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Ball State University

  1. 1. Ball State University Athletic Training Education Program Clinical Proficiencies Manual Purpose The purpose of this manual is to provide BSU athletic training students and Approved Clinical Instructors with proficiency assessments to guide and track the integration of professional skills into practical settings. This manual will serve as a measure of accomplishing the basic skills necessary for the National Athletic Trainers’ Association Board of Certification Examination. Instructions for Use This Clinical Proficiency Manual is to be used as a supplement to the Athletic Training Student (ATS) proficiency matrix that can be found at http://www.bsu.edu/web/00tgweidner. Each Approved Clinical Instructor (ACI) and ATS will be issued a manual for reference. The ATS will utilize the proficiency assessments under each proficiency domain to keep track of their progress. It is the responsibility of the ATS to obtain signatures and dates from an ACI for completion of each proficiency in both a laboratory and clinical setting. The ATS should consider this manual as a reflection of experiences obtained during their enrollment in Ball State University Athletic Training Education Program.
  2. 2. TABLE OF CONTENTS RISK MANAGEMENT & INJURY PREVENTION Screening procedure PEP 196, 340 Anthropometric measurements: Height, weight, body fat PEP 196 Anthropometric measurements: Girth & limb length PEP 196, 370, 371 Collecting & interpreting environmental data PEP 196 Environmental conditions PEP 196 Fitting protective equipment: The helmet PEP 340 Fitting protective equipment: Shoulder pads PEP 340 Fitting protective equipment: Rib/Thorax guard PEP 340 Fitting protective equipment: Mouth guards PEP 340 Selecting & fitting appropriate footwear PEP 340 Selecting prophylactic braces (knee & ankle) PEP 340 Weight training: Lifting & spotting EXSCI 147 Constructing protective devices PEP 340 Fabrication of protective devices: Orthoplast splints PEP 340 Protective pad fabrication & application PEP 340 Preventative and protective taping and bracing PEP 196, 340 Preventative taping: Closed basket weave PEP 196, 340 Metatarsal arch pad with taping PEP 340 Collateral knee taping PEP 340 Preventative wrapping: Hip spica PEP 196, 340 Shoulder spica wrap PEP 196, 340 Shoulder harness application PEP 340 ASSESSMENT & EVALUATION Postural assessment & screening procedure PEP 370, 371 Recognition & evaluation: Gait analysis PEP 370, 373 Obtaining a medical history PEP 370, 371 Neurological exam PEP 370, 371 Injury identification PEP 370, 371 Recognition & evaluation: Head & Cervical Spine Injuries PEP 371 Recognition & evaluation: Shoulder PEP 371 Recognition & evaluation: Elbow PEP 371 Recognition & evaluation: Wrist & fingers PEP 371 Recognition & evaluation: Abdomen & chest PEP 371 Recognition & evaluation: Lumbar spine PEP 370 Recognition & evaluation: Thigh & hip PEP 370 Recognition & evaluation: Knee PEP 370 Recognition & evaluation: Ankle PEP 370 Recognition & evaluation: Foot PEP 370
  3. 3. ACUTE CARE OF INJURY & ILLNESS First aid procedures: Closed soft tissue injuries PEP 196, 340 First aid procedures: Open wounds PEP 196, 340 Selecting immobilization/transportation devices PEP 196, 340 Transportation methods/immobilization devices with neck injury PEP 196, 340 Crutch fitting PEP 196 Cane fitting PEP 196 Environmentally related conditions PEP 196, 340 Cardiopulmonary resuscitation - Adult PEP 250 Cardiopulmonary resuscitation - Child PEP 250 PHARMACOLOGY Recording pharmaceutical use NUR 320, PEP 498 Using a physicians desk reference (PDR) NUR 320 Pharmaceutical policies & procedures NUR 320 THERAPEUTIC MODALITIES Clinical application of various cold modalities PEP 196, 340, 372 Clinical application of whirlpool (warm & cold) PEP 196, 340, 372 Clinical application of superficial heat (hot pack & paraffin) PEP 196, 340, 372 Electrotherapy PEP 196, 372 Iontophoresis PEP 372 Therapeutic modalities: DC muscle stimulation PEP 372 Clinical application of interferential current stimulation (IFC) PEP 372 Neuromuscular electrical stimulation (NMES) PEP 372 Transcutaneous electrical nerve stimulation (TENS) PEP 372 Ultrasound PEP 196, 372 Triton MP - 1 traction unit PEP 372 Intermittent compression PEP 372 Therapeutic massage PEP 196, 372 THERAPEUTIC EXERCISE Assessing strength PEP 196, 370, 371, 373 Flexibility PEP PEP 196, 370, 371, 373 Miscellaneous Improving muscular strength PEP 373 Improving muscular endurance PEP 373 Improving muscular speed PEP 373 Improving muscular power PEP 373 Improving proprioception PEP 373 Improving agility PEP 373 Improving cardiorespiratory endurance PEP 373 Activity specific skills PEP 373 Joint mobilization PEP 373 Goniometry PEP 370, 371 PEP 196, 373
  4. 4. Static stretching PEP 196, 373 PNF stretching PEP 370, 371, 373 Manual muscle testing PEP 196, 373 Strengthening PEP 196, 373 PNF strengthening PEP 196, 373 Proprioceptive neuromuscular facilitation PEP 373 Muscle shortening test PEP 373 Commercial fitness testing equipment: Cybex UBE PEP 373 Commercial fitness testing equipment: Cybex fitron PEP 373 Operation of isokinetic testing device: Cybex 6000 PEP 373 Isokinetic testing and interpretation of test results (using the cybex 6000) PEP 373 Evaluation of test results PEP 373 Cybex testing PEP 373 Cybex shoulder testing PEP 373 Pool exercise GENERAL MEDICAL CONDITIONS & DISABILITIES General medical conditions PEP 495 Activation of poison control services PEP 495 Administration & use of epinephrine & bronchodilators PEP 495 NUTRITIONAL ASPECTS OF INJURIES & ILLNESSES Nutritional aspects FCSFN 340 PSYCHO SOCIAL INTERVENTION & REFERRAL Psycho social intervention & referral PEP 477 Motivational techniques PEP 477 HEALTHCARE ADMINISTRATION Healthcare administration PEP 498 Organization administration PEP 498 Emergency action plan (EAP) PEP 196, 498 Record keeping skills PEP 370, 371, 498 Developing facilities & conducting research PEP 498, 497 PROFESSIONAL DEVELOPMENT & RESPONSIBILITIES Professional development & responsibilities PEP 498, 497
  5. 5. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ SCREENING PROCEDURES 42200.The student should demonstrate competency in the assessment of pulse rate, blood pressure and vision. 42201.Please check off the items as the student explains and demonstrates the following: ___ Is able to locate either radial or carotid pulse. ___ Calculates pulse rate in beats per minute by counting beats for 15 seconds and multiplying by four. ___ Analyzes pulse in terms of strength and regularity. ___ Applies sphygmomanometer in proper manner on forearm. ___ Places stethoscope on anterior aspect of elbow just below bottom edge of sphygmomanometer. ___ Inflates sphygmomanometer to pressure of 200 mm Hg. ___ Releases pressure at a slow, gradual rate. ___ Identifies systolic and diastolic blood pressure. ___ Determines visual acuity by asking patient to report what is seen on Snellen eye chart. ___ Analyzes results of Snellen eye chart. 1
  6. 6. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ ANTHROPOMETRIC MEASUREMENTS: HEIGHT, WEIGHT, BODY FAT 2124.The student should demonstrate the proper procedure to weigh someone on a scale, measure their height, and determine their body fat percentage through the use of skinfold calipers. 2125.Please check off the following items as the student demonstrates competency in taking these anthropometric measurements by explaining and demonstrating the following: ___ Able to balance the scale as person being weighed stands on it. ___ Has person stand with proper posture when measuring height. ___ Converts height measurement into feet and inches. ___ Takes skinfold measurements from the right side of the body. ___ Grasps a fold of skin and subcutaneous fat without the underlying muscle tissue. ___ Places caliper perpendicular to the fold, approximately 1 cm from the thumb and forefinger holding the skinfold. ___ Takes skinfold measurements at the proper sites according to the gender of the person being measured, and the body fat percentage equation chosen by the evaluator. Possible sites include: (check those appropriate for situation) ___ triceps ___ subscapular ___ suprailiac ___ abdominal ___ anterior thigh ___ Is able to plug measurements taken into the chosen equation and determine body fat percentage. 2
  7. 7. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ ANTHROPOMETRIC MEASUREMENTS: GIRTH AND LIMB LENGTH 2640.The student should measure true leg length and common girth measurements for the knee. 2.Please check off as student demonstrates competency in these anthropometric measurements by explaining and demonstrating the following: ___ Measures true leg length by measuring from anterior superior lilac spine to the medial malleolus. ___ Checks for leg length discrepancy by measuring bilaterally. ___ Takes girth measurements at the following points: ___ Joint line ___ 3" above joint line ___ 6" above joint line ___ 9" above joint line ___ 3" below joint line ___ Checks for joint swelling, atrophy of quadriceps, and atrophy of gastroc/soleus by measuring bilaterally. ___ Explains results of measurements sufficiently (Good conclusions). 3
