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Kin 2236 Athletic Injuries > (2) Lecture 7: Soft Tissue Assessment > Flashcards

(2) Lecture 7: Soft Tissue Assessment Flashcards

1
Q

Types of assessments

A

Field assessment
Sideline/clinical assessment

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2
Q

Field assessment

A

CONCISE assessment to get a GENERAL idea of how bad injuries are and how we’re going to remove it

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3
Q

Sideline assessment

A

a.k.a. clinical assessment

more IN-DEPTH, ROUTINE protocol

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4
Q

SOAP

A

Subjective (history)
Objective
Analysis/Assessment `S(working diagnosis)
Plan/Program

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5
Q

S of SOAP

A

Subjective - HISTORY

single MOST IMPORTANT aspect of eval

includes statements provided by the PATIENT regarding their symptoms

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6
Q

Why is the Subjective Assessment done?

A

The medical history (subjective assessment) is often more valuable than a physical exam

Interviewing must be done properly

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7
Q

How is the Subjective Assessment done?

A
  • ask OPEN-ENDED questions
  • ACTIVE listening (eye contact, non-verbal cues)
  • used to develop a strategy for further examination
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8
Q

Symptom

A

what the PATIENT tells you about

organic manifestation which only PATIENT is aware of

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9
Q

Questions to ask during history

A
  • what happened? MOI
  • when did it happen?
  • were you able to continue?
  • swelling? yes/no; fast/slow
  • describe pain (dull, sharp, shooting, numbness, tingling)
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10
Q

Speed of swelling

A

Fast (<4hrs): hemarthrosis
Slow (4-8 hrs): capsular swelling
- extracapular

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11
Q

Sign

A

OBJECTIVE

OBSERVABLE physical phenomenon indicative of a condition’s presence

  • bleeding, bruising, ROM, strength, reflexes, pain on palpation, etc
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12
Q

Order of Assessment

A
  1. Subjective
  2. Observation/visual inspection
  3. AROM
  4. PROM
  5. Resisted ROM
  6. Neuro/Sensation Reflex
  7. Special tests
  8. Palpation

2-8: OBJECTIVE information

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13
Q

What is included in Selective Tissue Tension Testing?

A

Includes
- AROM
- PROM
- Resisted movements

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14
Q

Observation/Visual Inspection

A
  • 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)
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15
Q

Theory of Selective Tissue Tension

A

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

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16
Q

Contractile tissues

A

Increases tension when tissue is BOTH contracted or stretched

active motion in one direction + passive motion in the opposite

  • muscles
  • tendons
  • tenoperiosteal insertion
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17
Q

Inert tissues

A

Increase in tension only when STRETCHED

will cause pain in ONE direction only

  • ligaments
  • bursa
  • capsules
  • fascia
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18
Q

Cyriax’s Theory

A

Theory of Selective Tissue Tension

When tension is applied to an injured tissue, it will give rise to pain

19
Q

Tension in the bicep

A
  • contraction = lifting something up
  • stretch = straightening arm out
20
Q

Active Range of Motion

A
  • 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

21
Q

What does AROM tell us?

A
  • where they are sore
  • willingness to move
  • quality of movement
  • amount of available ROM

Clues on how to HANDLE them

22
Q

Passive ROM

A
  • 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)
23
Q

Whar does PROM tell us?

A
  • used to detect lesions in INERT tissues
  • helps us assess END FEEL
24
Q

Normal End Feel

A
  • soft tissue approximation
  • bony or bone to bone
  • capsular
25
Q

Soft tissue approximation end feel

A

soft, spongy gradual painless stop when two muscle bellies meet

Ex. elbow/knee flexion

26
Q

Bony or bone to bone end feel

A
  • distinct ABRUPT endpoint/unyielding
  • painless (abnormal if painful)
  • like 2 pieces of wood being put together

Ex. elbow extension

27
Q

Capsular end feel

A
  • abrupt firm endpoint w/ LITTLE GIVE
  • LEATHERY feeling

Ex. hip rotation

28
Q

Abnormal end feel

A
  • springy block
  • spasm/stretch
  • abnormal capsular
  • empty
29
Q

Springy block end feel

A
  • INTERNAL issue of the jt.
  • rebound at end/some point thru ROM
  • bouncy like compressing a spring

Ex. common w/ meniscal injury

30
Q

Spasm/stretch end feel

A
  • involuntary contraction that prevents motion secondary to pain (guarding)
  • more of a rubbery feel prior to expected end of range

Ex. hamstrings

31
Q

Abnormal capsular end feel

A

occurs prior to expected end of range

Ex. knee extension

32
Q

Empty end feel

A

did NOT reach the end feel
- when considerable pain is produced by the movement
- no mechanical resistance
- significant soft tissue injury, bursitis

33
Q

What do we need for resisted testing?

A
  • contraction of ONLY target tissue
  • isometric contraction (no stretch)
  • NO stretch on antagonist
  • NO movement thru jt or stretch on surrounding inert tissues
34
Q

What does resisted testing tell us?

A
  • will tell us about pain in a contractile tissue
  • will give us an indication of how the nerve is working
35
Q

Interpreting resisted movements

A

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

36
Q

Neurological Testing

A
  • reflexes
  • sensation
  • key muscles
37
Q

Reflexes

A

C5-6: Biceps/Brachioradialis
C7-8: Triceps
L3: Knee jerk
S1: Achilles

38
Q

Myotomes

A
  • MUSCLE receiving the greater part of its innervation from a single spinal nerve
  • isometric contraction held for at least 5 seconds
39
Q

Dermatomes

A

sensation

CUTANEOUS AREA receiving the greater part of its innervation from a single spinal nerve

40
Q

Special Tests

A

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

41
Q

Analysis/Assessment

A
  • 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
42
Q

Grading Strains

A

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

43
Q

Grading Sprains

A

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

44
Q

Review Injury Chart

A

Kin 2236 Athletic Injuries (20 decks)

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