Injury Assessment & Evaluation

Today’s topics...  Principles of range of motion testing, neurological testing, and special tests  Functional testing

Range of Motion Assessment  Categories & progression 1. AROM 2. PROM 3. RROM

AROM  Voluntary movement through muscle contraction  Establishes willingness and ability to move  Helps determine damage to contractile tissue

AROM  Assess all movements of joint  Check for bilateral equality  Assess fluidity & extent of movement  Palpate joint throughout movement

AROM  Causes of limited movement 1. Pain*5. Joint contractures 2. Swelling6. Nerve damage 3. Muscle spasm7. Loose bodies 4. Muscle tightness *Where in the motion does it hurt? *Where in the motion does it hurt? “Painful arc”

PROM  Movement of the part w/o assistance from the injured individual  Distinguishes injury to contractile tissues from non-contractile tissues  Position person lying down to relax muscles  Perform painful movements last  Note end feel

RROM  Assess muscle strength after injury  Detect injury to nervous system  Examples of results & implications: 1. Muscle weakness & pain--> strain 2. Muscle weakness & pain -> nn damage  Static & dynamic testing (pressure vs resistance)  Grading system

Movement terminology  Flexion/extension

Movement terminology  ABDuction/ADDuction

Movement terminology  Internal/external rotation  Aka medial/lateral

Movement terminology  Plantar flexion/dorsiflexion  Inversion/eversion  Radial/ulnar deviation

Movement terminology  Horizontal ABDuction/ADDuction  Lateral flexion  L/R rotation

Manual muscle testing

Neurological testing  Evaluate  Sensation  Motor function  Deep tendon reflexes  Identify  Nerve root impingement  Peripheral nerve damage  CNS trauma  Disease

Neurological testing  Indicated by  Numbness  Paresthesia  Muscular weakness  Pain of unexplained origin  Injury to cervical or lumbar spine

Neurological testing  Spinal nerve roots & segmental nerves  Roots supply area of skin & series of muscles 1. Dermatome 2. Myotome

Neurological testing  Assessment of dermatomes & myotomes  Reflex testing 1. Changes -->degeneration OR injury in specific regions of nervous system 2. DTR’s tend to be absent if specific nerve root damage

Joint stability tests  Assess integrity of ligamentous & capsular tissues  Tests apply tension to specific ligaments  ALWAYS include tests for major ligament damage & fxs in “On-field” evaluations

Laxity vs instability  Laxity — clinical sign of the amount of “give” within a joint; identified by stress testing  Instability — joint’s inability to function under the stresses of function activity

Ligamentous Stress tests

Special tests  Specific procedures applied to a joint to determine presence of a particular pathological condition  Unique to each structure  Results are compared  Side to side  Cause provocation  Cause alleviation  Reported as positive (+) or negative (-)

Special tests

Functional Testing  Tests of motor coordination, proprioception, & sport specific skill  Tests are sport specific--> performed during sport participation

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