  8. 8. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ COLLECTING AND INTERPRETING ENVIRONMENTAL DATA 3672.The student should demonstrate competency in operating a sling psychrometer and interpreting its data. Please check off the following items: ___ Wets the string on the wet bulb. ___ Rotates the sling psychrometer at the proper speed and for the proper duration. ___ Identifies the wet bulb temperature. ___ Identifies the dry bulb temperature. ___ Aligns two temperatures on slide rule of psychrometer and determines relative humidity. ___ Makes proper recommendation for practice in accordance with the data collected. **The evaluator may now present hypothetical situations of temperature and humidity and ask student what procedure they would take. Possible situations: Temperature Humidity Correct Procedure 4188.80-90 F under 70% Watch athletes that are slightly overweight 4189.80-90 F over 70% Athletes should take a ten minute rest and water break 90-100 F under 70% every hour. All athletes should be under constant, careful supervision. 4190.90-100 Fover 70% Ideally it would be well to suspend practice or conduct over 100 F a shortened practice in shirts and short 4
  9. 9. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ ENVIRONMENTAL CONDITIONS The student should demonstrate the ability to 1) obtain and interpret environmental data, 2) recognize potential hazardous conditions and situations in the activity setting, and 3) make the appropriate recommendations for activity. ___ Use a sling psychrometer ___ Use a wet bulb globe index ___ Interpret and present environmental data for the following conditions: Heat Wind Humidity Potential for a lightening strike Cold Poor air quality ___ Check an activity setting for physical and/or environmental hazards ___ Use and interpret weight charts 5
  10. 10. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ FITTING PROTECTIVE EQUIPMENT: THE HELMET 1. The student should demonstrate competency in properly fitting a football helmet. Please check off as student explains and demonstrates proper fitting of a football helmet. ___ Check to make sure helmet fits snugly on head (no gaps between pads and head or face). ___ Make sure base of skull is covered. ___ Check to see that ear holes line up. ___ Check to see that front edge of helmet sits approximately 2 finger widths above the players eyebrows. ___ Try to move helmet w/o chin strap. ___ Apply downward pressure to helmet, checking for movement and dispersion of pressure felt. ___ Check that jaw pads have a snug fit. ___ Face mask should be 2-3 vertical fingers from the nose. ___ Adjust chin strap so that it is tight and centered. 6
  11. 11. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ FITTING PROTECTIVE EQUIPMENT: SHOULDER PADS 4704.The student should demonstrate competency in the proper fitting of shoulder pads. 4705.Please check off as student explains and demonstrates the proper fitting of shoulder pads. ___ Measure width of shoulder to determine proper size of pad. ___ Check to see that inside shoulder pad comes in a direct line with the lateral aspect of the shoulder and the flap covering the deltoid (make sure tip of shoulder is covered). ___ Check to see that neck opening allows overhead arm movement without placing pressure on the neck. (Neck opening cannot allow sliding back and forth.) ___ Check straps underneath arm to see that they hold pads firmly without constricting soft tissue. 7
  12. 12. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ FITTING PROTECTIVE EQUIPMENT: RIB/THORAX GUARD 5220.The student should demonstrate competency in the proper fitting rib/thorax guards. 5221.Please check off as student explains and demonstrates the proper fitting of rib/thorax guards. ___ Make sure the guard covers the appropriate area and is tight fitting and comfortable. ___ Make sure the guard provides protection against external forces. ___ Make sure guard is properly maintained. 8
  13. 13. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ FITTING PROTECTIVE EQUIPMENT: MOUTHGUARDS 44308.The student should demonstrate competency in the proper fitting of mouth guards. 44309.Please check off as student explains and demonstrates the proper fitting of mouth guards. ____ Check for proper and tight fit, comfort, unrestricted breathing, and unimpeded speech during competition. ___ Make sure athlete’s air passages are not obstructed in any way. ___ Make sure mouthpiece projects backward only as far as last molar. ___ Make sure mouthpiece is not cut down, covering only the front teeth. 9
  14. 14. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ SELECTING & FITTING APPROPRIATE FOOTWEAR 44800.The student should demonstrate competency in the proper fitting the proper footwear. 44801.Please check off as student explains and demonstrates the proper fitting of footwear. ___ Measure foot ___ 2 in. to 3/4 in. distance between the longest toe and the front of the shoe. ___ Check to make sure sole has shock absorbing function and is durable. ___ Check to make sure the sole provides good traction and is made of tough material that is resistant to wear. ___ Make sure the heel counter is firm and well fitted to minimize movement of the heel up and down or side to side. ___ Make sure the shoe uppers are lightweight, quick drying, and well ventilated. Should also have extra support in the saddle area as well as the area of the Achilles tendon just above the heel counter. ___ Make sure the arch support is made of some durable yet soft supportive material and smoothly joins with the insole. Make sure there are no rough seams or edges. 10
  15. 15. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ SELECTING PROPHYLACTIC BRACES (KNEE AND ANKLE) 12280.The student should demonstrate competency in the proper fitting of prophylactic braces. 12281.Please check off as student explains and demonstrates the proper fitting of prophylactic braces. ___ Select appropriate brace (depending upon injury and sport) ___ Select appropriate size and extremity. ___ Make sure brace fits snug and comfortable. ___ Make sure brace provides protection and limits effects of external forces. 11
  16. 16. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ WEIGHT TRAINING: LIFTING AND SPOTTING 12796.The student should demonstrate the ability to instruct and establish a safe environment for the use of strength and conditioning equipment. 12797.The student will demonstrate the proper lifting technique for the following exercises: ___ Parallel squat ___ Heel raises ___ Power clean ___ Bench press ___ Shoulder press ___ Dead lift ___ Arm curl ___ Triceps extension ___ Knee flexion ___ Knee extension ___ Leg press 3. The student will demonstrate the proper spotting technique for the following exercises: ___ Parallel squat ___ Shoulder press ___ Dead lift ___ Bench press ___ Power clean Clinical ACI __________________________________ Date __________________ 12
  17. 17. Pass _____ Needs Improvement _____ Fail _____ CONSTRUCTING PROTECTIVE DEVICES 17600.The student should demonstrate the ability to construct custom protective devices. 17601.These devices should include, but are not limited to, those that protect contusions, sprains, strains, wounds, and fractures from further injury. ___ Construct, apply, and remove the following protective devices: ___ bony prominence pad ___ muscle contusion pad ___ soft playing cast (e.g. silicone, thermo foam) ___ hard, immobilization splint or cast (e.g. thermoplastic, plaster, fiberglass) ___ friction pad (Adoughnut” pad) ___ checkrein device ___ Make sure the devices are applied correctly and cover the appropriate area. 13
  18. 18. Clinical ACI ______________________________ Date __________________ Pass ______ Needs Improvement _____ Fail _____ FABRICATION OF PROTECTIVE DEVICES: ORTHOPLAST SPLINTS 37544.The student should make a splint out of orthoplast for a wrist injury. 37545.Please check off as the student demonstrates competency in fabricating protective devices by explaining and demonstrating the following: ___ Cuts piece of orthoplast of sufficient length and size to immobilize joint or cover area to be protected. ___ Wraps body part with pre-wrap to prevent burning of skin. ___ Holds orthoplast in very hot water with tongs for 20-30 seconds. ___ Molds orthoplast on body part and wraps it with pre-wrap to hold it in place. ___ Allows sufficient cooling/hardening time. ___ Applies necessary felt and padding around edges of orthoplast for comfort and protection.
  19. 19. Clinical ACI _____________________________________ Date ___________________ Pass _____ Needs Improvement _____ Fail _____ PROTECTIVE PAD FABRICATION AND APPLICATION ____1. Evaluates injury to determine readiness to return to sport (safety). ____2. Evaluates injury to determine size of area to be projected. ____3. Selects materials appropriate for activity/sport. - Anticipates high velocity/low mass vs. low velocity/high mass impact - Combination of materials may be appropriate ____4. Manipulation of materials: - Cuts large enough piece to adequately cover are - Cuts donut (if appropriate) to allow freedom from pressure over injured area - Materials properly adhered together to adequately withstand participation demands - Finished product is neat (with beveled edges when appropriate) ____5. Secures to injured area properly (e.g. tape, compression shorts, ace wrap) ____6. Anatomically sound - provides protection but does not impede function/performance
  20. 20. Clinical ACI _____________________________________ Date ___________________ Pass _____ Needs Improvement _____ Fail _____ PREVENTATIVE AND PROTECTIVE TAPING AND BRACING 38060.The student should demonstrate the ability to select and apply preventative and protective taping, wrapping, splinting, bracing, and rehabilitative devices in order to prevent further injury. 38061.Please check off the items below as the student demonstrates competency in preventive and protective taping of each of the following. ___ cervical spine ___ shoulder joint and girdle ___ elbow ___ wrist ___ hand and fingers ___ lumbar spine ___ hip and pelvis ___ knee ___ leg ___ ankle ___ foot and toes ___ Make sure each procedure is appropriate for injured area. ___ Make sure each procedure has appropriate tension and is applied using the correct technique and in the correct direction. ___ Make sure procedure is efficient.
