Injury Assessment and Injury Assessment and EvaluationEvaluation

TIP Proper evaluation=

Proper injury assessment=Proper treatment=

Proper rehab.

vocabularyvocabulary• Biomechanics: Application of mechanical forces to living

organisms • Pathomechanics: Mechanical forces that are applied to a living

organism and adversely change the body’s structure and function • Etiology: The cause of an injury or disease

• Pathology: Structural and functional change that results in injury • Symptom: A perceptible change in an athlete's body or its

functions that indicates an injury or disease: subjectively described by the person.

• Sign: An objective indicator of a specific condition

• Diagnosis: The name of a specific condition made by a

physician

Vocab. continuedVocab. continued• Prognosis: A prediction of the course of the condition

• Sequela: A condition following and resulting from a disease or injury

• Syndrome: Refers to a group of symptoms and signs that, together, indicate a particular injury or disease.

• AROM:

• PROM:

• Goniometer: Act of measuring the range of motion at a joint

• Joint play: Movement that is not voluntary, but accessory

• Dysethesia:

• Anesthesia:

• Hyperesthesia:

Surface AnatomySurface Anatomy• Body PlanesBody Planes• TransverseTransverse

• MidsagittalMidsagittal

• coronal (frontal)coronal (frontal)

• Anatomical DirectionsAnatomical Directions• Anterior, posterior, medial, lateral, distal, proximal, inferior, superiorAnterior, posterior, medial, lateral, distal, proximal, inferior, superior

• Flex/Ext, Abd/adduction, internal/external rotation, Flex/Ext, Abd/adduction, internal/external rotation, supination/pronation, Inversion/eversion, dorsi/plantar supination/pronation, Inversion/eversion, dorsi/plantar flexion, Valgus/varus, kyphosis/lordosis/scoliosisflexion, Valgus/varus, kyphosis/lordosis/scoliosis

• Abdominopelvic QuadrantsAbdominopelvic Quadrants• 4 quadrants4 quadrants

• Right/left upper, right/left lowerRight/left upper, right/left lower

EvaluationEvaluation• Primary AssessmentPrimary Assessment

Serious or life threatening injuriesSerious or life threatening injuries

• Secondary AssessmentSecondary Assessment– HistoryHistory

• chief complaintchief complaint

• If pain is present:If pain is present:

• its location, characteristic, duration, variation, its location, characteristic, duration, variation, radiating, intensityradiating, intensity

• Is pain increased/decreased by specific Is pain increased/decreased by specific activities or stressactivities or stress

• What situation or trauma caused problemWhat situation or trauma caused problem

• Has theHas the problem occurred before? problem occurred before?

Evaluation cont..Evaluation cont..

• ObservationObservation– deformitydeformity

– are limb positions symmetricalare limb positions symmetrical

– How do limbs look by: size, shape, color, temperature, and How do limbs look by: size, shape, color, temperature, and muscle tone compared bilateralmuscle tone compared bilateral

– heat swelling, rednessheat swelling, redness

– Is the athlete willing to move a body partIs the athlete willing to move a body part

– Does the athlete display facial expressions indicating painDoes the athlete display facial expressions indicating pain

• Palpation Palpation BonyBony- compare bilaterally- compare bilaterally

– might reveal abnormal gap at a jointmight reveal abnormal gap at a joint

– swelling on a bone, joints that are mis-aligned or abnormal swelling on a bone, joints that are mis-aligned or abnormal protuberancesprotuberances

– Soft tissueSoft tissue- - swelling, lumps, gaps, abnormal muscle tension, swelling, lumps, gaps, abnormal muscle tension, temptemp

– tissue tightnesstissue tightness

– excessive skin dryness or moistureexcessive skin dryness or moisture

– abnormal skin sensationabnormal skin sensation

Movement Assessment (Functional Tests)Movement Assessment (Functional Tests)

• AROM / PROMAROM / PROM

• Normal EndpointsNormal Endpoints

– Soft-tissue: soft/spongy, a gradual painless stop (knee flexion)Soft-tissue: soft/spongy, a gradual painless stop (knee flexion)

– Capsular feel: an abrupt, hard, firm endpoint with only a little give Capsular feel: an abrupt, hard, firm endpoint with only a little give (endpoint of hip rotation)(endpoint of hip rotation)

– Bone to bone: a distinct abrupt endpoint when 2 hard surfaces Bone to bone: a distinct abrupt endpoint when 2 hard surfaces come in contact with one another (elbow in full extension)come in contact with one another (elbow in full extension)

– Muscular: springy feel with some discomfort (end of shoulder Muscular: springy feel with some discomfort (end of shoulder abductionabduction

