systematic evaluation process
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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 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
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