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Assessment and Evaluation Mazyad Alotaibi. Assessment and Evaluation Good assessment is dependent upon: –Knowledge of functional anatomy –History –Complete.

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Presentation on theme: "Assessment and Evaluation Mazyad Alotaibi. Assessment and Evaluation Good assessment is dependent upon: –Knowledge of functional anatomy –History –Complete."— Presentation transcript:

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

8 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

10 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 –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 –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 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 HardBone contacting bone elbow extension SoftSoft 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 SoftSoft tissue edema synovitis FirmCapsular,muscular, ligamentous shortening Hardosteoarthritis Fracture EmptyBursitis, 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 0/5ZeroNo contraction 1/5TracePalpable contraction No muscle movement 2/5PoorAble to move body part through gravity eliminated 3/5FairMove against gravity throughout ROM 4/5GoodModerate resistance 5/5NormalMaximal resistance

25 Clinical Significance StrengthPainFinding –GoodNoneNormal –GoodPresentMinor soft tissue injury –WeakPresentMajor injury –WeakNoneNeurological 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)

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 –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

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