• Abnormal EndpointsAbnormal Endpoints

– Empty feel: movement beyond the anatomical limit with Empty feel: movement beyond the anatomical limit with pain at the end of the ROM (grade 3 ligament injury)pain at the end of the ROM (grade 3 ligament injury)

– Spasm: involuntary muscle contraction, prevent ROM Spasm: involuntary muscle contraction, prevent ROM because of pain (back spasm)because of pain (back spasm)

– Loose: extreme hyper mobility (previously sprained ankle)Loose: extreme hyper mobility (previously sprained ankle)

– Springy block: a rebound at the endpoint (meniscus tear)Springy block: a rebound at the endpoint (meniscus tear)

Movement Assessment (Functional Tests)Movement Assessment (Functional Tests)

• Resisted motionsResisted motions• strong/painless- normal musclestrong/painless- normal muscle

• strong/painful- minor injury to musclestrong/painful- minor injury to muscle

• weak/painless- complete rupture of muscleweak/painless- complete rupture of muscle

• weak/painful- gross lesion of muscleweak/painful- gross lesion of muscle

• pain on repetition- single contraction is strong/painless, pain on repetition- single contraction is strong/painless, but repetition causes pain- vascular disorderbut repetition causes pain- vascular disorder

• all muscle painful- serious emotional/psychological all muscle painful- serious emotional/psychological problemproblem

• Goniometric measurementGoniometric measurement--

• measures joint ROMmeasures joint ROM

• anatomical positionanatomical position

•Manual Muscle testingManual Muscle testing

• Grade/%Grade/% ValueValue StrengthStrength

• 5/1005/100 normalnormal Full ROM against gravity with full resistanceFull ROM against gravity with full resistance

• 4/754/75 goodgood Full ROM against gravity with some resistance Full ROM against gravity with some resistance

• 3/503/50 FairFair Full ROM against gravity with no resistance Full ROM against gravity with no resistance

• 2/252/25 poorpoor Full ROM without gravityFull ROM without gravity

• 1/101/10 tracetrace slight contraction without motionslight contraction without motion

• 0/00/0 zerozero no muscle contractionno muscle contraction

• Neurological/sensory examNeurological/sensory exam• Cerebral functionCerebral function- ?’s asked for level of consciousness, emotional - ?’s asked for level of consciousness, emotional

status, concentrationstatus, concentration

• Cranial nerve function- Cranial nerve function- 12 cranial nerves

• Cerebellar function-Cerebellar function- coordinated movements coordinated movements

• Sensory testing-Sensory testing- nerve involvement. Test bilaterally

Special TestsSpecial Tests

• Testing joint playTesting joint play- movement that is not - movement that is not voluntary but accessory. Ligament stabilityvoluntary but accessory. Ligament stability

• Functional evaluationFunctional evaluation- check strength, - check strength, joint stability, coordination and is pain free. joint stability, coordination and is pain free. You should test gradual or little stress on the You should test gradual or little stress on the area to more sport specificarea to more sport specific

• Postural exam-Postural exam-is designed to test for is designed to test for malalignments and asymmetries of the bodymalalignments and asymmetries of the body

SOAP NotesSOAP Notes

• SubjectiveSubjective

• statements statements presented by the presented by the injured athlete. injured athlete. History and what did History and what did it feel likeit feel like

• ObjectiveObjective

• Findings found by Findings found by the evaluator the evaluator pertaining to:pertaining to:

• observation, observation, palpation, stress palpation, stress testingtesting

• AssessmentAssessment

• The evaluators The evaluators judgement of the judgement of the injury. What his/her injury. What his/her findings werefindings were

• PlanPlan

• TreatmentTreatment

• Therapeutic Therapeutic exercisesexercises

• Follow up evaluationFollow up evaluation

Diagnostic testsDiagnostic tests

• Blood testingBlood testing-RBC/WBC count, hemoglobin levels-RBC/WBC count, hemoglobin levels

• urinalysisurinalysis- specific gravity (dehydration), pH levels, - specific gravity (dehydration), pH levels, glucose, ketones, hemoglobin,proteinglucose, ketones, hemoglobin,protein

• x-rayx-ray- determines bony problems- determines bony problems

• ArtrographyArtrography- x-ray with injection of opaque dye- x-ray with injection of opaque dye

• ArthroscopyArthroscopy- joint surgery - joint surgery

• MyelographyMyelography- opaque dye injected into the spinal - opaque dye injected into the spinal canal. canal.

• Bone scanBone scan- radioactive tracer injected - radioactive tracer injected

• MRIMRI-used for soft tissue injuries-used for soft tissue injuries

• SonographySonography- ultra sound- ultra sound

• CT scanCT scan- used for bone injuries- used for bone injuries

• Electromyography/ nerve conduction velocityElectromyography/ nerve conduction velocity- - muscle nerve relationship to determine any malfunctionsmuscle nerve relationship to determine any malfunctions