Injury Assessment & Evaluation
Today’s topics...Today’s topics...
Principles of range of motion testing, Principles of range of motion testing, neurological testing, and special testsneurological testing, and special tests
Functional testingFunctional testing
Range of Motion AssessmentRange of Motion Assessment
Categories & progressionCategories & progression
1. AROM1. AROM
2. PROM2. PROM
3. RROM3. RROM
AROMAROM
Voluntary movement through muscle Voluntary movement through muscle contractioncontraction
Establishes willingness and ability to moveEstablishes willingness and ability to move Helps determine damage to contractile Helps determine damage to contractile
tissuetissue
AROMAROM
Assess Assess allall movements of joint movements of joint Check for bilateral equalityCheck for bilateral equality Assess fluidity & extent of movementAssess fluidity & extent of movement Palpate joint throughout movementPalpate joint throughout movement
AROMAROM
Causes of limited movementCauses of limited movement
1. Pain1. Pain** 5. Joint contractures5. Joint contractures
2. Swelling2. Swelling 6. Nerve damage6. Nerve damage
3. Muscle spasm3. Muscle spasm 7. Loose bodies7. Loose bodies
4. Muscle tightness4. Muscle tightness
**Where in the motion does it hurt?Where in the motion does it hurt?
““Painful arc”Painful arc”
PROMPROM
Movement of the part w/o assistance from Movement of the part w/o assistance from the injured individualthe injured individual
Distinguishes injury to contractile tissues Distinguishes injury to contractile tissues from non-contractile tissuesfrom non-contractile tissues
Position person lying down to relax Position person lying down to relax musclesmuscles
Perform painful movements lastPerform painful movements last Note Note end feelend feel
RROMRROM
Assess muscle strength after injuryAssess muscle strength after injury Detect injury to nervous systemDetect injury to nervous system Examples of results & implications:Examples of results & implications:
1. Muscle weakness & pain--> strain1. Muscle weakness & pain--> strain
2. Muscle weakness & pain -> nn damage2. Muscle weakness & pain -> nn damage Static & dynamic testing (pressure vs resistance)Static & dynamic testing (pressure vs resistance) Grading systemGrading system
Movement terminologyMovement terminology
Internal/external rotationInternal/external rotation Aka medial/lateralAka medial/lateral
Movement Movement terminologyterminology
Plantar flexion/dorsiflexionPlantar flexion/dorsiflexion
Inversion/eversionInversion/eversion
Radial/ulnar deviationRadial/ulnar deviation
Movement terminologyMovement terminology
Horizontal ABDuction/ADDuctionHorizontal ABDuction/ADDuction
Lateral flexionLateral flexion
L/R rotationL/R rotation
Neurological testingNeurological testing
EvaluateEvaluate SensationSensation Motor functionMotor function Deep tendon reflexesDeep tendon reflexes
IdentifyIdentify Nerve root impingementNerve root impingement Peripheral nerve damagePeripheral nerve damage CNS traumaCNS trauma DiseaseDisease
Neurological testingNeurological testing
Indicated byIndicated by NumbnessNumbness ParesthesiaParesthesia Muscular weaknessMuscular weakness Pain of unexplained originPain of unexplained origin Injury to cervical or lumbar spineInjury to cervical or lumbar spine
Neurological testingNeurological testing
Spinal nerve roots & segmental Spinal nerve roots & segmental nervesnerves
Roots supply area of skin & Roots supply area of skin & series of musclesseries of muscles
1. Dermatome1. Dermatome
2. Myotome2. Myotome
Neurological testingNeurological testing
Assessment of dermatomes & myotomesAssessment of dermatomes & myotomes Reflex testingReflex testing
1. Changes -->degeneration OR 1. Changes -->degeneration OR injury injury in specific regions of nervous in specific regions of nervous systemsystem
2. DTR’s tend to be absent if 2. DTR’s tend to be absent if specific specific nerve root damagenerve root damage
Joint stability testsJoint stability tests
Assess integrity of ligamentous & capsular Assess integrity of ligamentous & capsular tissuestissues
Tests apply tension to specific ligamentsTests apply tension to specific ligaments ALWAYSALWAYS include tests for major ligament include tests for major ligament
damage & fxs in “On-field” evaluationsdamage & fxs in “On-field” evaluations
Laxity vs instabilityLaxity vs instability
Laxity — clinical sign of the amount of Laxity — clinical sign of the amount of “give” within a joint; identified by stress “give” within a joint; identified by stress testingtesting
Instability — joint’s inability to function Instability — joint’s inability to function under the stresses of function activityunder the stresses of function activity
Special testsSpecial tests
Specific procedures applied to a joint Specific procedures applied to a joint to determine presence of a to determine presence of a particular particular pathological conditionpathological condition
Unique to each structureUnique to each structure Results are comparedResults are compared
Side to sideSide to side Cause provocationCause provocation Cause alleviationCause alleviation
Reported as positive (+) or negative (-)Reported as positive (+) or negative (-)
Functional TestingFunctional Testing
Tests of motor coordination, Tests of motor coordination, proprioception, & sport specific skillproprioception, & sport specific skill
Tests are sport specific--> performed Tests are sport specific--> performed during sport participationduring sport participation