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IInjury Evaluation Processnjury Evaluation Process

KIN 191AKIN 191AAdvanced Assessment of Advanced Assessment of Lower Extremity InjuriesLower Extremity Injuries

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INTRODUCTIONINTRODUCTION

INJURY EVALUATION PROCESSINJURY EVALUATION PROCESS Systematic Evaluation TechniqueSystematic Evaluation Technique Clinical EvaluationsClinical Evaluations On-Field EvaluationsOn-Field Evaluations Termination of the EvaluationTermination of the Evaluation

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Systematic Evaluation TechniqueSystematic Evaluation Technique

Description of the evaluation modelDescription of the evaluation model HIPS/HOPS HIPS/HOPS ProcessProcess

HHistoryistory IInspection/nspection/OObservationbservation PPalpationalpation Range of Motion (ROM) TestsRange of Motion (ROM) Tests Ligamentous testsLigamentous tests SSpecial Testspecial Tests Neurological TestsNeurological Tests

The Role of the Non-injured Paired StructureThe Role of the Non-injured Paired Structure

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Clinical EvaluationsClinical Evaluations

HHistoryistory The quality of information = ability to The quality of information = ability to

communicate with the patientcommunicate with the patient Open-ended question are usefulOpen-ended question are useful

• What causes your pain?What causes your pain?

vs.vs.• Does it hurt when you raise your arm?Does it hurt when you raise your arm?

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HHistory (istory (cont.)cont.) Mechanism of the injury (MOI)Mechanism of the injury (MOI) Sounds and sensations at the time of injurySounds and sensations at the time of injury Location of symptomsLocation of symptoms Onset and duration of symptomsOnset and duration of symptoms Description of symptomsDescription of symptoms Changes in the symptomsChanges in the symptoms Previous historyPrevious history Related history to the opposite body partRelated history to the opposite body part General medical healthGeneral medical health

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IInspection/nspection/OObservationbservation Gross deformityGross deformity SwellingSwelling DiscolorationDiscoloration Skin/InSkin/Inffectionection

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PPalpationalpation Point tendernessPoint tenderness Trigger pointsTrigger points

• Specific points in the muscular and fascial tissues Specific points in the muscular and fascial tissues that produce a sharp pain when pressedthat produce a sharp pain when pressed

Change in tissue densityChange in tissue density CrepitusCrepitus

• Repeated cracking sensations or sound emanating Repeated cracking sensations or sound emanating from a joint or tissues, it may caused by a fraction from a joint or tissues, it may caused by a fraction or inflammationor inflammation

SymmetrySymmetry Tissue temperatureTissue temperature

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Range of Motion (ROM)Range of Motion (ROM) AActive ctive ROM (AROM)ROM (AROM) PPassive assive ROM (PROM)ROM (PROM)

• End-feel: the specific quality of movement felt by End-feel: the specific quality of movement felt by an examiner moving a joint to the end of its ROMan examiner moving a joint to the end of its ROM

RResisted esisted ROM (RROM)ROM (RROM)

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ROMROM Goniometric evaluationGoniometric evaluation

• ProtractorProtractor• FulcrumFulcrum• Stationary armStationary arm• Movement armMovement arm

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Physiological (Normal ) End-FeelsPhysiological (Normal ) End-Feels Soft (Soft tissue approximation)Soft (Soft tissue approximation)

• Knee flexionKnee flexion Firm (Muscular/Capsular/Ligamentous stretchesFirm (Muscular/Capsular/Ligamentous stretches

• Hip flexion/MCP joint flexion/Forearm supinationHip flexion/MCP joint flexion/Forearm supination Hard (Bone contracting bone)Hard (Bone contracting bone)

• Elbow extensionElbow extension

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Pathological (Abnormal) End-FeelsPathological (Abnormal) End-Feels SoftSoft

