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I njury Evaluation Process   KIN 191A Advanced Assessment of  Lower Extremity Injuries
INTRODUCTION <ul><li>INJURY EVALUATION PROCESS </li></ul><ul><ul><li>Systematic Evaluation Technique </li></ul></ul><ul><u...
Systematic Evaluation Technique <ul><li>Description of the evaluation model </li></ul><ul><li>HIPS/HOPS  Process </li></ul...
Clinical  Evaluations <ul><li>H istory </li></ul><ul><ul><li>The quality of information = ability to communicate with the ...
<ul><li>H istory ( cont.) </li></ul><ul><ul><li>Mechanism of the injury (MOI) </li></ul></ul><ul><ul><li>Sounds and sensat...
<ul><li>I nspection/ O bservation </li></ul><ul><ul><li>Gross deformity </li></ul></ul><ul><ul><li>Swelling </li></ul></ul...
<ul><li>P alpation </li></ul><ul><ul><li>Point tenderness </li></ul></ul><ul><ul><li>Trigger points </li></ul></ul><ul><ul...
<ul><li>Range of Motion (ROM) </li></ul><ul><ul><li>A ctive  ROM (AROM) </li></ul></ul><ul><ul><li>P assive  ROM (PROM) </...
<ul><li>ROM </li></ul><ul><ul><li>Goniometric evaluation </li></ul></ul><ul><ul><ul><li>Protractor </li></ul></ul></ul><ul...
<ul><li>Physiological (Normal ) End-Feels </li></ul><ul><ul><li>Soft (Soft tissue approximation) </li></ul></ul><ul><ul><u...
<ul><li>Pathological (Abnormal) End-Feels </li></ul><ul><ul><li>Soft </li></ul></ul><ul><ul><ul><li>Soft tissue edema </li...
Manual Muscle Testing Grading No evidence of muscle contractility Zero 0 0 Evidence of slight contractility, w/ no joint m...
<ul><li>Ligamentous and Capsular Tests </li></ul><ul><ul><li>Evaluates the structural integrity of the  noncontractile tis...
<ul><li>S pecial Tests </li></ul><ul><ul><li>Involve specific procedures applied to a joint a determine the presence of  p...
<ul><li>Neurological Tests </li></ul><ul><ul><li>Sensory testing </li></ul></ul><ul><ul><li>Motor testing </li></ul></ul><...
On-Field Evaluations <ul><li>On-Field History </li></ul><ul><ul><li>Location of pain </li></ul></ul><ul><ul><li>Peripheral...
<ul><li>On-Field Inspection/Observation </li></ul><ul><ul><li>Is the athlete moving? </li></ul></ul><ul><ul><li>What is th...
<ul><li>On-Field Palpation </li></ul><ul><ul><li>Bony structure </li></ul></ul><ul><ul><ul><li>Bony alignment </li></ul></...
 
<ul><li>On-Field ROM Testing </li></ul><ul><li>On-Field Special Testing </li></ul><ul><li>On-Field Neurologic testing </li...
Termination of the Evaluation <ul><li>No other information need be collected </li></ul><ul><ul><li>Obvious fractures or di...
