1. Assessment and Evaluation
Mazyad Alotaibi

2. Assessment and Evaluation
Good assessment is dependent upon:
Knowledge of functional anatomy
History
Complete examination

3. Evaluation Structure governs function Anatomy is the structure
Biomechanics/physiology are the function

4. 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

5. Clinical Evaluation Sequence
History
Inspection
Palpation
Functional Testing
A/P/ROM
Ligamentous Testing
Special Tests
Neurological Testing

6. 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

7. History Mechanism Relevant Sounds or sensations How did injury occur
Macrotrauma (single traumatic force)
Microtrauma (accumulation of repeated forces)
Relevant Sounds or sensations
Pop
“Giving Way”

8. Onset and duration of symptoms
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

9. 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
Pain Descriptions
Muscle-cramping, dull, aching
Ligament-dull, aching
Nerve root-sharp, shooting
Nerve-sharp, bright
Bone-deep, nagging
Fracture-sharp, severe

10. Related history to opposite body part General health status
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

11. 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

12. Girth Measurements Swelling Atrophy Lay tape symmetrically around body
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

13. Palpation Detect tissue damage Bones (rule out fracture)
Ligaments/tendons
Soft tissue
Pulses

14. Point tenderness Trigger Points
Visualize structure which lie beneath fingers
Compare bilaterally
Trigger Points
Palpated points in muscle which refer pain to another body area

15. Change in tissue density (or feel of tissue) may indicate:
Muscle spasm
Hemorrhage
Edema
Scarring
Myositis ossificans

16. Increased tissue temperature
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

17. Range of Motion (ROM) Helps to assess functional status
Compare bilaterally
Test joints proximal and distal to injured area

18. Functional Testing AROM
Contraindications:
immature fracture sites
newly repaired
Cardinal Planes (test all planes of ROM)
Painful ARC
compression within range

19. Functional Testing PROM
Quantity of available movement
“End feel” reach limit of available ROM
Most accurate method is with goniometry measurements

20. Normal End Feel Physiological
Hard Bone contacting bone
elbow extension
Soft Soft tissue approximation
elbow flexion
Firm Capsule stretch(ext of MCP jt)
Ligament Stretch
(forearm supination)
Muscle Stretch
(hip flexion with knee extended)

21. Abnormal End Feel Pathological
Soft Soft tissue edema
synovitis
Firm Capsular,muscular, ligamentous shortening
Hard osteoarthritis
Fracture
Empty Bursitis, Joint inflammation

22. 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

23. Manual Resistance Stabilize limb proximally
Resistance provided distally on bone to which muscle attaches
Watch for compensation

24. Grading system for Manual Muscle Testing
0/5 Zero No contraction
1/5 Trace Palpable contraction No muscle movement
2/5 Poor Able to move body part through gravity eliminated
3/5 Fair Move against gravity throughout ROM
4/5 Good Moderate resistance
5/5 Normal Maximal resistance

25. Clinical Significance
Strength Pain Finding
Good None Normal
Good Present Minor soft tissue injury
Weak Present Major injury
Weak None Neurological or Rupture or Chronic

26. Ligamentous and Capsular Testing
Ligamentous testing compare bilaterally compare with baseline measures correct positioning (if incorrect positioning may lead to false results) •
Sprains
Grade
Endfeel
Damage I
Firm
Slight Stretch II
Soft
Partial Tearing
“opens up”
III
Empty
Complete Rupture
motion is restricted by
structures

27. Special Tests
Specific procedures applied to joint to determine presence of injury
Unique to each structure
Bilateral comparison

28. Neurological (Referred Pain)
Involves Upper/lower quarter screen of:
Sensory (dermatome)
Motor (myotome)
DTR (Deep Tendon Reflex)

29. Sensory Testing Motor 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