This is a slide containing principles of examining musculoskeletal injuries.. Through this slide you are able to famarilize yourself with the examination process.

1. Chapter ??
2
Principles
of Examination:
An Overview
C H A P T E R

2. Goals for Chapter 2
• Become familiar with examination
components and goals for each component.
• Become familiar with examination
procedures.
• Identify the SINS of injury examination.
• Learn SOAP notes procedures for injury
documentation.

3. Injury Examination
• The term “examination” is used throughout
the text as it relates to injuries and
conditions.
• The words “assessment” or “evaluation”
are commonly used in other texts.

4. Injury Survey
• Primary survey
– Concerned with determining the presence of life or
limb threatening conditions
– Airway, breathing, circulation
• Secondary survey
– A rapid examination of the seriousness of the injury
– Occurs before athlete is moved

5. SINS
• Once primary and secondary surveys are
complete, SINS are determined
– Severity
– Irritability
– Nature
– Stage
• These can be obtained from the subjective
and objective segments following

6. Subjective Segment
• History
– Observation
– Interview
– Medical records
• Quality of information is directly related to
clinician’s observation skills and quality of
available information.

7. Objective Segment
• Consists of impartial information collected
through various tests.
• Various tests determine nature and severity
of injury.
• Subjective information should dictate
aggressiveness of objective segment.

8. Objective Segment Testing
• Comparable sign
• Bilateral comparison
• Observation
• Palpation
• Range of motion
(continued)

9. Objective Segment Testing
(continued)
• Strength
• Special tests
• Neurological status
• Vascular status
• Functional tests

10. Comparable Sign
• The reproduction of a patient’s complaint of
pain through various methods of testing.
• Reproduction of pain is deemed a positive
response.
• Positive responses are desirable.

11. Bilateral Comparison
• All tests should be performed bilaterally for
the purpose of gauging the patient’s normal
response.

12. Observation
• Gives clues as to nature and severity of
injury
– Facial expressions
– General posture
– Contour of injured segment
– Alignment
– Discoloration

13. Palpation
• Can aid in detecting
– Swelling
– Pain
– Temperature
– Spasm
– Deformity
– Pulse

14. Range of Motion
• Active range of motion (AROM) determines
integrity of contractile tissue.
• Passive range of motion (PROM) determines
integrity of inert tissues.
• Quality and quantity of movement is
assessed, as well as pain levels.

15. Strength Examination
• Purposes of strength exam
– Determine musculotendinous resistive ability
– Determine neuromuscular integrity
– Pain level of contractile tissue

16. Types of Strength Examination
• Isometric testing (“break” test)
• Manual muscle testing

17. Special Tests
• Designed to eliminate or confirm a
suspected condition
• Reproduces symptoms or creates a
comparable sign
• Special tests are performed on uninvolved
side first

18. Selecting Accurate Special Tests
• Special tests vary in their ability to
accurately detect injuries and conditions.
• Using more than one special test will
improve the accuracy of the clinician’s
findings.

19. Sensitivity
• The percentage of times that a test yields a
positive result when the condition is truly
present
• Ranges from 0.0-1.0
• Tests with high sensitivity are good at
ruling OUT conditions

20. Specificity
• The percentage of times that a test yields a
negative result when the condition is truly
absent
• Ranges from 0.0-1.0
• Tests with high specificity are good at
ruling IN conditions

21. Likelihood Ratios
• More clinician friendly measures of special
test accuracy
• Combines sensitivity and specificity
• Positive Likelihood Ratio (+LR): >10 is
desirable
• Negative Likelihood Ratio (-LR): <0.1 is
desirable

22. Likelihood Ratios by the Numbers

23. Accuracy of Special Tests

24. Neurological Status
• Determine presence of numbness, tingling,
shooting, or burning pain
• Referred pain
• Sensory testing
• Motor testing
• Reflex testing

25. Vascular Status
• Pulse
• Pallor
• Capillary refill

26. Functional Tests
• Determines athlete’s ability to safely resume
full activity
• Only administered when athlete is deemed
ready to return to play
• Functional tests are unique to specific
athlete, body part, sport, and position

27. Documentation
• Often the final component in the
examination process
• Useful for
– Legal purposes
– Relaying information to colleagues
– Continuity of care

28. SOAP Notes
• Simplest and most common form of
documentation
• Subjective
• Objective
• Assessment
• Plan

29. Subjective
• Chief complaint
• Mechanism of injury
• Reported signs and symptoms
• A clear picture of the injury’s SINS

30. Objective
• ROM testing results
• Strength testing results
• Neurovascular testing results
• Special tests results
• Results of any diagnostic testing

31. Assessment and Plan
• Assessment
– The clinician’s impression of the injury
– Drawing a conclusion based on examination results
• Plan
– Immediate treatment
– Any referral plans

32. Summary
• SINS
• Components of injury examination
• Selecting accurate special tests
• Proper documentation procedures