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Kin191 A. Ch.1. Fall 2007

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Kin191 A. Ch.1. Fall 2007

  1. 1. I njury Evaluation Process KIN 191A Advanced Assessment of Lower Extremity Injuries
  2. 2. INTRODUCTION <ul><li>INJURY EVALUATION PROCESS </li></ul><ul><ul><li>Systematic Evaluation Technique </li></ul></ul><ul><ul><li>Clinical Evaluations </li></ul></ul><ul><ul><li>On-Field Evaluations </li></ul></ul><ul><ul><li>Termination of the Evaluation </li></ul></ul>
  3. 3. Systematic Evaluation Technique <ul><li>Description of the evaluation model </li></ul><ul><li>HIPS/HOPS Process </li></ul><ul><ul><li>H istory </li></ul></ul><ul><ul><li>I nspection/ O bservation </li></ul></ul><ul><ul><li>P alpation </li></ul></ul><ul><ul><li>Range of Motion (ROM) Tests </li></ul></ul><ul><ul><li>Ligamentous tests </li></ul></ul><ul><ul><li>S pecial Tests </li></ul></ul><ul><ul><li>Neurological Tests </li></ul></ul><ul><li>The Role of the Non-injured Paired Structure </li></ul>
  4. 4. Clinical Evaluations <ul><li>H istory </li></ul><ul><ul><li>The quality of information = ability to communicate with the patient </li></ul></ul><ul><ul><li>Open-ended question are useful </li></ul></ul><ul><ul><ul><li>What causes your pain? </li></ul></ul></ul><ul><ul><ul><li>vs. </li></ul></ul></ul><ul><ul><ul><li>Does it hurt when you raise your arm? </li></ul></ul></ul>
  5. 5. <ul><li>H istory ( cont.) </li></ul><ul><ul><li>Mechanism of the injury (MOI) </li></ul></ul><ul><ul><li>Sounds and sensations at the time of injury </li></ul></ul><ul><ul><li>Location of symptoms </li></ul></ul><ul><ul><li>Onset and duration of symptoms </li></ul></ul><ul><ul><li>Description of symptoms </li></ul></ul><ul><ul><li>Changes in the symptoms </li></ul></ul><ul><ul><li>Previous history </li></ul></ul><ul><ul><li>Related history to the opposite body part </li></ul></ul><ul><ul><li>General medical health </li></ul></ul>
  6. 6. <ul><li>I nspection/ O bservation </li></ul><ul><ul><li>Gross deformity </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>Discoloration </li></ul></ul><ul><ul><li>Skin/In f ection </li></ul></ul>
  7. 7. <ul><li>P alpation </li></ul><ul><ul><li>Point tenderness </li></ul></ul><ul><ul><li>Trigger points </li></ul></ul><ul><ul><ul><li>Specific points in the muscular and fascial tissues that produce a sharp pain when pressed </li></ul></ul></ul><ul><ul><li>Change in tissue density </li></ul></ul><ul><ul><li>Crepitus </li></ul></ul><ul><ul><ul><li>Repeated cracking sensations or sound emanating from a joint or tissues, it may caused by a fraction or inflammation </li></ul></ul></ul><ul><ul><li>Symmetry </li></ul></ul><ul><ul><li>Tissue temperature </li></ul></ul>
  8. 8. <ul><li>Range of Motion (ROM) </li></ul><ul><ul><li>A ctive ROM (AROM) </li></ul></ul><ul><ul><li>P assive ROM (PROM) </li></ul></ul><ul><ul><ul><li>End-feel: the specific quality of movement felt by an examiner moving a joint to the end of its ROM </li></ul></ul></ul><ul><ul><li>R esisted ROM (RROM) </li></ul></ul>
  9. 9. <ul><li>ROM </li></ul><ul><ul><li>Goniometric evaluation </li></ul></ul><ul><ul><ul><li>Protractor </li></ul></ul></ul><ul><ul><ul><li>Fulcrum </li></ul></ul></ul><ul><ul><ul><li>Stationary arm </li></ul></ul></ul><ul><ul><ul><li>Movement arm </li></ul></ul></ul>
  10. 10. <ul><li>Physiological (Normal ) End-Feels </li></ul><ul><ul><li>Soft (Soft tissue approximation) </li></ul></ul><ul><ul><ul><li>Knee flexion </li></ul></ul></ul><ul><ul><li>Firm (Muscular/Capsular/Ligamentous stretches </li></ul></ul><ul><ul><ul><li>Hip flexion/MCP joint flexion/Forearm supination </li></ul></ul></ul><ul><ul><li>Hard (Bone contracting bone) </li></ul></ul><ul><ul><ul><li>Elbow extension </li></ul></ul></ul>