  21. 21. Clinical ACI _____________________________________ Date ___________________ Pass _____ Needs Improvement _____ Fail _____ PREVENTATIVE TAPING: CLOSED BASKET WEAVE 38576.The student should demonstrate competency in preventative taping by doing a closed basket weave. 38577.Please check off as student explains and demonstrates the following: ___ Sprays on tape adherent. ___ Places heel and lace pads in proper places. ___ Applies pre-wrap. ___ Places three anchors on lower leg, just below belly of gastrocnemius. ___ Places one anchor on foot, posterior to head of the fifth metatarsal. ___ Alternates three stirrups and three Gibney's, crossing over the malleoli. ___ Closes up the upper portion of the basket weave by continuing the Gibney's up the ankle to the anchors. ___ Applies two figure eights and heel locks. ___ Applies closing strips around the foot (arch). ___ Throughout taping, overlaps tape at least 2 width.
  22. 22. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ METATARSAL ARCH PAD WITH TAPING ANATOMICAL POSITION: _____ Ankle should be positioned in a slight plantar flexed position. PRE-TAPING PROCEDURES: _____1. 1/4" or 2" felt should be cut in a diamond shape (metatarsal pad) with all sides slightly tapered. TAPING PROCEDURES: _____1. Place this metatarsal pad proximal to the heads of the 2nd through 4th metatarsals. _____2. Secure this supportive pad to the foot by utilizing 2" or 3" inch elastic tape. It is preferred that this circular strip begin on the dorsal aspect, go lateral, and continue across plantar aspect to medial portion of the foot, crossing the tape ends. _____3. A strip of l-1/2" adhesive tape should be applied over the tape ends to secure the elastic tape. _____4. Neatness _____5. Tension
  23. 23. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ COLLATERAL KNEE TAPING ANATOMICAL POSITION: _____1 Knee joint in slight flexion (10 - 15 degrees). PRE-TAPING PROCEDURES: _____1. Gauze and lubricant should be applied to the posterior aspect (popliteal space) of the knee joint. TAPING PROCEDURES: _____1. Apply two anchor strips of 3" elastic tape to the extremity. The proximal anchor strip should be placed at the mid-thigh or higher. The distal anchor should be applied at the mid-gastrocnemius region or lower. All collateral strips will attach on these two anchors. _____2. Medial side: In providing support for the medial side of the knee, a collateral "X" pattern will be applied. Using 3" elastic tape, start on the lateral aspect of the distal anchor, coming below the patella, cross the medial joint line, and anchor on the posterior-medial aspect of the proximal anchor. The second strip begins on the posterior aspect of the distal anchor, cross the medial joint line, and anchor on the anterior portion of the proximal anchor. A third strip will be applied vertically on the medial side. This support strip will begin on the distal anchor, cross the joint line, and anchor on the proximal anchor. _____3. Lateral side: In providing support for the lateral side of knee, a collateral "X" pattern will be applied. Using 3" elastic tape, start on the medial aspect of the distal anchor, coming below the patella, cross the lateral joint line, and anchor the posterior-lateral aspect of the proximal anchor. second strip begins on the posterior aspect of the distal anchor, crosses the lateral joint line, and anchors on anterior portion of the proximal anchor. A third strip will be applied vertically on the lateral side. This support strip begins on the distal anchor, cross the joint line, and on the proximal anchor. _____4. Depending on which collateral (medial or lateral) ligament the knee is injured, it is recommended that a second series of collateral strips be applied. At this time, you should repeat step #2 and/or step #3. _____5. Final closure strips are applied. _____6. Apply 6" elastic wrap. _____7. Neatness _____8. Tension _____9. Direction of application Clinical ACI ____________________________________ Date ____________ Pass _____ Needs Improvement _____ Fail _____
  24. 24. PREVENTATIVE WRAPPING: HIP SPICA 39092.The student should demonstrate competency in preventative wrapping by performing a hip spica. 39093.Please check off as student explains and demonstrates the following: ___ Places tape roll or other object under heel. ___ Instructs athlete to internally rotate hip slightly. ___ Uses 6" double length wrap. ___ Starts medially as mid thigh. ___ Anchors on thigh and then goes around waist. ___ Goes back around thigh and provides support of groin. ___ Repeats pattern until end of wrap and anchors wrap with tape.
  25. 25. Clinical ACI _____________________________________ Date ________________________ Pass _____ Needs Improvement _____ Fail _____ SHOULDER SPICA WRAP ____ Position the athlete with their arm internally rotated (as if their hand were in their back pocket). ____ Have the athlete tighten upper arm muscles during the wrap procedure. ____ Begin the wrap by securing it around the biceps. ____ The wrap must start: 1.on the outside of the arm, 2.inward under the arm pit 3.outward and around the arm again 4.across the chest 5.under the opposite arm 6.then traverse upward and around affected shoulder again ____ Repeat this procedure then tape the wrap at the arm. ____ Try to finish the tape on the biceps. ____ Make sure the contract biceps muscle prior to applying the closures. ____ Do not finish the wrap so that the tape is next to the chest.
  26. 26. Clinical ACI ___________________________________ Date ____________________ Pass _____ Needs Improvement _____ Fail _____ SHOULDER HARNESS APPLICATION ____1. Evaluates shoulder injury to determine specific purpose of harness. ____2. Selects appropriate harness for activity/sport. ____3. Measures size of shoulder, arm and chest for sizing of harness. ____4. Proper placement of harness on shoulder. ____5. Materials properly adhered together to adequately withstand participation demands. ____6. Application is neat (with beveled edges when appropriate). ____7. Secured to injured area properly (no potential irritations and/or gaps). ____8. Anatomically sound - provides protection but does not impede function/performance.
  27. 27. ASSESSMENT & EVALUATION
  28. 28. Clinical ACI _________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ POSTURAL ASSESSMENT AND SCREENING PROCEDURES 39608.The student should conduct static and postural evaluations and screening procedures. 39609.Please check off the items below as the student demonstrates and describes each of the following. ___ Recognizes the following postural deviations and predisposing conditions. ___ kyphosis ___ genu valgum, varum, recurvatum ___ lordosis ___ rearfoot valgus and varus ___ scoliosis ___ forefoot valgus and varus ___ pelvic obliquity ___ pes cavus and planus ___ tibial torsion ___ foot and toe posture ___ hip anteversion ___ Performs a postural assessment of the following: ___ cervical spine and head ___ hip and pelvis ___ shoulder ___ knee ___ lumbo-thoracic region ___ ankle, foot, and toes ___ Identifies and classifies body type as one of the following: ___ endomorph ___ ectomorph ___ mesomorph
  29. 29. Clinical ACI ____________________________________ Date _____________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: GAIT ANALYSIS 40124.The student should explain and demonstrate a complete evaluation of gait. 40125.Please check off as student explains and demonstrates the following: ___ Checks body alignment ___ AC joints ___ Inferior angle of scapula ___ Iliac crests ___ Greater trochanter ___ Head of fibula ___ Medial malleoli ___ Shoe wear pattern ___ Achilles tendon angle (pronation/supination) ___ Arches (pes cavus or plantus) ___ Subtalar neutral test (forefoot valgus or varus) ___ Gait analysis walking ___ Heel strike - lateral portion of calaneus ___ Midstance - wt. transferred along 4 & 5 metatarsals ___ Toe off - comes off of 1st metatarsal ___ Gait analysis jogging/sprinting ___ Heel strike - meddle of calaneus ___ Midstance - wt. transferred along 3rd metatarsal ___ Toe off - comes off 1st metatarsal
  30. 30. Clinical ACI ____________________________________ Date _____________________ Pass _____ Needs Improvement _____ Fail _____ OBTAINING A MEDICAL HISTORY 40640.Present student with an injury situation and ask him or her to obtain a brief medical history from you. 40641.Please check off the following items as the student demonstrates competency in obtaining a medical history by asking questions concerning the following: ___ Location of pain ___ Chief complaints ___ Previous history of injury and treatment to this area ___ Type and severity of pain ___ Onset of pain; what caused it (mechanism of injury) ___ Sounds heard (snap or pop) ___ Numbness or tingling ___ What situations/activities increase pain ___ What situations/activities relieve pain
  31. 31. Clinical ACI ______________________________________ Date ________________ Pass _____ Needs Improvement _____ Fail _____ NEUROLOGICAL EXAM The student should demonstrate the assessment of two from each of the following categories: (1) Upper extremity nerve root level, (2) Upper extremity peripheral nerves, (3) Lower extremity nerve root level and (4) Lower extremity peripheral nerves. Upper extremity Sensory Testing Motor Testing Reflex Testing Nerve Root Level (sensation, radiating pain) (strength, atrophy) (when appropriate) C5 C6 C7 C8 T1 Peripheral Nerve Musculocutaneous Axillary Radial Median Ulnar Lower Extremity Sensory Testing Motor Testing Reflex Testing Nerve Root Level (sensation, radiating pain) (strength, atrophy) (when appropriate) L1 L2 L3 L4 L5 S1 S2 Peripheral Nerve Femoral n. Tibial n.