• Soft tissue edemaSoft tissue edema• SynovitisSynovitis

FirmFirm• Increased muscular toneIncreased muscular tone• Capsular/Muscular/Ligamentous shorteningCapsular/Muscular/Ligamentous shortening

HardHard• OsteoarthritisOsteoarthritis• Loose bodies in jointLoose bodies in joint• Myositis ossificansMyositis ossificans• FractureFracture

EmptyEmpty• Acute joint inflammationAcute joint inflammation• BursitisBursitis• AbscessAbscess• FractureFracture• Psychogenic originPsychogenic origin

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Manual Muscle Testing GradingManual Muscle Testing GradingGradeGrade %% Qualitative Qualitative

ValueValueMuscle StrengthMuscle Strength

55 100100 NormalNormal Complete ROM against gravity, Complete ROM against gravity, w/ full resistancew/ full resistance

44 7575 GoodGood Complete ROM against gravity, Complete ROM against gravity, w/ some resistancew/ some resistance

33 5050 FairFair Complete ROM against gravity, Complete ROM against gravity, w/ no resistancew/ no resistance

22 2525 PoorPoor Complete ROM, w/ gravity Complete ROM, w/ gravity omittedomitted

11 1010 TraceTrace Evidence of slight contractility, w/ Evidence of slight contractility, w/ no joint motionno joint motion

00 00 ZeroZero No evidence of muscle No evidence of muscle contractilitycontractility

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Ligamentous and Capsular TestsLigamentous and Capsular Tests Evaluates the structural integrity of the Evaluates the structural integrity of the

noncontractile tissuesnoncontractile tissues surrounding joint surrounding joint• Ligamentous and capsular tissue surrounding jointLigamentous and capsular tissue surrounding joint

Laxity vs. InstabilityLaxity vs. Instability

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SSpecial Testspecial Tests Involve specific procedures applied to a joint a Involve specific procedures applied to a joint a

determine the presence of determine the presence of pathomechanicspathomechanics• Pathomechanics: abnormal motion and forces Pathomechanics: abnormal motion and forces

produced by the body, most often occurring produced by the body, most often occurring secondary to traumasecondary to trauma

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Neurological TestsNeurological Tests Sensory testingSensory testing Motor testingMotor testing Reflex testingReflex testing

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On-Field EvaluationsOn-Field Evaluations

On-Field HistoryOn-Field History Location of painLocation of pain Peripheral symptomsPeripheral symptoms Mechanism of injury (MOI)Mechanism of injury (MOI) Sounds and symptomsSounds and symptoms History of injuryHistory of injury

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On-Field Inspection/ObservationOn-Field Inspection/Observation Is the athlete moving?Is the athlete moving? What is the position of the athlete?What is the position of the athlete? Is the athlete conscious?Is the athlete conscious?

• Primary surveyPrimary survey ABCDsABCDs Activation of Emergency Medical Services (EMS)Activation of Emergency Medical Services (EMS) Emergency Action Plan (EAP)Emergency Action Plan (EAP)

Inspection of the injured areaInspection of the injured area Secondary surveySecondary survey

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On-Field PalpationOn-Field Palpation Bony structureBony structure

• Bony alignmentBony alignment• CrepitusCrepitus• Joint alignmentJoint alignment

Soft tissuesSoft tissues• SwellingSwelling• Painful areasPainful areas• Deficit in the muscles or tendonsDeficit in the muscles or tendons

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On-Field ROM TestingOn-Field ROM Testing

On-Field Special TestingOn-Field Special Testing

On-Field Neurologic testingOn-Field Neurologic testing Particularly important with a suspected head Particularly important with a suspected head

or spine injuryor spine injury

Removal of the Athlete from the FieldRemoval of the Athlete from the Field

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Termination of the EvaluationTermination of the Evaluation

No other information need be collectedNo other information need be collected Obvious fractures or dislocationsObvious fractures or dislocations Gross joint instabilityGross joint instability Neurovascular deficitsNeurovascular deficits