  11. 11. <ul><li>Pathological (Abnormal) End-Feels </li></ul><ul><ul><li>Soft </li></ul></ul><ul><ul><ul><li>Soft tissue edema </li></ul></ul></ul><ul><ul><ul><li>Synovitis </li></ul></ul></ul><ul><ul><li>Firm </li></ul></ul><ul><ul><ul><li>Increased muscular tone </li></ul></ul></ul><ul><ul><ul><li>Capsular/Muscular/Ligamentous shortening </li></ul></ul></ul><ul><ul><li>Hard </li></ul></ul><ul><ul><ul><li>Osteoarthritis </li></ul></ul></ul><ul><ul><ul><li>Loose bodies in joint </li></ul></ul></ul><ul><ul><ul><li>Myositis ossificans </li></ul></ul></ul><ul><ul><ul><li>Fracture </li></ul></ul></ul><ul><ul><li>Empty </li></ul></ul><ul><ul><ul><li>Acute joint inflammation </li></ul></ul></ul><ul><ul><ul><li>Bursitis </li></ul></ul></ul><ul><ul><ul><li>Abscess </li></ul></ul></ul><ul><ul><ul><li>Fracture </li></ul></ul></ul><ul><ul><ul><li>Psychogenic origin </li></ul></ul></ul>
  12. 12. Manual Muscle Testing Grading No evidence of muscle contractility Zero 0 0 Evidence of slight contractility, w/ no joint motion Trace 10 1 Complete ROM, w/ gravity omitted Poor 25 2 Complete ROM against gravity, w/ no resistance Fair 50 3 Complete ROM against gravity, w/ some resistance Good 75 4 Complete ROM against gravity, w/ full resistance Normal 100 5 Muscle Strength Qualitative Value % Grade
  13. 13. <ul><li>Ligamentous and Capsular Tests </li></ul><ul><ul><li>Evaluates the structural integrity of the noncontractile tissues surrounding joint </li></ul></ul><ul><ul><ul><li>Ligamentous and capsular tissue surrounding joint </li></ul></ul></ul><ul><ul><li>Laxity vs. Instability </li></ul></ul>
  14. 14. <ul><li>S pecial Tests </li></ul><ul><ul><li>Involve specific procedures applied to a joint a determine the presence of pathomechanics </li></ul></ul><ul><ul><ul><li>Pathomechanics: abnormal motion and forces produced by the body, most often occurring secondary to trauma </li></ul></ul></ul>
  15. 15. <ul><li>Neurological Tests </li></ul><ul><ul><li>Sensory testing </li></ul></ul><ul><ul><li>Motor testing </li></ul></ul><ul><ul><li>Reflex testing </li></ul></ul>
  16. 16. On-Field Evaluations <ul><li>On-Field History </li></ul><ul><ul><li>Location of pain </li></ul></ul><ul><ul><li>Peripheral symptoms </li></ul></ul><ul><ul><li>Mechanism of injury (MOI) </li></ul></ul><ul><ul><li>Sounds and symptoms </li></ul></ul><ul><ul><li>History of injury </li></ul></ul>
  17. 17. <ul><li>On-Field Inspection/Observation </li></ul><ul><ul><li>Is the athlete moving? </li></ul></ul><ul><ul><li>What is the position of the athlete? </li></ul></ul><ul><ul><li>Is the athlete conscious? </li></ul></ul><ul><ul><ul><li>Primary survey </li></ul></ul></ul><ul><ul><ul><ul><li>ABCDs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Activation of Emergency Medical Services (EMS) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Emergency Action Plan (EAP) </li></ul></ul></ul></ul><ul><ul><li>Inspection of the injured area </li></ul></ul><ul><ul><li>Secondary survey </li></ul></ul>
  18. 18. <ul><li>On-Field Palpation </li></ul><ul><ul><li>Bony structure </li></ul></ul><ul><ul><ul><li>Bony alignment </li></ul></ul></ul><ul><ul><ul><li>Crepitus </li></ul></ul></ul><ul><ul><ul><li>Joint alignment </li></ul></ul></ul><ul><ul><li>Soft tissues </li></ul></ul><ul><ul><ul><li>Swelling </li></ul></ul></ul><ul><ul><ul><li>Painful areas </li></ul></ul></ul><ul><ul><ul><li>Deficit in the muscles or tendons </li></ul></ul></ul>
  19. 20. <ul><li>On-Field ROM Testing </li></ul><ul><li>On-Field Special Testing </li></ul><ul><li>On-Field Neurologic testing </li></ul><ul><ul><li>Particularly important with a suspected head or spine injury </li></ul></ul><ul><li>Removal of the Athlete from the Field </li></ul>
  20. 21. Termination of the Evaluation <ul><li>No other information need be collected </li></ul><ul><ul><li>Obvious fractures or dislocations </li></ul></ul><ul><ul><li>Gross joint instability </li></ul></ul><ul><ul><li>Neurovascular deficits </li></ul></ul>

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