(2) Lecture 7: Soft Tissue Assessment Flashcards
Types of assessments
Field assessment
Sideline/clinical assessment
Field assessment
CONCISE assessment to get a GENERAL idea of how bad injuries are and how we’re going to remove it
Sideline assessment
a.k.a. clinical assessment
more IN-DEPTH, ROUTINE protocol
SOAP
Subjective (history)
Objective
Analysis/Assessment `S(working diagnosis)
Plan/Program
S of SOAP
Subjective - HISTORY
single MOST IMPORTANT aspect of eval
includes statements provided by the PATIENT regarding their symptoms
Why is the Subjective Assessment done?
The medical history (subjective assessment) is often more valuable than a physical exam
Interviewing must be done properly
How is the Subjective Assessment done?
- ask OPEN-ENDED questions
- ACTIVE listening (eye contact, non-verbal cues)
- used to develop a strategy for further examination
Symptom
what the PATIENT tells you about
organic manifestation which only PATIENT is aware of
Questions to ask during history
- what happened? MOI
- when did it happen?
- were you able to continue?
- swelling? yes/no; fast/slow
- describe pain (dull, sharp, shooting, numbness, tingling)
Speed of swelling
Fast (<4hrs): hemarthrosis
Slow (4-8 hrs): capsular swelling
- extracapular
Sign
OBJECTIVE
OBSERVABLE physical phenomenon indicative of a condition’s presence
- bleeding, bruising, ROM, strength, reflexes, pain on palpation, etc
Order of Assessment
- Subjective
- Observation/visual inspection
- AROM
- PROM
- Resisted ROM
- Neuro/Sensation Reflex
- Special tests
- Palpation
2-8: OBJECTIVE information
What is included in Selective Tissue Tension Testing?
Includes
- AROM
- PROM
- Resisted movements
Observation/Visual Inspection
- assess their general demeanour (expression, tone of voice)
- posture (protective postures, guarding)
- obvious deformity/asymmetry
- signs of inflammation (swelling, redness, bruising)
- quality of movement (speed, quality - smooth, jerky)
Theory of Selective Tissue Tension
Dr. James Cyriax developed a method for LOCATING+ IDENTIFYING A LESION by applying tension selectively to each of the structures that might produce pain
Tissues are classified as either CONTRACTILE or INERT
Contractile tissues
Increases tension when tissue is BOTH contracted or stretched
active motion in one direction + passive motion in the opposite
- muscles
- tendons
- tenoperiosteal insertion
Inert tissues
Increase in tension only when STRETCHED
will cause pain in ONE direction only
- ligaments
- bursa
- capsules
- fascia
Cyriax’s Theory
Theory of Selective Tissue Tension
When tension is applied to an injured tissue, it will give rise to pain
Tension in the bicep
- contraction = lifting something up
- stretch = straightening arm out
Active Range of Motion
- movement assessment should begin w/ AROM
- active movements which cause pain do not differentiate btwn an inert/contractile lesion
causes contractile and inert tension to BOTH occur
does NOT give a lot of info about the injury
What does AROM tell us?
- where they are sore
- willingness to move
- quality of movement
- amount of available ROM
Clues on how to HANDLE them
Passive ROM
- patient must RELAX completely and allow therapist to move the extremity
- look for limitation + presence of pain
- pay attention to feel at END of ROM
(pain before end of range = inflammation or a red flag)
Whar does PROM tell us?
- used to detect lesions in INERT tissues
- helps us assess END FEEL
Normal End Feel
- soft tissue approximation
- bony or bone to bone
- capsular
Soft tissue approximation end feel
soft, spongy gradual painless stop when two muscle bellies meet
Ex. elbow/knee flexion
Bony or bone to bone end feel
- distinct ABRUPT endpoint/unyielding
- painless (abnormal if painful)
- like 2 pieces of wood being put together
Ex. elbow extension
Capsular end feel
- abrupt firm endpoint w/ LITTLE GIVE
- LEATHERY feeling
Ex. hip rotation
Abnormal end feel
- springy block
- spasm/stretch
- abnormal capsular
- empty
Springy block end feel
- INTERNAL issue of the jt.
- rebound at end/some point thru ROM
- bouncy like compressing a spring
Ex. common w/ meniscal injury
Spasm/stretch end feel
- involuntary contraction that prevents motion secondary to pain (guarding)
- more of a rubbery feel prior to expected end of range
Ex. hamstrings
Abnormal capsular end feel
occurs prior to expected end of range
Ex. knee extension
Empty end feel
did NOT reach the end feel
- when considerable pain is produced by the movement
- no mechanical resistance
- significant soft tissue injury, bursitis
What do we need for resisted testing?
- contraction of ONLY target tissue
- isometric contraction (no stretch)
- NO stretch on antagonist
- NO movement thru jt or stretch on surrounding inert tissues
What does resisted testing tell us?
- will tell us about pain in a contractile tissue
- will give us an indication of how the nerve is working
Interpreting resisted movements
Strong-painless: normal nerve, normal muscle
Strong-painful: normal nerve, minor muscle problem
Weak-painless: possible nerve lesion, old/complete muscle rupture
Weak-painful: possible nerve lesion, acute/significant muscle tear
Neurological Testing
- reflexes
- sensation
- key muscles
Reflexes
C5-6: Biceps/Brachioradialis
C7-8: Triceps
L3: Knee jerk
S1: Achilles
Myotomes
- MUSCLE receiving the greater part of its innervation from a single spinal nerve
- isometric contraction held for at least 5 seconds
Dermatomes
sensation
CUTANEOUS AREA receiving the greater part of its innervation from a single spinal nerve
Special Tests
help in differential diagnosis of the patient’s injury
indication of “HOW BAD IT IS”
includes manual muscle testing specific “special” muscle and ligament tests
Analysis/Assessment
- should have an idea of contractile, inert or both
- neuro, special tests and palpation should give a good idea of degree of injury
- from there, form a clinical opinion or diagnosis
Grading Strains
Grade 1
- 0-20% of torn fibres
- some pain
- strength: 4/5 (Oxford Scale)
- near full ROM
Grade 2
- 20-80% of torn fibres
- significant pain
- strength: 2/3 (Oxford Scale)
- significant decrease in ROM w/ pain near end
Grade 3:
- 80-100% of torn fibres
- variable to no pain
- strength: 0/1 (Oxford Scale)
- PROM only may have little pain on stretch
Grading Sprains
Grade 1
- 0-50% of fibres torn
- some pain
- no laxity
- firm endpoint
Grade 2
- 50-80% of fibres torn
- significant pain
- laxity
- firm endpoint
Grade 3
- 80-100% of fibres torn
- variable to no pain
- gross laxity
- no endpoint
Review Injury Chart
