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