  32. 32. Saphenous n. Lateral plantar n. Deep Peroneal n.
  33. 33. Clinical ACI _______________________________________ Date ________________ Pass _____ Needs Improvement _____ Fail _____ INJURY IDENTIFICATION 41156.The student should perform clinical evaluations of major body areas to assess and interpret for injury and illness. 41157.The student should obtain and describe a medical history of an ill or injured athlete or other physically active individual. 41158.The student should identify and describe the clinical signs and symptoms associated with the injuries and illnesses indicated below. 41159.Please check off the items below as the student demonstrates competency. Head ___ Amnesia ___ Intra cranial hematoma ___ Concussion Eye ___ Orbital blowout fracture ___ Conjunctivitis ___ Detached retina ___ Corneal abrasion ___ Cornea l lacerati on ___ Hyphe ma ___ Stye Ear ___ Pinna hematoma (Acauliflower ear@ ) ___ Otitis externa ___ Impacted cerumen ___ Otitis media Nose ___ Deviated septum
  34. 34. ___ Nasal fracture ___ Epistaxis Jaw, Mouth, Teeth ___ Gingivitis ___ Tooth abscess ___ Mandibular fracture ___ Tooth extrusion ___ Maxilla fracture ___ Tooth fracture ___ Periodontitis ___ Tooth intrusion ___ Temporomandibular joint dislocation ___ Tooth luxation ___ Temporomandibular joint dysfunction Cervical Spine ___ Dislocation or subluxation ___ Intervertebral disc herniation ___ Vertebral fracture ___ Nerve root compression / stretch ___ Ischemia ___ Torticollis Shoulder Evaluation ___ Bursitis ___ Nerve injury ___ Dislocation or subluxation ___ Strain ___ Fracture ___ Tenosynovitis and tendonitis ___ Sprain Elbow ___ Dislocation and subluxation ___ Fracture ___ Bursitis ___ Epicondylitis ___ Tenosynovitis and tendonitis ___ Osteochondritis dissecans ___ Strain ___ Sprain
  35. 35. ___ Nerve injury Forearm, Wrist and Hand ___ Dislocation and subluxation ___ Colles= fracture ___ Bennett’s fracture ___ Carpal fracture ___ Boxer’s fracture ___ Metacarpal fracture ___ Phalange fracture ___ Clubbed nails ___ Spoon shaped nails ___ Sprain ___ Jersey finger ___ Mallet finger ___ Boutonniere deformity ___ Volar plate rupture ___ Dupuytren’s contracture ___ Ganglion ___ Swan neck deformity ___ Trigger finger ___ Carpal tunnel syndrome ___ Bishop’s / Benediction deformity ___ Ape hand ___ Claw fingers ___ Drop wrist deformity ___ Volkmann’s contracture Thoracic / Lumbar Spine ___ Café au lait macules (spots) ___ Dislocation or subluxation ___ Spina bifida occulta ___ Facet syndrome ___ Intervertebral disc pathology ___ Kyphosis ___ Lordosis ___ Nerve root compression ___ Sacroiliac dysfunction ___ Scoliosis ___ Spondylitis ___ Spondylolysis ___ Spondylolisthesis ___ Sprain ___ Stenosis ___ Strain
  36. 36. Hip / Pelvis ___ Hip retroversion ___ Hip anteversion ___ Legg-Calve Perthes disease ___ Apophysitis ___ Slipped capital femoral epiphysis ___ Dislocation or subluxation ___ Fracture ___ Osteitis pubis ___ Stress fracture ___ Athletic pubalgia ___ Bursitis ___ Piriformis syndrome ___ Iliotibial band syndrome ___ Contusion ___ Sprain ___ Strain ___ Tendonitis Knee ___ Bursitis ___ Chondromalacia patella ___ Dislocation or subluxation ___ Fat pad contusion ___ Fracture ___ Meniscal tear ___ Osgood-Schlatter disease ___ Osteochondritis dissecans ___ Patella alta ___ Patella baja ___ Squinting patella ___ Patellar tendon rupture ___ Peroneal nerve contusion or palsy ___ Popliteal cyst ___ Sprain ___ Strain ___ Tendonitis ___ Tibial torsion ___ Genu recurvatum ___ Genu valgum ___ Genu varum Leg, Ankle, and Foot ___ Bursitis ___ Exostosis
  37. 37. ___ Fasciitis ___ Stress fracture ___ Tarsal tunnel syndrome ___ Tendonitis / Tenosynovitis ___ Tibial stress syndrome ___ Achilles tendon rupture ___ Compartment syndromes ___ Apophysitis ___ Dislocation or subluxation ___ Forefoot varus ___ Forefoot valgus ___ Equinus deformity ___ Pes cavus ___ Pes planus ___ Plantar flexed first ray ___ Hindfoot varus ___ Hindfoot valgus ___ Fracture ___ Deep vein thrombosis ___ Neuroma ___ Osteochondritis dissecans ___ Sprain ___ Strain ___ Bunion ___ Claw toes ___ Hallux rigidus ___ Hallux valgus ___ Hammer toes ___ Mallet toe ___ Morton’s toe
  38. 38. Clinical ACI __________________________________ Date _________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: HEAD & CERVICAL SPINE INJURIES 41672.The student should explain and demonstrate a complete evaluation of head injuries, including history, observation, and palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 41673.Please check off as student explains and demonstrates the following: Emergency Procedures ___ Survey Scene ___ Primary survey (ABC's) ___ CPR or Rescue breathing if situation requires it. ___ Establish consciousness/unconsciousness History ___ How did it happen? (Mechanism) ___ Did you hear a snap or pop? ___ Was there a direct blow? ___ Have you hurt it before? (Previous history) ___ How severe was the injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? Does it change in intensity? ___ Do you have a headache? ___ Did you ever black out or lose consciousness? How long? Any relapses? ___ What brought on the pain? (Gradual or acute onset) ___ Do you have any numbness or tingling in your extremities? ___ Has there been any swelling? How soon did it appear? ___ What activities increase the pain? ___ What do you do for the relief of pain? Does it persist into the night? ___ Have you had any tinnitus in your ears?
