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

Flexion/extensionFlexion/extension

Movement terminologyMovement terminology

ABDuction/ADDuctionABDuction/ADDuction

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

Manual muscle testingManual muscle testing

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

Ligamentous Stress testsLigamentous Stress tests

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 (-)

Special testsSpecial tests

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

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