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Assessment and Evaluation

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Presentation on theme: "Assessment and Evaluation"— 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 Relevant Sounds or sensations How did injury occur
Macrotrauma (single traumatic force) Microtrauma (accumulation of repeated forces) Relevant Sounds or sensations Pop “Giving Way”

8 Onset and duration of symptoms
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 Pain Descriptions Muscle-cramping, dull, aching Ligament-dull, aching Nerve root-sharp, shooting Nerve-sharp, bright Bone-deep, nagging Fracture-sharp, severe

10 Related history to opposite body part General health status
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 Atrophy Lay tape symmetrically around body
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 Trigger Points
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 Increased tissue temperature
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
Hard Bone contacting bone elbow extension Soft Soft 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
Soft Soft tissue edema synovitis Firm Capsular,muscular, ligamentous shortening Hard osteoarthritis Fracture Empty Bursitis, 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
0/5 Zero No contraction 1/5 Trace Palpable contraction No muscle movement 2/5 Poor Able to move body part through gravity eliminated 3/5 Fair Move against gravity throughout ROM 4/5 Good Moderate resistance 5/5 Normal Maximal resistance

25 Clinical Significance
Strength Pain Finding Good None Normal Good Present Minor soft tissue injury Weak Present Major injury Weak None Neurological 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) Sprains Grade Endfeel Damage I Firm Slight Stretch II Soft Partial Tearing “opens up” III Empty Complete Rupture motion is restricted by structures

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 Motor 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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