1. The Injury Examination Process ATHT 305 Fall 2015

2. Objectives: Describe systematic examination technique List appropriate history questions List steps of a clinical examination in logical order

3. Human body parts work together to produce normal movement known as biomechanics Pathomechanics occurs after injury – Example: Limping Examination process connects the findings of dysfunctional anatomy, physiology, biomechanics.

4. Diagnosing Initial diagnosis success determines rehabilitative outcomes – Need to reexamine Final determination is differential diagnosis – __________________________________________________ ____________________________________________________ Clinical diagnosis achieved via lab tests

5. Uninjured Pair Structure The uninjured equivalent, the ___________ ____________, should always be compared Which do you test first: injured or non- injured? When do you not test the uninjured? – Acute situations such as dislocation

6. Clinical assessment Have informed consent – Under 18 – Cross gender – Unconscious?

7. Step 1: History Most informative portion- info about structures involved, extent of tissue damage Communication barriers – Use jargon-free language – Use pictures or models – Speak slower, not louder – Ask about one symptom at a time Use ________ questions – Will get more information – During catastrophic injury use “yes or no” questions – Example:

8. Questions to ask- Previous history Is there a history of injury to the area? Or “have you hurt this before”? – Follow up questions: _______________________? Does it feel the same as before? ________________________? Did that help?

9. Questions to ask- General Medical Health Looking for comorbidities- presence of multiple unrelated disorders in the person at the same time Chronic illness? Medications? Smoking?

10. Questions to ask ______________________ – How did this happen? – Acute onset or insidious? Relevant sounds – Did you (or bystanders) hear a “pop” or “crack”? Location – Point with one finger to the spot it hurts most

11. OPQRST of Pain ____________- When did it start? ____________- What makes it worse/better? – Identifies tissues stretched/compressed ____________- – Nerve- _________________ – Bone- __________________ – Vascular- poorly localized, aching, reffered from another area – Muscle- ____________________ ____________________________ _______________________- – Radiating is result of nerve root or peripheral nerve compressed or contused – Referred pain at site other than trauma ____________-scale of 1-10 __________- when does it hurt? – Morning vs night (muscle fatigue) – After sitting for long periods of time – Goes away during activity= chronic

12. Other Weakness? Does it “give out”? Cold? – arterial involvment Heavy? Venous or lymphatic involvement

13. Step 2- Inspection & Functional Assessment Starts as soon as patient walks in-_______, guarding Looking for: – _________________ – _________________- measured by girth or volume – ______- ecchymosis, open wounds, surgical scars – ____________- red, swelling, pus, red streaks, temperature

14. Functional Assessment Perform tasks identified as problematic

15. Step 3: Palpation Performed bilateral Start away from pain and move towards- can rule out sources of pain and identify involved secondary structures – Start with _________________, then __________________ OR all structures away from then progress towards

16. Palpation- what to look for Point tenderness- begin gentle then increase pressure Trigger points Change in tissue density – Muscle spasm, hemorrage, edema, scarring, myositis ossificans Crepitus- _____________________ Tissue temperature – Increased= inflammation – Decreased= vascular insufficiency

17. Step 4- Joint and Muscle Function Assessment: AROM, PROM, RROM, & MMT _______ Range of Motion- joint motion produced by patient contracting muscles – Assesses physiological and accessory motion – Contraindication: fx or recently repaired soft tissue Evaluates: – Willingness and ability to move – Unwilling is extreme pain, neurological deficit, or malingering – “Painful arc”- part of ROM causing pain due to compression, impingement or abrasion

18. Passive Range of Motion Clinician moves joint through ROM Apply over pressure to identify end feels to indicate what type of structure stressed at terminal ROM PROM should be _______ than AROM When they fall short, capsular adhesions When AROM less= muscle weakness

19. Normal End-feels End-feelsStructureExample SoftKnee flexion FirmHip flex with knee ext Ext of MCP joints Forearm supination HardElbow ext

20. Resistive Range of Motion & MMT Gross strength of muscle group through cardinal plane of motion Manual Muscle Tests- Isometric test in mid- range of ROM (also called _______________) – Differentiates between __________________ – Ligaments not taut in joints midrange – Compensation may be seen

21. MMT Grades VerbalNumericalClinical Finding Normal5/5 Can resist against max pressure. Examiner unable to break patient’s resistance. Good4/5 Patient can resist against moderate pressure. Fair3/5 Patient can move the body part against gravity through full ROM Poor2/5 Patient can move body part in gravity-eliminated position through full ROM Trace1/5 Patient cannot produce movement, but contraction is palpable Zero0/5 No contraction felt.

22. Other things to consider Hyper vs hypomobility – Can be congenital laxity Joint play – Accessory motion: roll, spin, glide Assessed with Pt. relaxed, loose-packed position. Distract joint.

23. Step 5: __________________ Step 6: Neurological screening – ________________= sensory – ________________= motor – Reflex= integrity of CNS via GTO Step 7: Vascular Screen

24. Homework questions 1. What is the difference between a “sign” and a “symptom”? 2. When asking about medications, what are 2 possible negative effects that could influence the injury. – Example: prolonged bleeding time 3. Describe where and what you would start palpating if an athlete told you the lateral side of their ankle hurt. 4. If I say “MMT of knee flexion is 3/5” describe the patient position and results of the test.