– Joint dislocation– Peripheral nerve
injury– Other
On-field Evaluation -- History
• Clear Communication
• Briefer than Clinical• Mechanism• Pain location• Noises• Signs and
symptoms
On-field Evaluation --- Inspection• When does this
begin?• Is the athlete
moving?• Position of Athlete?• Conscious or
unconscious?• Observe as soon as
walk on the field
On-field Evaluation --- Palpation
• Bone alignment• Crepitus• Joint alignment• Swelling• Pain• Deficits in muscle
or tendons
On-field evaluation – ROM Testing
• AROM, PROM, RROM• Contraindications
On-field evaluation --- Ligamentous and Special Tests
• Usually single plane tests• Gives immediate impression
On-field evaluation --- Neurological Tests
• Very important if suspect head or spine injury
• Also with fractures and dislocation
Removal of Athlete from Field
• DECISIONS, DECISIONS. WHAT SHOULD YOU DO?
• Fractures, dislocations, gross joint instability, spinal injury
• Ways to remove athlete once make the decision