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 Process Tips 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 produce movement, but feel muscle contraction 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

Must 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