  39. 39. ___ Have you had any nausea, vomiting, slurred speech, dizziness or uncontrolled emotions? ___ Have you had any blurred vision, diplopia, photophobia? Memory Questions: Retrograde amnesia - test pre-injury memories ___ What’s your name? ___ What happened? ___ What is today’s date? ___ What play were you running? ___ Who are you playing? Anterograde amnesia - test post-injury memories (things that have happened since the injury). ___ How did you get to the athletic training room? ___ Who was the first person who helped you after the injury? ___ Give the athlete 3 or 4 unrelated words to remember, ask them to recall the words after 10 minutes. Cognitive function ___ Analytical skills 100 - 7 test Alphabet backward ___ Information processing Give simple directions, notice any confusion Observation/Inspection ___ Vital signs (heart rate, respiratory rate, blood pressure) ___ Conscious / unconscious ___ Position of athlete ___ Paralysis ___ Head / Neck posture and symmetry (muscular atrophy, holding one arm lower, position of the head, etc.) ___ Alignment of cervical vertebrae
  40. 40. ___ Facial posture / symmetry ___ Leakage of CSF from nose or ears ___ Blood leaking from nose (epistaxis) or ears ___ Deformity ___ Swelling ___ Ecchymosis ___ Torticollis ___ Pupils: ___ Symmetry ___ Dilated ___ Reaction to light ___ Tracking (Smooth or Nystagmus) ___ Ability to focus ___ Vision ___ Hyphema ___ Stye ___ Deviated septum ___ Balance and coordination ___ Battle sign ___ Raccoon eyes ___ Temporomandibular joint motion ___ Occlusion of mouth ___ Teeth abnormalities (fracture, extrusion, intrusion, luxation, abscess) ___ Cauliflower ear (pinna hematoma) Palpation Bony Palpation ___ Skull ___ Occiput ___ Inion ___ Superior nuchal line
  41. 41. ___ Spinous processes of cervical spine ___ Transverse processes of cervical spine ___ Mastoid process ___ Mandible ___ Maxilla ___ Zygomatic arch ___ Nose ___ Hyoid bone Soft Tissue Palpation ___ Scalp ___ Ears ___ Thyroid cartilage ___ Cricoid rings ___ Supraspinous ligaments ___ Interspinous ligaments ___ Sternocleidomastoid ___ Trapezius ___ Deltoid ___ Parotid gland ___ Carotid artery ___ Nasal cartilage Neurological Tests - note any abnormalities or differences for each of the following. ___ Cranial nerves ___ Sensation ___ Motor ___ Reflex
  42. 42. Circulatory Tests - note any abnormalities for each of the following. ___ Carotid pulse ___ Brachial pulse ___ Radial pulse Active Range of Motion - note pain and restricted motion. ___ Flexion ___ Extension ___ Lateral flexion ___ Rotation ___ Opening of mouth ___ Closing of mouth Passive Range of Motion - note pain and restricted motion. ___ Flexion ___ Extension ___ Lateral flexion ___ Rotation ___ Opening of mouth ___ Closing of mouth Manual Muscle Tests - note pain and weakness. ___ Flexion ___ Extension ___ Lateral flexion ___ Rotation Special Tests - note pain, loss of balance or coordination and any abnormalities for each of the following. ___ Romberg test ___ Babinski test
  43. 43. ___ Heel-toe walking (straight line) ___ Finger-to-nose test ___ Heel-to-knee standing ___ Distraction test ___ Compression test ___ Brachial plexus traction test ___ Spurling’s test ___ Shoulder abduction test ___ Shoulder depression test ___ Tinel’s sign ___ Vertebral artery test ___ Valsalva maneuver ___ Adson’s test Functional Tests - note any difficulty, pain or inability for each of the following. ___ Sport specific activities Impression
  44. 44. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: THE SHOULDER The student should explain and demonstrate a complete evaluation of the shoulder, including history, observation, palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ What activity were you doing? ___ How long ago did it happen? ___ Hear a snap or pop? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? ___ What brought on pain? (Gradual onset or acute) ___ Have you had any change in activity level or training habits? ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Do you have any numbness or tingling in you arm/hand? ___ Do you have any crepitus, clicking, locking, grinding or snapping? ___ Has there been any swelling? If so, how long after the injury did it appear? ___ Did you get hit in the abdomen? (Referred pain) Observation/Inspection
  45. 45. ___ General appearance ___ Posture / alignment ___ Symmetry of musculature ___ Swelling ___ Deformity ___ Ecchymosis ___ Sign’s of trauma ___ Atrophy ___ Scapular winging ___ Sprengel’s deformity ___ Step off deformity ___ Erb’s Palsy Palpation - note pain, tenderness, deformity and swelling for each of the following. DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD DDDDDDDDDDDDDDDDDDDDD.Bony Palpation ___ Suprasternal notch ___ Sternoclavicular joint ___ Clavicle ___ Acromioclavicular joint ___ Acromion process
  46. 46. ___ Coracoid process ___ Greater and lesser tuberosities (rotator cuff insertion) ___ Bicipital groove ___ Humerus ___ Axilla ___ Spine of scapula ___ Superior angle of scapula ___ Vertebral border of scapula ___ Inferior angle of scapula ___ Axial border of scapula EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE EEEEEEEEEEE.Soft Tissue Palpation ___ Supraspinatus ___ Infraspinatus ___ Teres minor ___ Teres major ___ Pectoralis major (anterior axillary wall) ___ Latissimus dorsi (posterior axillary wall) ___ Deltoid (anterior, middle, posterior) ___ Biceps ___ Triceps
  47. 47. ___ Trapezius (upper, middle, lower) ___ Levator scapulae ___ Rhomboids ___ Serratus anterior (medial axillary wall) ___ Sternocleidomastoid Active Range of Motion - note pain and restricted motion bilaterally. ___ Apley "Scratch" Test (3 positions) ___ Scapulohumeral rhythm ___ Flexion / Extension ___ Abduction / Adduction ___ Internal / External rotation (neutral and 90) ___ Horizontal Adduction / Abduction ___ Elbow flexion / extension ___ Elevation ___ Protraction / Retraction ___ Circumduction Passive Range of Motion - note pain and restricted motion bilaterally. ___ Flexion / Extension ___ Abduction / Adduction ___ Internal / External rotation (neutral and 90) ___ Horizontal Adduction / Abduction ___ Elbow flexion / extension Manual Muscle Testing - note pain and weakness bilaterally.
  48. 48. ___ Flexion / Extension ___ Abduction /Adduction ___ Internal / External rotation (neutral and 90) ___ Horizontal Adduction / Abduction ___ Elbow flexion / extension ___ Elevation ___ Protraction / Retraction ___ Wall push-up (winging scapula - serratus anterior weakness) Special Tests - note pain, laxity and abnormalities for each of the following. ___ SC laxity test ___ AC laxity test ___ Sulcus sign ___ Clunk test ___ Anterior drawer test ___ Posterior drawer test ___ Anterior apprehension test (dislocation/subluxation) ___ Relocation test ___ Posterior apprehension test ___ Piano key test ___ Traction test ___ AC compression test ___ Shear test ___ Impingement test ___ Hawkins-Kennedy Impingement test
  49. 49. ___ Neer test ___ Speed’s test ___ Drop arm test ___ Empty can test ___ Pectoralis major contracture test ___ Yergason’s test ___ Ludington’s test ___ Load & shift test ___ Adson’s maneuver ___ Allen test ___ Military brace position Neurological Tests - note any abnormalities or differences for each of the following. ___ Sensory ___ Motor ___ Reflex Circulatory Tests - note any abnormalities or differences for each of the following. ___ Brachial pulse ___ Radial pulse Functional Tests ___ Sport specific activities ___ Throwing ___ Catching ___ Other Overhead Activities Impression
  50. 50. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: THE ELBOW 14192.The student should explain and demonstrate a complete evaluation of the elbow, including history, observation, palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 14193.Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ What activity were you doing? ___ How long ago did it happen? ___ Hear a snap or pop? ___ Was there a direct blow? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? ___ What brought on pain? (Gradual onset or acute) ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Do you have any numbness or tingling in your arm / hand? ___ Do you have any crepitus, clicking, locking, grinding or snapping? ___ Has there been any swelling? If so, how long after the injury did it appear? Observation/Inspection
  51. 51. ___ General appearance ___ Symmetry of musculature ___ Carrying angle ___ Swelling ___ Deformity ___ Ecchymosis ___ Hand and forearm alignment ___ Cubital recurvatum ___ Signs of trauma ___ Scars ___ Atrophy ___ Efficiency of movement ___ ME, LE, and olecranon alignment Palpation - note pain, tenderness, deformity and swelling for each of the following. RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRR.Bony Palpation ___ Medial epicondyle (common wrist flexor origin) ___ Medial supracondylar line of humerus ___ Ulnar groove ___ Capitulum
  52. 52. ___ Olecranon process ___ Olecranon fossa ___ Length of ulna ___ Lateral epicondyle (common wrist extensor origin) ___ Head of and length of radius B.Soft Tissue Palpation ___ Pronator teres ___ Flexor carpi radialis ___ Palmaris longus ___ Flexor carpi ulnaris ___ Flexor digitorum superficialis ___ Biceps brachii ___ Brachioradialis ___ Ulnar collateral ligament ___ Subcutaneous olecranon bursa ___ Triceps ___ Extensor carpi radialis longus & brevis (part of mobile wad of three) ___ Extensor digitorum ___ Extensor carpi ulnaris ___ Anconeus ___ Radial collateral ligament ___ Annular ligament ___ Cubital fossa (biceps tendon, brachial artery, median nerve, musculocutaneous nerve)
  53. 53. Active Range of Motion - note pain and restricted motion bilaterally. ___ Flexion ___ Extension ___ Pronation ___ Supination ___ Wrist flexion ___ Wrist extension Passive Range of Motion - note pain and restricted motion bilaterally. ___ Flexion ___ Extension ___ Pronation ___ Supination ___ Wrist flexion ___ Wrist extension Manual Muscle Tests - note pain and weakness bilaterally. ___ Flexion (Biceps, Brachialis, Brachioradialis) ___ Extension (Triceps) ___ Pronation (pronator teres and quadratus) ___ Supination (biceps and supinator) ___ Wrist flexion ___ Wrist extension
  54. 54. Special Tests - note pain, laxity and abnormalities for each of the following. ___ Valgus stress (Ulnar collateral ligament) ___ Varus stress (Radial collateral ligament) ___ Tennis elbow test ___ Middle digit test ___ Tinel sign ___ Bounce test ___ Pinch grip test Neurological Tests - note any abnormalities or differences for each of the following. ___ Sensory ___ Motor ___ Reflex Circulatory Tests - note any abnormalities or differences for each of the following. ___ Brachial pulse ___ Radial pulse Functional Tests ___ Sport specific activities ___ Throwing ___ Catching Impression
