1. Systematic Evaluation Process

2. What need to know for successful evaluation and impression? –ANATOMY –Pathomechanics –Biomechanics of Sport –Pathologies

3. Systematic Evaluation Process Many different ways Must be Sequential Process Types of Evaluations –Clinical –On-field

4. 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

5. 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

6. Systematic Evaluation Process Inspection (Observation) –Really begins when patient enters athletic training room Gait Posture Functional movement

7. Systematic Evaluation Process Inspection cont. –Deformities

8. Systematic Evaluation Process Inspection cont. –Deformities

9. Systematic Evaluation Process Inspection cont. –Deformities –Ecchymosis

10. Systematic Evaluation Process Inspection cont. –Deformities –Ecchymosis –Swelling Effusion vs edema Localized vs diffuse

11. Systematic Evaluation Process Inspection cont. –Deformities –Ecchymosis –Swelling Effusion vs edema Localized vs diffuse –Bilateral Symmetry

12. Systematic Evaluation Process Inspection cont. –Deformities –Ecchymosis –Swelling Effusion vs edema Localized vs diffuse –Bilateral Symmetry –Skin Scars, ecchymosis, temp, color

13. Systematic Evaluation Process Palpation –Feeling for: Point tenderness Deformities Crepitus Gapping Muscle tension/spasm Temperature Swelling (edema/effusion)

14. Systematic Evaluation Process Palpation Procedures –Injured vs non-injured side –Start away from injured part –Bony Tissue First

15. Systematic Evaluation Process Palpation Procedures –Injured vs non-injured side –Start away from injured part –Bony Tissue First –Ligament Structures Second

16. Systematic Evaluation Process Palpation Procedures –Injured vs non-injured side –Start away from injured part –Bony Tissue First –Ligament Structures Second –Muscle Tissue Third

17. Systematic Evaluation Process Range-of-Motion (ROM) –Active ROM (AROM) Contraindications Willingness to move

18. Systematic Evaluation Process Range-of-Motion (ROM) –Active ROM (AROM) Contraindications Willingness to move –Passive ROM (PROM) Quantity of movement Endfeels –Normal vs abnormal

19. 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

20. 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

21. 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

22. Systematic Evaluation Process Ligament and Capsular Tests –Structural integrity of non-contractile tissue –Bilateral comparison

23. Systematic Evaluation Process Special Tests –Bilateral comparison –Specific to a structure, joint or body part

24. Systematic Evaluation Process Neurological Tests –Sensory Dermatome Myotome Reflex Testing

25. Systematic Evaluation Process Neurological Tests –Sensory Dermatome Myotome Reflex Testing

26. Systematic Evaluation Process Neurological Tests –Sensory Dermatome Myotome Reflex Testing

27. Systematic Evaluation Process Functional Tests –Coordinated movements specific to sport or position

28. On-field Evaluation

29. Must rule out –Cardiovascular or respiratory failure –Life-threatening head or spinal injury –Profuse bleeding –Fractures –Joint dislocation –Peripheral nerve injury –Other

30. On-field Evaluation -- History Clear Communication Briefer than Clinical Mechanism Pain location Noises Signs and symptoms

31. 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

32. On-field Evaluation --- Palpation Bone alignment Crepitus Joint alignment Swelling Pain Deficits in muscle or tendons

33. On-field evaluation – ROM Testing AROM, PROM, RROM Contraindications

34. On-field evaluation --- Ligamentous and Special Tests Usually single plane tests Gives immediate impression

35. On-field evaluation --- Neurological Tests Very important if suspect head or spine injury Also with fractures and dislocation

36. 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