Injury Assessment

1. Injury Assessment

2. Injury Assessment • The comprehensive evaluation of an orthopedic injury beginning when the injury occurs and continues through the healing process until the injured area has been rehab. back to full functionability.

3. Orthopedic injury assessment process • Anatomy • Athletic Injuries • Evaluation Tech • Information Signs and Symptoms • Symptoms: Subjective • Signs: Objective • Diagnostic Procedures

4. Laboratory Evaluation • The evaluator needs to be familiar with these evaluation tools • Radiology/Stress Radiology • Tomography/Enhanced Radiography: • Arthrography • Angiograph • Arthroscopy • Magnetic Resonance Imaging (MRI) • Bone Scan

5. Musculoskeletal Assessment • Patient History • Observation • Examination of movement • Reflexes and cutaneous distribution • Joint play movements • Palpation • Diagnostic Imaging

6. Patient History • Type or quality of pain • Type of sensation • Joint involvement • Bladder function • Circulatory problems • Psychological stress • Chronic or serious systemic illness • Family history • X-ray or imaging tech. Performed • Medications • History of surgery • Demographic information • Chief complaint • Occupation • Mechanism of injury • Location of pain • Date of onset • Exact movement causing pain • Duration & frequency of symptoms • Past history • Present status • Is pain associated with rest

7. Observation • Body mechanics • Gait • Postural alignment • Obvious deformities • Bony contours • Soft tissue contours • Limb position equal & symmetrical • Color & texture of the skin normal • Scars from recent surgery or injury • Crepitus • Inflammatory conditions • Psychological state • Overall willingness to move

8. Principles of examination • With passive movements and ligamentous testing, both the degree and quality of opening are important • With ligamentous testing, repeat with increasing stress • With myotome testing, contractions must be held for 5 seconds • Warn of possible exacerbations • Refer if necessary • Test normal (uninvolved) side first • AROM, PROM, RROM • Painful movements are done last • Apply pressure with care • Repeat or sustain movements if history indicates • Do resisted isometric movements in a resting position

9. Active Movement of Muscles/Joint • ALWAYS PERFORM ACTIVE MOTION FIRST • LOOK FOR: • Joint ROM • Control of Movement • Muscle Power • Patient’s willingness to perform movement

10. CONTRACTILE TISSUE • INCLUDES: • Muscles and their tendons • Muscles attachment at the bone insertion • Contractile tissue can be stretched or contracted when tension is place on them

11. Nervous Tissue • Includes: • Nerves & their sheaths • Can be stretched and pinched with tension placed on them

12. INERT TISSUE • INCLUDES ALL STRUCTURES NOT CONSIDERED CONTRACTILE OR NEUROLOGICAL : • JOINT CAPSULE • LIGAMENTS • BURSAE • BLOOD VESSELS • CARTILAGE • DURA MATER

13. Key components of Active Movement Assessment • When and where during each of the movements the onset of pain occurs • Whether the movement increases the intensity and quality of the pain • The reaction of the patient to pain • The amount of observable restriction • The pattern of movement • The movement of associated joints • The willingness of the patient to move the part • Any limitation and its nature

14. Factors to consider with passive movement • When and where during each of the movements the pain occurs • Whether the movement increases the intensity and quality of pain • The patterns of limitation of movement • The end feel of movement •   a characteristic sensation perceived by the examiner when the end of joint range of motion is reached. • The movement of associated joints • The range of motion available

15. Movement Assessment • Tissues are classified • Contractile = muscles & their tendons • Inert = Bones, ligaments, Jt. Capsules, fascia, bursae, nerve roots and dura mater. • If a lesion is present in contractile tissue pain will occur on AROM in one direction and PROM in opposite direction. • A lesion of inert tissue will elicit pain on AROM & PROM in the same direction

16. Patterns of contractile tissue • NO PAIN AND MOVEMENT IS STRONG • PAIN, AND MOVEMENT IS RELATIVELY STRONG • PAIN, AND MOVEMENT IS WEAK • NO PAIN, AND MOVEMENT IS WEAK - USUALLY SIGN OF RUPTURE TENDON

17. Patterns of inert tissue lesions • ROM is full and there is NO PAIN • PAIN & LIMITATION OF MOVEMENT IN EVERY DIRECTION • PAIN & LIMITATION OR EXCESSIVE MOVEMENT IN SOME DIRECTION BUT NOT IN OTHERS • LIMITED MOVEMENT THAT IS PAIN FREE

18. Resistive Isometric Movements(No Visible Movement of the joint) • 1. Strong voluntary muscle contraction • 2. Amount of pain or weakness is related to the degree of injury • 3. Keep the contraction static • 4. Always perform in neutral position or at rest • Encourage pt. to make maximum contraction

19. Key points when performing resisted isometric movement • Whether the contraction causes pain and, if it does, the pain’s intensity and quality • Strength of the contraction • Type of contraction causing problem (concentric, isometric, eccentric) • -Concentric: contraction of muscle resulting in approximation of attachments. • Isometric: Muscular contraction in which tension is developed but no mechanical work is done. • -Eccentric: the lengthening of the muscle while under the tension of resistance

21. Functional Assessment • This part of the exam helps the examiner to determine what is important to the pt. And the pt’s. expectations. IT IS A WHOLE BODY TASK PERFORMANCE ABILITY AS OPPOSED TO ISOLATED EXAMINATION OF A JOINT. • It relates to the effect the injury has on the pt’s life. Those activities that causes symptoms and restrict activities desired by the pt.

22. Functional Assessment • Discuss activities pertaining to Self Care Activities or ADL ( Activities of Daily Living) • Functional testing may be used to bring on symptoms the patient Has complained of or to determine how the patient is progressing or ready to return to activity

23. Special Test • Many different test are used to assess instability of certain joints, type of disease, condition or injury present to the specific body part. • Seldom lab test can be used to make a diagnosis. Usually takes several rule out test and several confirmation test to diagnosis, or differential diagnosis between structures.

24. Reflexes and Cutaneous Distribution • Examiner should test the: • Superficial reflexes • Deep tendon reflexes • Pathological reflexes • To obtain an indication of the state of the nerve or nerve root supplying the reflex.

26. Joint Play Movement • Loose Packed (resting ) Position • The articular surfaces are at their greatest laxity and passive separation of the joint surfaces being the greatest. • Close Pack Position • The two joints surfaces fit together precisely meaning they are fully congruent. • The joint surfaces are tightly compressed, the ligaments and capsule are maximally tight and the joint surfaces cannot be separated by distractive forces.

27. Key points to note when palpating • Differences in tissue tension and texture • Differences in tissue thickness • Abnormalities • Tenderness • Temperature variation • Pulses, tremors, and fasciculations • Pathological state of tissue • Dryness or excessive moisture • Abnormal sensation

28. Key points regarding swelling • Comes on soon after injury -------- Blood • Comes on after 8 to 24 hours ------ Synovial • Boggy, spongy feeling -------------- Synovial • Harder, tense feeling with warmth - Blood • Tough, dry ---------------------------- callus • Leathery thickening ----------------- chronic • Soft, fluctuating ---------------------- acute • Hard ------------------------------------ bone • Thick, slow-moving ------------------ pitting edema