  55. 55. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: THE WRIST AND FINGERS 15740.The student should explain and demonstrate a complete evaluation of the wrist and fingers, including history, observation, and palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 15741.Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ What activity were you doing? ___ How long ago did it happen? ___ Hear a snap or pop? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? ___ What brought on pain? (Gradual onset or acute) ___ Have you had any change in activity level or training habits? ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Do you have any numbness or tingling in your arm/hand? ___ Do you have any crepitus, clicking, locking grinding or snapping? ___ Has there been any swelling? If so, how long after the injury did it appear? Observation/Inspection ___ Swelling
  56. 56. ___ Deformity ___ Ecchymosis ___ Colle's fracture ___ Bennett’s fracture ___ Boxer’s fracture ___ Metacarpal fracture ___ Phalanges fracture ___ Ganglion ___ Murphy sign (dislocation of lunate) ___ Mallet finger (Distal extensor tendon avulsion) ___ Boutonniere deformity (Central extensor tendon avulsion) ___ Volkmann's ischemic contractures (pale, reduced radial pulse) ___ Jersey finger ___ Trigger finger ___ Dislocation or subluxation ___ Condition of nails (clubbed nails, spoon nails, etc.) ___ Volar plate rupture ___ Dupuytren’s contracture ___ Swan neck deformity ___ Bishop’s or benediction’s deformity
  57. 57. ___ Ape hand ___ Claw fingers ___ Drop wrist Palpation XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.Bony Palpation ___ Carpal bones ___ Proximal row: navicular, lunate, triquetrium, piciform ___ Distal row: trapezium, trapezoid, capitate, hamate ___ Styloid process of radius and ulna ___ Lister’s tubercle ___ Metacarpal/Carpal joints ___ Length of metacarpals ___ Metacarpophalangeal joints ___ Proximal interphalangeal joints ___ Distal interphalangeal joints B.Soft Tissue Palpation ___ RCL
  58. 58. ___ UCL ___ Anatomical Snuffbox ___ Abductor pollicis longus & extensor pollicis brevis tendons (radial border) ___ Extensor pollicis longus tendon (ulnar border) ___ Radial artery / Radial nerve ___ Extensor carpi radialis longus & brevis ___ Extensor digitorum ___ Extensor indicis ___ Extensor digiti minimi ___ Extensor carpi ulnaris ___ Flexor carpi ulnaris ___ Ulnar nerve / artery (Tunnel of Guyon) ___ Palmaris longus ___ Carpal tunnel ___ Flexor digitorum superficialis ___ Flexor digitorum profundus ___ Median nerve ___ Flexor carpi radialis ___ Thenar eminence ___ Hypothenar eminence ___ Palmar aponeurosis ___ Interphalangeal collateral ligaments ___ Volar plate ___ Finger tufts
  59. 59. Active Range of Motion ___ Wrist flexion / extension ___ Radial / Ulnar deviation ___ Pronation / Supination ___ Finger flexion / extension ___ Finger abduction / adduction ___ Thumb opposition ___ Thumb abduction / adduction ___ Thumb flexion / extension Passive Range of Motion ___ Wrist flexion / extension ___ Radial / Ulnar deviation ___ Pronation / Supination ___ Finger flexion / extension ___ Finger abduction / adduction ___ Thumb opposition ___ Thumb abduction / adduction ___ Thumb flexion / extension Manual Muscle Testing: ___ Wrist flexion (flexor carpi radialis & ulnaris) ___ Wrist extension (extensor carpi radialis longus & brevis/ulnaris) ___ Radial / Ulnar deviation ___ Pronation / Supination
  60. 60. ___ Finger flexion (flexor digitorum profundus & superficialis) ___ Finger extension (extensor digitorum communis, extensor idicis, extensor digiti minimi) ___ Finger abduction / adduction (palmar & dorsal interossi) ___ Thumb opposition (opponens pollicis) ___ Thumb abduction / adduction ___ Thumb flexion / extension Special Tests ___ Fracture tests (compression, torsion, tap) ___ Valgus stress of MP, PIP, DIP joints ___ Varus stress of MP, PIP, DIP joints ___ Finkelstein Test (de Quervain's Disease) ___ Phalen's test (Carpal tunnel) ___ Tinel sign (Carpal tunnel) ___ Glide test ___ Flexor digitorum superficialis test ___ Flexor digitorum profundus test ___ Bunnel-Littler test ___ Retinacular test ___ Allen test Neurological Tests ___ Sensory testing ___ Motor testing ___ Reflexes ___ Nerve isolation tests (Radial, Median, and Ulnar)
  61. 61. Circulatory Testing ___ Radial pulse ___ Capillary refill Functional Tests ___ Sport specific activities Impression
  62. 62. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: ABDOMEN AND CHEST 20864.The student should explain and demonstrate a complete evaluation of the abdomen/chest, including history, observation, palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 20865.Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ Did you hear a snap or pop? ___ Was there a direct blow? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? ___ What brought on pain? (Gradual onset or acute) ___ Are you feeling worse now than when it happened? ___ Any nausea / vomiting? Is there blood in the vomit? ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Do you have pain with inspiration/expiration? ___ Is there pain with coughing, sneezing, or laughing? Has blood been coughed up? ___ Is there any blood in the urine or is urinating painful? ___ Are there normal bowel movements? Is there blood in the stool?
  63. 63. ___ Dizziness or shortness of breath? ___ Are you more thirsty than normal? Observation/Inspection ___ Swelling ___ Deformity ___ Ecchymosis ___ Posture ___ Pale face, skin (sign of shock) ___ Position of trachea (pneumothorax) ___ Auscultation of Abdomen (use stethoscope to listen to bowel sounds) Palpation - note pain, tenderness, deformity and swelling for each of the following. ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ.Bony Palpation ___ Sternum (manubrium, body, xiphoid process) ___ Sternocostal and Costochondral joints ___ Ribs B.Soft Tissue Palpation
  64. 64. ___ Abdominal quadrants: 1.Upper right (liver - referred pain to right arm) 2.Lower right abdomen (appendicitis) 3.Upper left (spleen - referred pain to left arm (Kehr’s sign)) 4.Lower left ___ Kidneys (referred pain into legs) ___ McBurney’s point (appendicitis) ___ Stomach ___ Abdominal muscles Active Range of Motion - note pain and restricted motion. ___ Trunk flexion ___ Trunk extension ___ Trunk lateral flexion ___ Trunk rotation Manual Muscle Tests - note pain and weakness. ___ Trunk flexion (rectus abdominis) ___ Trunk extension (Sacrospinalis, erector spine, etc.) ___ Trunk lateral flexion (transverse abdominis) ___ Trunk rotation (internal and external obliques) Special Tests ___ Lateral compression of rib cage (fracture) ___ Anterior / Posterior compression of rib cage (fracture) Vital Signs ___ Heart rate (normal in adults = 60-80, children = 80-100 bpm) ___ Respiratory rate (12-20 breaths / minute)
  65. 65. ___ Blood pressure (Normal = 100-140 over 65-90) * Record values periodically to note trends Neurological Tests Referral Patterns: ___ Spleen - left shoulder ___ Liver - right shoulder ___ Kidneys - low back, legs Functional Tests ___ Sport specific activities Impression
  66. 66. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: LUMBAR SPINE 28484.The student should explain and demonstrate a complete evaluation of the lumbar spine, including history, observation, palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 28485.Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ Hear a snap or pop? ___ Was there a direct blow? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? ___ Any numbness tingling in extremities? ___ What brought on pain? (Gradual onset or acute) ___ Have you had any change in activity level or training habits? ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Is there crepitus, clicking, grinding, or snapping? ___ Is there any giving way, weakness or locking? ___ Has there been any swelling? (How long after the injury & where was it located?) ___ What are the effects of ascending or descending the stairs?
  67. 67. ___ Is there stiffness in the morning or after sitting? ___ Is there any loss of bowel or bladder control? ___ Is there or has there been any blood in the urine? (Hematuria) Observation/Inspection ___ General appearance ___ Spinal posture (scoliosis, lordosis, kyphosis) ___ Gait / general movement ___ Leg length discrepancy ___ Swelling ___ Deformity ___ Ecchymosis ___ Muscle spasm ___ Atrophy ___ Signs of trauma ___ Café au lait macules (spots) ___ Spina bifida occulta ___ Step deformity
  68. 68. Palpation - note pain, tenderness, deformity, and swelling for each of the following. JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ.Bony Palpation Anterior Structures ___ Anterior superior iliac spine ___ Anterior inferior iliac spine Lateral Structures ___ Iliac crests ___ Greater trochanter Posterior Structures ___ Ischial tuberosity ___ Sacroiliac joint ___ Coccyx ___ Posterior superior iliac spine ___ Median sacral crests ___ Spinous processes of the lumbar spine ___ Transverse processes of the lumbar spine B.Soft Tissue Palpation
  69. 69. ___ Supraspinous ligaments ___ Interspinous ligaments ___ Paraspinal muscles (erector Spinae, Multifidious, Intertransverse) ___ Gluteus maximus ___ Cluneal nerves ___ Sciatic Nerve ___ Abdominal muscles (Rectus Abdominis, Internal and External Oblique) ___ Inguinal crease Active Range of Motion - note pain and restricted motion bilaterally. ___ Trunk flexion ___ Trunk extension ___ Trunk lateral flexion ___ Trunk rotation Passive Range of Motion - note pain and restricted motion bilaterally. ___ Trunk flexion ___ Trunk extension ___ Trunk lateral flexion ___ Trunk rotation Range of motion Goniometry ___ Trunk flexion, tape measure, S1 to C7 (10cm different norm) ___ Trunk extension, tape measure, S1 to C7 (no norms) ___ Trunk lateral flexion, Fulcrum S1, Stat Arm-Medial sacral crests, Movem. Arm-C7 (25deg norm) ___ Trunk rotation, Fulcrum-Skull, Stat Arm-Iliac crest, Movem. Arm - Acromion Process
  70. 70. Manual Muscle Tests - note pain and weakness bilaterally. ___ Trunk flexion (All abdominal muscles) ___ Trunk extension (Erector Spinae) ___ Trunk lateral flexion (Internal oblique) ___ Trunk rotation (same side internal oblique, opposite side external oblique) Special Tests - note pain, laxity, and abnormalities for each of the following. Nerve/Disc pathology ___ Valsalva test ___ Milgram test ___ Kernig test with Brudzinski=s ___ Straight leg raise test (Laseques) ___ Well straight leg raise test ___ Tension sign (bowstring) Miscellaneous ___ Hoover test ___ Spring test ___ Single leg stance test Neurological Tests - note any abnormalities or differences for each of the following. ___ Sensory (L1 - S2) ___ Motor (L1-L2 Hip Lumbar plexus, L3 Knee extension femoral N, L4 Deep peroneal N, L5, deep peroneal N, S1 tibial N) ___ Reflex (Patellar and Achilles) Circulatory Tests - note any abnormalities or differences for each of the following.
