Sterner Notes

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Sterner Notes

  1. 1. Systematic Evaluation Process
  2. 2. Systematic Evaluation Process <ul><li>What need to know for successful evaluation and impression? </li></ul><ul><ul><li>ANATOMY </li></ul></ul><ul><ul><li>Pathomechanics </li></ul></ul><ul><ul><li>Biomechanics of Sport </li></ul></ul><ul><ul><li>Pathologies </li></ul></ul>
  3. 3. Systematic Evaluation Process <ul><li>Many different ways </li></ul><ul><li>Must be Sequential Process </li></ul><ul><li>Types of Evaluations </li></ul><ul><ul><li>Clinical </li></ul></ul><ul><ul><li>On-field </li></ul></ul>
  4. 4. Systematic Evaluation Process <ul><li>History </li></ul><ul><ul><li>Most important part of evaluation </li></ul></ul><ul><ul><li>Communication skills </li></ul></ul><ul><ul><li>Simple Open-ended Questions </li></ul></ul><ul><ul><ul><li>Mechanism </li></ul></ul></ul><ul><ul><ul><li>Sounds </li></ul></ul></ul><ul><ul><ul><li>Pain Location </li></ul></ul></ul><ul><ul><ul><li>Onset of Symptoms </li></ul></ul></ul><ul><ul><ul><li>Description of Symptoms </li></ul></ul></ul><ul><ul><ul><ul><li>When </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Joint Position </li></ul></ul></ul></ul><ul><ul><ul><ul><li>How </li></ul></ul></ul></ul><ul><ul><ul><li>Previous Injury </li></ul></ul></ul>
  5. 5. Systematic Evaluation Process <ul><li>Tips for taking a good history </li></ul><ul><ul><li>LISTEN </li></ul></ul><ul><ul><li>Verbal vs Nonverbal Communication </li></ul></ul><ul><ul><li>Avoid slang and jargon language </li></ul></ul><ul><ul><li>Maintain eye contact </li></ul></ul><ul><ul><li>Be Calm and reassuring </li></ul></ul>
  6. 6. Systematic Evaluation Process <ul><li>Inspection (Observation) </li></ul><ul><ul><li>Really begins when patient enters athletic training room </li></ul></ul><ul><ul><ul><li>Gait </li></ul></ul></ul><ul><ul><ul><li>Posture </li></ul></ul></ul><ul><ul><ul><li>Functional movement </li></ul></ul></ul>
  7. 7. Systematic Evaluation Process <ul><li>Inspection cont. </li></ul><ul><ul><li>Deformities </li></ul></ul>
  8. 8. Systematic Evaluation Process <ul><li>Inspection cont. </li></ul><ul><ul><li>Deformities </li></ul></ul>
  9. 9. Systematic Evaluation Process <ul><li>Inspection cont. </li></ul><ul><ul><li>Deformities </li></ul></ul><ul><ul><li>Ecchymosis </li></ul></ul>
  10. 10. Systematic Evaluation Process <ul><li>Inspection cont . </li></ul><ul><ul><li>Deformities </li></ul></ul><ul><ul><li>Ecchymosis </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><ul><li>Effusion vs edema </li></ul></ul></ul><ul><ul><ul><li>Localized vs diffuse </li></ul></ul></ul>
  11. 11. Systematic Evaluation Process <ul><li>Inspection cont . </li></ul><ul><ul><li>Deformities </li></ul></ul><ul><ul><li>Ecchymosis </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><ul><li>Effusion vs edema </li></ul></ul></ul><ul><ul><ul><li>Localized vs diffuse </li></ul></ul></ul><ul><ul><li>Bilateral Symmetry </li></ul></ul>
  12. 12. Systematic Evaluation Process <ul><li>Inspection cont. </li></ul><ul><ul><li>Deformities </li></ul></ul><ul><ul><li>Ecchymosis </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><ul><li>Effusion vs edema </li></ul></ul></ul><ul><ul><ul><li>Localized vs diffuse </li></ul></ul></ul><ul><ul><li>Bilateral Symmetry </li></ul></ul><ul><ul><li>Skin </li></ul></ul><ul><ul><ul><li>Scars, ecchymosis, temp, color </li></ul></ul></ul>
