Assessment and Evaluation

1. Assessment and Evaluation Mazyad Alotaibi

2. Assessment and Evaluation • Good assessment is dependent upon: • Knowledge of functional anatomy • History • Complete examination

3. Evaluation • Structure governs function • Anatomy is the structure • Biomechanics/physiology are the function

4. Evaluation Purpose • Develop database to establish Patient’s level of function • Plan a treatment program and establish outcomes • Evaluate results of treatment program • Modify treatment program

5. Clinical Evaluation Sequence • History • Inspection • Palpation • Functional Testing • A/P/ROM • Ligamentous Testing • Special Tests • Neurological Testing

6. History • Most important portion of exam • Any special test should confirm what is learned in the history • Key questions(identify forces on the body) • Acute Injury= What is the mechanism • Chronic Injury= Are there changes in treatment routines/equipment/posture

7. History • Mechanism • How did injury occur • Macrotrauma (single traumatic force) • Microtrauma (accumulation of repeated forces) • Relevant Sounds or sensations • Pop • “Giving Way”

8. Location of symptoms • Localized • Referred(pain from another source) • Isolated vs. diffuse • Onset and duration of symptoms • Immediate pain v. chronic • Classification for overuse injuries • Stage 1 • Pain after activity • Stage 2 • Pain during/after activity • Stage 3 • Constant pain

9. Description of symptoms • Sharp/dull/achy • Intermittent v. constant • Weakness • Paresthesia (numbness/tingling) • Dysfunction/ inability to perform activity • Change in symptoms • Intensity change with specific motions, postures, treatment, modalities, medications

10. Previous history • Previous injury • When did previous episode occur • Who evaluated and treated injury • Diagnosis • Course of treatment/rehab/surgery performed • Did previous treatment plan decrease symptoms • Related history to opposite body part • Previous history of injury to uninvolved side • General health status • congenital abnormality/disease

11. Inspection • Gait • Gross Deformity fracture/discoloration/serious bleeding • Swelling (localized v. diffuse) • Bilateral Symmetry • Discoloration • Keloids (surgical scars) • Infection • Redness/warmth/pus/swelling/red streaks/lymph nodes

12. Girth Measurements • Swelling • Identify joint line using bony landmarks • Atrophy • Make incremental marks (2,4,6 inch) from jt. line • Lay tape symmetrically around body • Take 3 measurement and record average • Repeat and record for uninjured limb

13. Palpation • Detect tissue damage • Bones (rule out fracture) • Ligaments/tendons • Soft tissue • Pulses

14. Point tenderness • Visualize structure which lie beneath fingers • Compare bilaterally • Trigger Points • Palpated points in muscle which refer pain to another body area

15. Change in tissue density (or feel of tissue) may indicate: • Muscle spasm • Hemorrhage • Edema • Scarring • Myositis ossificans

16. Crepitus- repeated crackling sensations or sound emanating from the joint or tissue • Symmetry • Compare muscle tone, bony prominence • Increased tissue temperature • Indicates active inflammatory process

17. Range of Motion (ROM) • Helps to assess functional status • Compare bilaterally • Test joints proximal and distal to injured area

18. Functional TestingAROM Contraindications: immature fracture sites newly repaired Cardinal Planes (test all planes of ROM) Painful ARC compression within range

19. Functional TestingPROM • Quantity of available movement • “End feel” reach limit of available ROM • Most accurate method is with goniometry measurements

20. Normal End FeelPhysiological Hard Bone contacting bone elbow extension Soft Soft tissue approximation elbow flexion Firm Capsule stretch(ext of MCP jt) Ligament Stretch (forearm supination) Muscle Stretch (hip flexion with knee extended)

21. Abnormal End FeelPathological Soft Soft tissue edema synovitis Firm Capsular,muscular, ligamentous shortening Hard osteoarthritis Fracture Empty Bursitis, Joint inflammation

22. Functional TestingRROM • Two types of testing • Manual muscle testing • Break test • Contraindications for RROM • Patient is unable to voluntarily contract injured muscle • Patient is unable to perform AROM • Underlying fracture site is not healed • Involved tissues are not yet healed

23. Manual Resistance • Stabilize limb proximally • Resistance provided distally on bone to which muscle attaches • Watch for compensation

24. Grading system for Manual Muscle Testing • 0/5 Zero No contraction • 1/5 Trace Palpable contraction No muscle movement • 2/5 Poor Able to move body part through gravity eliminated • 3/5 Fair Move against gravity throughout ROM • 4/5 Good Moderate resistance • 5/5 Normal Maximal resistance

25. Clinical Significance • Strength Pain Finding • Good None Normal • Good Present Minor soft tissue injury • Weak Present Major injury • Weak None Neurological or Rupture or Chronic

26. Ligamentous and Capsular Testing Ligamentous testing compare bilaterally compare with baseline measures correct positioning (if incorrect positioning may lead to false results)

27. Special Tests • Specific procedures applied to joint to determine presence of injury • Unique to each structure • Bilateral comparison

28. Neurological (Referred Pain) • Involves Upper/lower quarter screen of: • Sensory (dermatome) • Motor (myotome) • DTR (Deep Tendon Reflex)

29. Sensory Testing • Bilateral • Dermatone • Area of skin innervated by a single nerve root • Slight stroke over area/pin prick • Sharp v. dull • Hot v. cold Motor Testing Manuel Muscle Testing