  71. 71. ___ Femoral pulse ___ Posterior tibial pulse ___ Dorsal pedal pulse Functional Tests ___ Quarter squats (bilateral and unilateral) ___ Hopping (bilateral then injured side only) ___ Walk ___ Jog ___ Run ___ Cutting ___ Carioca ___ Figure 8 (large to small) ___ Sport specific activities Impression
  72. 72. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: THIGH AND HIP 30032.The student should explain and demonstrate a complete evaluation of the thigh/hip, including history, observation, palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 30033.Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ Hear a snap or pop? ___ Was there a direct blow? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? ___ What brought on pain? (Gradual onset or acute) ___ Have you had a change in activity level or training habits? ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Do you have numbness or tingling? ___ Is there any crepitus, clicking, grinding, or snapping? ___ Is there any giving way, weakness, or locking? ___ Has there been any swelling? (How long after the injury & where was it located?) ___ Is there any stiffness in the morning or after sitting?
  73. 73. ___ What are the effects of ascending or descending stairs? Observation/Inspection ___ General appearance and posture ___ Pelvic obliquity ___ Gait ___ Swelling ___ Deformity ___ Ecchymosis ___ Genu Varum ___ Genu Valgum ___ Genu Recurvatum ___ Hip retroversion ___ Hip anteversion ___ Leg length discrepancy (measure) ___ Q-angle ___ Signs of trauma
  74. 74. Palpation - note pain, tenderness, deformity, and swelling for each of the following. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.Bony Palpation Anterior Structures ___ Anterior superior iliac spine ___ Anterior inferior iliac spine ___ Pubic tubercle ___ Iliac tubercle Lateral Structures ___ Iliac crest ___ Greater trochanter Posterior Structures ___ Ischial tuberosity ___ Sacroiliac joint
  75. 75. ___ Coccyx ___ Posterior superior iliac spine ___ Median sacral crests B.Soft Tissue Palpation Anterior/Medial Structures ___ Iliospoas ___ Sartorius ___ Inguinal crease ___ Inguinal ligament ___ Adductors (Longus, Magnus, Brevis, Pectineus, Gracillis) ___ Femoral Triangle ___ Femoral artery ___ Lymph nodes ___ Rectus femoris ___ Vastus lateralis ___ Vastus medialis Posterior Structures ___ Semitendinosus ___ Semimembranosus ___ Biceps femoris ___ Cluneal nerves ___ Sciatic nerve ___ Gluteus Maximus ___ Gluteus Medius
  76. 76. ___ Ischial bursa Lateral Structures ___ Tensor facia latae/Iliotibial tract ___ Trochanteric bursa Active Range of Motion - note pain and restricted motion bilaterally. ___ Hip flexion ___ Hip extension ___ Hip adduction ___ Hip abduction ___ Hip internal rotation ___ Hip external rotation ___ Knee flexion ___ Knee extension Passive Range of Motion - note pain and restricted motion bilaterally. ___ Hip flexion ___ Hip extension ___ Hip adduction ___ Hip abduction ___ Hip internal rotation ___ Hip external rotation ___ Knee flexion ___ Knee extension Range of Motion Goniometry - compare bilaterally and states norm values (F=Fulcrum, SA=Stationary Arm, MA=Movement Arm)
  77. 77. ___ Hip flexion, F=Greater troch, SA=mid trunk, MA=mid lat thigh, lat epic, 120-130deg norm ___ Hip extension, F=Greater troch, SA=mid trunk, MA=mid lat thigh, lat epic, 10-20deg norm ___ Hip adduction, F=ASIS, SA=ASIS, MA=Mid ant femur, 30 deg norm ___ Hip abduction, F=ASIS, SA=ASIS, MA=Mid ant femur, 45 deg norm ___ Hip internal rotation, F=center patella, SA=straight up, MA, middle of malleoli, norm 45deg ___ Hip external rotation, F=center patella, SA=straight up, MA, middle of malleoli, norm 50deg Manual Muscle Tests - note pain and weakness bilaterally. ___ Hip flexion (rectus femoris, iliopsoas group) ___ Hip extension (gluteus maximus) ___ Sartorius (hip abduction, flexion, external rotation) ___ Hip adduction (adductor group) ___ Hip abduction (gluteus medius) ___ Hip internal rotation (gluteus med/min) ___ Hip external rotation (gluteus max and med) ___ Knee flexion (hamstrings) ___ Knee extension (quadriceps) Special Tests - note pain, laxity and abnormalities for each of the following. ___ Ober test (contraction of Iliotibial Band) ___ Trendelenburg Test (gluteus medius weakness) ___ Thomas test (flexion contracture) ___ Kendall Test
  78. 78. Gen Hip Tests ___ Long sit test ___ Hip scouring test ___ Femoral nerve traction test ___ Stress fracture test ___ Noble's Test (IT band friction syndrome) ___ Piriformis test SJ Joint Tests ___ Fabere Sign (Patrick’s test) ___ Gaenslen’s test ___ SI compression test ___ SI distraction AGapping@ test ___ Hibb’s test (posterior distraction) ___ Caudal glide ___ Sacral apex compression test Neurological Tests - note any abnormalities or differences for each of the following. ___ Sensory (L1, L2, L3, L4) ___ Motor (L1-L2 Hip flexion, L3 Knee extension) ___ Reflex (Patellar) Circulatory Tests - note any abnormalities or differences for each of the following. ___ Femoral pulse ___ Dorsal pedal pulse ___ Posterior tibial pulse
  79. 79. Functional Tests - note any difficulty, pain, or inability for each of the following. ___ Quarter Squat (bilateral and unilateral) ___ Hopping (bilateral then injured side only) ___ Walk ___ Jog ___ Run ___ Cutting ___ Carioca ___ Figure 8 (large to small) ___ Sport specific activities Impression
  80. 80. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: THE KNEE 31580.The student should explain and demonstrate a complete evaluation of the knee, including history, observation, palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 31581.Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ Did you hear a snap or pop? ___ Was there a direct blow? ___ Were you running, cutting or twisting? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ What type of pain is it? ___ Do you or have you ever worn orthotics? ___ What brought on pain? (Gradual onset or acute) ___ Have you had a change in activity level or training habits? ___ Have you had any change in footwear or terrain? ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Do you have numbness or tingling? ___ Is there any crepitus, clicking, grinding, or snapping?