  13. 13. Systematic Evaluation Process <ul><li>Palpation </li></ul><ul><ul><li>Feeling for: </li></ul></ul><ul><ul><ul><li>Point tenderness </li></ul></ul></ul><ul><ul><ul><li>Deformities </li></ul></ul></ul><ul><ul><ul><li>Crepitus </li></ul></ul></ul><ul><ul><ul><li>Gapping </li></ul></ul></ul><ul><ul><ul><li>Muscle tension/spasm </li></ul></ul></ul><ul><ul><ul><li>Temperature </li></ul></ul></ul><ul><ul><ul><li>Swelling (edema/effusion) </li></ul></ul></ul>
  14. 14. Systematic Evaluation Process <ul><li>Palpation Procedures </li></ul><ul><ul><li>Injured vs non-injured side </li></ul></ul><ul><ul><li>Start away from injured part </li></ul></ul><ul><ul><li>Bony Tissue First </li></ul></ul>
  15. 15. Systematic Evaluation Process <ul><li>Palpation Procedures </li></ul><ul><ul><li>Injured vs non-injured side </li></ul></ul><ul><ul><li>Start away from injured part </li></ul></ul><ul><ul><li>Bony Tissue First </li></ul></ul><ul><ul><li>Ligament Structures Second </li></ul></ul>
  16. 16. Systematic Evaluation Process <ul><li>Palpation Procedures </li></ul><ul><ul><li>Injured vs non-injured side </li></ul></ul><ul><ul><li>Start away from injured part </li></ul></ul><ul><ul><li>Bony Tissue First </li></ul></ul><ul><ul><li>Ligament Structures Second </li></ul></ul><ul><ul><li>Muscle Tissue Third </li></ul></ul>
  17. 17. Systematic Evaluation Process <ul><li>Range-of-Motion (ROM) </li></ul><ul><ul><li>Active ROM (AROM) </li></ul></ul><ul><ul><ul><li>Contraindications </li></ul></ul></ul><ul><ul><ul><li>Willingness to move </li></ul></ul></ul>
  18. 18. Systematic Evaluation Process <ul><li>Range-of-Motion (ROM) </li></ul><ul><ul><li>Active ROM (AROM) </li></ul></ul><ul><ul><ul><li>Contraindications </li></ul></ul></ul><ul><ul><ul><li>Willingness to move </li></ul></ul></ul><ul><ul><li>Passive ROM (PROM) </li></ul></ul><ul><ul><ul><li>Quantity of movement </li></ul></ul></ul><ul><ul><ul><li>Endfeels </li></ul></ul></ul><ul><ul><ul><ul><li>Normal vs abnormal </li></ul></ul></ul></ul>
  19. 19. Endfeels (Normal vs Abnormal) No endfeel, Ex fracture, severe sprain, acute inflammation Empty Loose bodies, fracture Hard Spasm, soft tissue shortening Firm Boggy feeling, Ex edema Soft Abnormal Bone-on-bone Hard Muscle, capsular, ligament stretch Firm Soft Tissue approximation Soft Normal
  20. 20. Systematic Evaluation Process <ul><li>Range-of-Motion (ROM) </li></ul><ul><ul><li>Active ROM (AROM) </li></ul></ul><ul><ul><ul><li>Contraindications </li></ul></ul></ul><ul><ul><ul><li>Willingness to move </li></ul></ul></ul><ul><ul><li>Passive ROM (PROM) </li></ul></ul><ul><ul><ul><li>Quantity of movement </li></ul></ul></ul><ul><ul><ul><li>Endfeels </li></ul></ul></ul><ul><ul><ul><ul><li>Normal vs abnormal </li></ul></ul></ul></ul><ul><ul><li>Resistive ROM (RROM) </li></ul></ul><ul><ul><ul><li>Break test vs manual muscle test </li></ul></ul></ul><ul><ul><ul><li>Grading System </li></ul></ul></ul>
  21. 21. Grading Scale for RROM No contraction felt Gone (0/5) Cannot prodce movement, but feel muscle contration Trace (1/5) Move through full ROM in gravity eliminated position Poor (2/5) Move through full ROM against gravity Fair (3/5) Resist against moderate pressure Good (4/5) Resist against maximal pressure Normal (5/5)
