EVALUATIONS - Wellesley College



EVALUATIONS

SUBJECTIVE QUESTIONING (HISTORY)

Chief complaint?

Date of injury/When did it happen? (acute vs. chronic)

Previous history of injury?

Mechanism of injury/How did injury happen?

Did athlete hear or feel anything?

- “snap” and/or “crack” fracture and/or dislocation

- “pop” muscle/ligament injury

- clicking and/or catching loose bodies

- grating and/or crepitus degeneration/osteoarthritic changes

Deformity present? Did it reduce spontaneously or with help?

Immediate or delayed disability or swelling?

- localized swelling = superficial structures; bursitis, contusion, strain, sprain

- diffuse swelling = severe hematoma; dislocation, fracture

- intramuscular swelling = swelling within a muscle

- intermuscular swelling = swelling between muscles

- immediate swelling = under 2 hrs; severe injury; damage to structure with rich blood supply

- delayed swelling = 6-24 hrs; synovial irritation; capsular/ligament sprain

- delayed swelling = post-activity only; bursitis, chronic synovial irritation

What type of pain is it?

- cramping, dull, aching muscle

- sharp, shooting nerve root

- deep, nagging, dull, localized bone

- sharp, bright, burning nerve

- throbbing, diffuse, aching, poorly localized vasculature

- pain/stiffness improves with activity chronic inflammation

- morning pain acute injury

- pain that escalates as day progresses aggravating injury

- night pain pathologic problem

- constant pain

- pain only with repeating mechanism of injury

- immediate pain

- pain of gradual onset overuse syndrome

What does the condition currently feel like?

Any numbness and/or tingling?

When and where does it hurt? (show with 1 finger)

What is the level of pain? (0-10 scale)

Does the pain radiate? If so, where?

What makes it feel better or worse?

Are you taking any medications? Any allergies to medications?

What was functional status prior to injury? Dominant hand/leg?

PHYSICAL OBSERVATION (INSPECTION)

Athlete’s gait/movement patterns

Athlete’s posture

How athlete is carrying injured body part

Bilateral joint/body contour symmetry

Obvious deformity – malalignment, fracture/dislocation

Muscle atrophy

Swelling

Skin color/texture

Open wounds/external bleeding

Scars

Athlete’s facial expressions

Athlete’s ability and willingness to use the injured body part

PALPATION (PERFORM BILATERALLY)

Perform in a specific sequence – beginning away from pain site

Perform bony and soft tissue palpation

Note – point tenderness, crepitus, symmetry, tissue temperature

When palpating, note:

Differences in tissue tension and texture

Differences in tissue thickness

Abnormalities/deformities

Tenderness

Temperature variations

Abnormal sensation

Swelling/inflammation

Range of Motion (active, active-assisted, passive) – PERFORM BILATERALLY

Active first unless contraindicated by fractures or recently repaired tissue Observe movement patterns, facial expressions, painful arcs

Manual Muscle Testing (PERFORM BILATERALLY)

Isometric resistive muscle testing (break test)

Resisted full range of motion testing

Special Tests (PERFORM BILATERALLY)

- Stress tests: evaluates the structural integrity of ligaments and joint capsules; determines the amount of laxity in a specific ligament and/or the amount of instability in a specific joint

- Special tests: specific procedures applied to a body part to determine the amount of damage done

Neurological tests (dermatomes, myotomes, reflexes) PERFORM BILATERALLY

- Dermatome (sensation) – area of skin innervated by a single nerve root

- Myotome (motor) – group of muscles supplied by a specific nerve root

- Deep tendon reflex – involuntary muscle contraction initiated by the stretching of receptors within a tendon

ANKLE/LOWER LEG

PALPATIONS

_medial malleolus

_deltoid ligament

_navicular

_calcaneous

_1-5 metatarsals

_styloid process 5th metatarsal

_lateral malleolus

_ATF, CF, PTF ligaments

_tibialis anterior

_extensor digitorum

_extensor hallucis longus

_Achilles tendon

_tibialis posterior

_flexor digitorum

_flexor hallucis longus

_gastroc/soleus

_shaft of tibia

_shaft of fibula

_peroneal

LIGAMENT/SPECIAL TESTS

_Anterior Drawer _Heel Tap

_Talar tilt _Compression

_Kleiger’s _Metatarsal Glides

_Navicular Drop _AROM/PROM (PF,DF,IN,EV)

_Tuning fork _MMT

KNEE/THIGH

PALPATIONS

_patella _quadriceps tendon

_tibial tubercle _Biceps Femoris tendon

_medial joint line _Semimembranosis/Semitendinosis

_lateral joint line _IT band

_adductor tubercle _pes anserine insertion

_lateral epicondyle _medial collateral ligament

_medial epicondyle _lateral collateral ligament

_head of the fibula _patella tendon

LIGAMENT/SPECIAL TESTS

_AROM/PROM

_Patella tracking

_Isometric resistive muscle testing

_Valgus 0º /30º

_Varus 0º /30º

_Lachman test

_Anterior Drawer test (neutral, internal, external rotation)

_Posterior Sag test (Gravity Drawer test)

_Patellar grind test

_Patellar apprehension test for subluxation

_MMT

_Apley’s compression/distraction

SHOULDER/UPPER TRUNK EVALUATION

PALPATION

_sternoclavicular joint _biceps brachii long head

_clavicle _biceps brachii

_acromioclavicular joint _deltoid

_coracoid process _trapezius

_acromion _triceps brachii

_head of the humerus _rhomboid

_bicipital groove _latissimus dorsi

_spine of the scapula _serratus anterior

_vertebral border of the scapula _axilla

_axillary border of the scapula _supraspinatus

_sternoclavicular (SC) joint _sternocleidomastoid

_acromioclavicular (AC) joint _pectoralis major

_coracoacromial ligament _glenohumeral ligaments

SPECIAL TESTS

_AROM/PROM

_MMT

_sulcus sign

_biceps long head (speed’s test)

_impingement (Hawkins, neers)

_bicipital tendonitis and subluxation test

_empty can test (supraspinatus)

_check movement of clavicle

_apprehension test

BACK INJURY

PALPATION

_spinous processes _iliac crest

_transverse processes _erector spinae

_L4, L5 _latissimus dorsi

_PSIS standing _int./ext. oblique

_PSIS seated _rhomboid

_ASIS _iliopsoas

_piriformis _sacral base

SPECIAL TESTS

_Leseque's sign (SLR)

_Bowstring Test (sciatic nerve irritation)

_Straight Leg Test (sciatic nerve irritation)

_Slump test

_Figure 4 Test (FABERs)

_SI joint testing (forward flexion, gillette’s, supine to long sit)

_reflexes

achilles, patella tendon, biceps, brachioradialis, triceps

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