  81. 81. ___ Is there any giving way, weakness, or locking? ___ Has there been any swelling? (How long after the injury & where was it located) Observation/Inspection ___ General appearance and posture ___ Unilateral Patella Alignment ___ Swelling/Girth measurements ___ Deformity ___ Ecchymosis ___ Gait / weight bearing ___ Leg length discrepancy ___ Tibial torsion ___ Shoe wear pattern ___ Genu Valgum ___ Genu Varum ___ Genu Recurvatum ___ Q-angle ___ Patella baja ___ Patella alta ___ Squinting patella ___ Frog-eyed patella ___ Tibial torsion ___ Signs of trauma ___ Malalignments of feet
  82. 82. Palpation - note pain, tenderness, deformity and swelling for each of the following. LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL.Bony Palpation Anterior Knee ___ Patella - underside of medial and lateral aspect ___ Trochlear groove ___ Tibial tubercle Medial Knee ___ Medial Window ___ Medial joint line ___ Medial tibial plateau ___ Medial tibial flare ___ Medial femoral condyle ___ Medial femoral epicondyle
  83. 83. ___ Adductor tubercle Lateral Knee ___ Lateral Window ___ Lateral joint line ___ Lateral tibial plateau ___ Gerdy’s (lateral) tubercle ___ Lateral femoral condyle ___ Lateral femoral epicondyle ___ Head of fibula B.Soft Tissue Palpation Anterior Knee ___ Rectus femoris ___ Vastus lateralis ___ Vastus medialis / VMO ___ Vastus Intermedius ___ Infrapatellar tendon ___ Superficial Infrapatellar bursa ___ Prepatellar bursa ___ Sartorius ___ Anterior superior tibiofibular ligament Medial Knee ___ Pes Anserine Tendon and Bursa ___ Medial meniscus ___ Medial collateral ligament
  84. 84. ___ Gracilis Lateral Knee ___ Lateral meniscus ___ Lateral collateral ligament ___ Popliteus ___ Biceps femoris tendon ___ Iliotibial tendon ___ common peroneal nerv Posterior Knee ___ Semitendinosus ___ Semimembranosus ___ Gastrocnemius - lateral and medial heads ___ Popliteal fossa ___ Posterior tibial nerve ___ Popliteal vein ___ Popliteal artery Active Range of Motion - note pain and restricted motion bilaterally. ___ Knee flexion ___ Knee extension Passive Range of Motion - note pain and restricted motion bilaterally. ___ Knee flexion ___ Knee extension Range of Motion Goniometry - compare bilaterally and states norm values (F=Fulcrum, SA=Stationary Arm, MA=Movement Arm)
  85. 85. ___ Knee flexion, F=lat epic, SA=mid lat thigh, MA=mid lat lower leg, norm 135-145deg ___ Knee extension, F=lat epic, SA=mid lat thigh, MA=mid lat lower leg, norm 0deg Manual Muscle Tests - note pain and weakness bilaterally and states prime mover. ___ Knee flexion in IR (SM & ST) ___ Knee flexioin in ER (BF) ___ Knee extension (quadriceps) Special Tests - note pain, laxity and abnormalities for each of the following. Ligamentous Testing ___ Anterior drawer (ACL) ___ Posterior drawer (PCL) ___ Posterior sag sign / Godfreys (PCL) ___ Lachman (ACL) ___ Valgus stress 0 and 25 degrees flexion (MCL) ___ Varus stress 0 and 25 degrees flexion (LCL) ___ Anteroposterior fibular glide / Tibiofibular Translation test Ligamentous Plus Rotational Instabilities ___ Pivot shift ___ Hughston=s ___ Slocum drawer with internal rotation of tibia ___ Slocum drawer with external rotation of tibia ___ Slocum ALRI Meniscal Tests ___ McMurray test
  86. 86. ___ Apley=s compression test ___ Apley=s distraction test (meniscus or ligament damage) IT Band Tests ___ Noble=s Compression Test ___ Ober=s Test Edema ___ Sweep test ___ Ballotable patella Patellar Pathology ___ Apprehension test (subluxation/dislocation of patella) ___ Patellar glides ___ Lateral glide test Chondromalacia/Patellar Femoral Stress Syndrome ___ Patella femoral grind test / Clarke=s Sign (chondromalacia) ___ Patellar compression Plica ___ Medial synovial plica test ___ Stutter test Miscellaneous Pathology Test ___ Bounce home test ___ Wilson=s test (osteochondral defects) ___ Figure 4 test
  87. 87. ___ Tinels Sign
  88. 88. Neurological Tests - note any abnormalities or differences for each of the following. ___ Sensory L2-S1 Dermatomes ___ Motor L1 L2, Illipsoas, L3 Quadriceps, L4 Anterior Tibialis, L5 Extensor Hallicus Longus ___ Reflexes, Patellar Tendon and Achilles, stating nerve root tested Circulatory Testing - note any abnormalities or differences for each of the following. ___ Dorsal Pedal Pulse ___ Posterior Tibial Pulse Functional Tests - note any difficulty, pain, or inability for each of the following. ___ Toe raise (bilateral then injured side only) ___ Hopping (bilateral then injured side only) ___ Walk ___ Jog ___ Run ___ Cutting ___ Carioca ___ Figure 8 (large to small) ___ Sport specific activities Impression
  89. 89. Clinical ACI __________________________________ Date __________________ Pass _____ Needs Improvement _____ Fail _____ RECOGNITION AND EVALUATION: THE ANKLE AND LOWER LEG 33128.Ask student to explain and demonstrate a complete evaluation of the ankle, including history, observation, and palpation, active and passive range of motion, manual muscle tests, neurological tests, special tests, and functional tests. 33129.Please check off as student explains and demonstrates the following: History ___ How did it happen? (Mechanism) ___ Did you hear anything (a snap or pop?, crepitis, grinding,?) ___ Was there a direct blow? ___ Were you running, cutting or twisting? ___ Have you hurt it before? (Previous history) ___ How severe was the previous injury? Did you do any treatment or rehab for the injury? ___ Where does it hurt? (Location of pain) ___ Can you describe the pain? ___ Do you or have you ever worn orthotics? ___ What brought on pain? (Gradual onset or acute) ___ Have you had a change in activity level or training habits? ___ Have you had any change in footwear or terrain? ___ What activities increase pain? ___ What do you do for relief of pain? ___ When do you have pain? Does it persist into the night? ___ Do you have numbness or tingling? ___ Is there any giving way, weakness, or locking?
  90. 90. ___ Has there been any swelling? (How long after the injury & where was it located?) Observation/Inspection ___ States will compare bilaterally ___ General appearance and posture ___ Swelling ___ Deformity ___ Ecchymosis ___ Gait / weight bearing / excessive pronation and supination ___ Leg length discrepancy ___ Tibial torsion ___ Shoe wear pattern ___ Genu Valgum ___ Genu Varum ___ Genu Recurvatum ___ Arches (Pes cavus or pes planus) ___ Foot deformities ___ Toe nails ___ Skin ___ Callus fornation
  91. 91. Palpation - note pain, tenderness, deformity and swelling for each of the following. ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ.Bony Palpation Medial Structures ___ Tibia - start superior and work down ___ Medial malleous ___ First MTP joint ___ First metatarsal ___ First Cunieform ___ Navicular and navicular tuberosity ___ Talar head ___ Sustentaculum tali ___ Spring ligament ___ Calcaneus and Calcaneal Tubercle
  92. 92. Lateral Structures ___ Fibula - start superior (at the head of fibula) and work down ___ Lateral malleoli ___ Fifth MTP joint ___ Fifth metatarsal ___ Styloid or base of the 5th metatarsal ___ Cuboid ___ Peroneal tuberble
  93. 93. Dorsal and Plantar Structures ___ Interphalangeal joints and can identify PIP and DIP ___ Metatarsal heads ___ Medial calcaneal tubercle ___ Sesamoid bones B.Soft Tissue Palpation Medial Tissues/Ligaments ___ Tibialis Posterior ___ Flexor Digitorum Longus ___ Posterior Tibial Artery ___ Tibial Nerve ___ Flexor Hallucis Longus ___ Long Saphenous Vein ___ Spring Ligament ___ Deltoid Ligament Lateral Tissues Ligaments ___ Peroneal Longus ___ Peroneal Brevis ___ Anterior Talofibular Ligament ___ Calcaneoufibular Ligament ___ Posterior Talofibular Ligament
  94. 94. Dorsal Tissues ___ Anterior Tibiofibular Ligament ___ Anterior Tibialis ___ Extensor Digitorum Longus ___ Extensor Hallucis Longus ___ Dorsal Pedal Artery Posterior Tissues ___ Plantar fascia ___ Posterior Tibofibular Ligament ___ Achilles Tendon ___ Gastroncnemius ___ Soleus Active Range of Motion - note pain and restricted motion bilaterally ___ Proper stabilization for all tests ___ Plantarflexion ___ Dorsiflexion ___ Inversion ___ Eversion Passive Range of Motion - note pain and restricted motion bilaterally. ___ Proper stabilization for all tests ___ Plantarflexion ___ Dorsiflexion ___ Inversion ___ Eversion Goniometry Measurements - Can also state normal values in addition to reading partner (F=Fulcrum, SA=Stationary Arm, MA=Movement Arm)
  95. 95. ___ Plantarflexion, F=Lat malleoli, SA=fibular head, MA, 5th metatarsal, 50deg norm ___ Dorsiflexion, F=Lat malleoli, SA=fibular head, MA, 5th metatarsal, 20deg norm ___ Inversion, F=Achilles Tendon, SA=mid gastroc, MA, mid calcaneus, 20deg norm ___ Eversion, F=Achilles Tendon, SA=mid gastroc, MA, mid calcaneus, 5deg norm Manual Muscle Tests - note pain and weakness bilaterally. ___ Proper stabilization for all tests ___ Plantarflexion / Gastroc soleus ___ Dorsiflexion / Anterior Tib ___ Inversion / Tib Posterior ___ Eversion / Peroneal longus and brevis ___ Extensor hallucis longus ___ Extensor digitorum longus ___ Flexor hallucis longus ___ Flexor digitorum longus Special Tests - note pain, laxity and abnormalities for each of the following. Points only given if test is performed properly, student can explain why. Fracture tests ___ Squeeze test ___ Heel tap test ___ Percussion test ___ Bimalleolar squeeze _____ Ligamentous Testing ___ Anterior drawer test ___ Talor tilt test inversion ___ Talor tilt test eversion

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