  22. 22. Systematic Evaluation Process <ul><li>Ligament and Capsular Tests </li></ul><ul><ul><li>Structural integrity of non-contractile tissue </li></ul></ul><ul><ul><li>Bilateral comparison </li></ul></ul>
  23. 23. Systematic Evaluation Process <ul><li>Special Tests </li></ul><ul><ul><li>Bilateral comparison </li></ul></ul><ul><ul><li>Specific to a structure, joint or body part </li></ul></ul>
  24. 24. Systematic Evaluation Process <ul><li>Neurological Tests </li></ul><ul><ul><li>Sensory </li></ul></ul><ul><ul><ul><li>Dermatome </li></ul></ul></ul><ul><ul><ul><li>Myotome </li></ul></ul></ul><ul><ul><ul><li>Reflex Testing </li></ul></ul></ul>
  25. 25. Systematic Evaluation Process <ul><li>Neurological Tests </li></ul><ul><ul><li>Sensory </li></ul></ul><ul><ul><ul><li>Dermatome </li></ul></ul></ul><ul><ul><ul><li>Myotome </li></ul></ul></ul><ul><ul><ul><li>Reflex Testing </li></ul></ul></ul>
  26. 26. Systematic Evaluation Process <ul><li>Neurological Tests </li></ul><ul><ul><li>Sensory </li></ul></ul><ul><ul><ul><li>Dermatome </li></ul></ul></ul><ul><ul><ul><li>Myotome </li></ul></ul></ul><ul><ul><ul><li>Reflex Testing </li></ul></ul></ul>
  27. 27. Systematic Evaluation Process <ul><li>Functional Tests </li></ul><ul><ul><li>Coordinated movements specific to sport or position </li></ul></ul>
  28. 28. On-field Evaluation
  29. 29. On-field Evaluation <ul><li>Must rule out </li></ul><ul><ul><li>Cardiovascular or respiratory failure </li></ul></ul><ul><ul><li>Life-threatening head or spinal injury </li></ul></ul><ul><ul><li>Profuse bleeding </li></ul></ul><ul><ul><li>Fractures </li></ul></ul><ul><ul><li>Joint dislocation </li></ul></ul><ul><ul><li>Peripheral nerve injury </li></ul></ul><ul><ul><li>Other </li></ul></ul>
  30. 30. On-field Evaluation -- History <ul><li>Clear Communication </li></ul><ul><li>Briefer than Clinical </li></ul><ul><li>Mechanism </li></ul><ul><li>Pain location </li></ul><ul><li>Noises </li></ul><ul><li>Signs and symptoms </li></ul>
  31. 31. On-field Evaluation --- Inspection <ul><li>When does this begin? </li></ul><ul><li>Is the athlete moving? </li></ul><ul><li>Position of Athlete? </li></ul><ul><li>Conscious or unconscious? </li></ul><ul><li>Observe as soon as walk on the field </li></ul>
  32. 32. On-field Evaluation --- Palpation <ul><li>Bone alignment </li></ul><ul><li>Crepitus </li></ul><ul><li>Joint alignment </li></ul><ul><li>Swelling </li></ul><ul><li>Pain </li></ul><ul><li>Deficits in muscle or tendons </li></ul>
  33. 33. On-field evaluation – ROM Testing <ul><li>AROM, PROM, RROM </li></ul><ul><li>Contraindications </li></ul>
  34. 34. On-field evaluation --- Ligamentous and Special Tests <ul><li>Usually single plane tests </li></ul><ul><li>Gives immediate impression </li></ul>
  35. 35. On-field evaluation --- Neurological Tests <ul><li>Very important if suspect head or spine injury </li></ul><ul><li>Also with fractures and dislocation </li></ul>
  36. 36. Removal of Athlete from Field <ul><li>DECISIONS, DECISIONS. WHAT SHOULD YOU DO? </li></ul><ul><li>Fractures, dislocations, gross joint instability, spinal injury </li></ul><ul><li>Ways to remove athlete once make the decision </li></ul>

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