clinical assessment Flashcards
signs vs symptoms
signs = objective physical findings i.e. sight, ROM, heat, smell
symptoms: subjective feeling/perception i.e. pain, paresthesia, numbness, pressure
clinical assessment
determine needs of rehab, ult aim is to return to ADLs and competition
- athlete’s goals
- therapist’s goals
- short term = protect injury, dec sequelae and pain
- long term = power, ROM
LT goals broken down w rehab
what are the components of clinical assessment
HOPS
functional assessment
rule outs/special tests
suspected condition
HOPS
history = subjective
observations = objective
SOAP
subjective, objective, assessment, plan
charting method, leally required from healthcare practitioners
history
ask non-leading, OPEN ENDED questions…allows athlete to tell their own perspective
by end, should know:
- primary complaint
- acute/chronic
- functional ability
- prev injuries
- medications, med history
- MOI
- areas and nature of pain
- symptoms
- aggro/allev
index of suspcision
at least 3 potential conditions…if not, dive deeper into history
use to rule in/out conditions
PQRST
provocative/palliative: what makes better/worse
quality: nature of pain, descriptions i.e. aching
region/radiating/referred: location of pain, if it travels
- referred pain occurs outside origin i.e. heart attack –> arm
scale/severity
timing: onset, posture, etc.
observation
begins the moment the athlete is seen i.e. gait, posture, lesion
rule outs…functional mvmnts of proximal and distal joints
types of functional testing
AROM: active, athlete voluntarily moves limb
- always comes first, allows to see willingness, pain, ROM
- quality (same of both sides) and quantity (degrees) of pain-free mvmnt
PROM: passive, therapist moves limb thru full range…allows to test INERT tissue
- comes last if suspect lig injury
- comes second if suspect musc/tendon
- athlete in relaxed state, supported injured area
- assessing endfeels
resisted testing: isometric contraction for at least 5secs, goal to determine strength, pain, ROM
- 2nd is suspect inert tissue
- last if suspect musc/tendon
- athlete should meet resistance
- 0-5 scale: 0 = unwilling/cannot, 5 = full ROM
end feels
assessed w PROM
normal end feels
- soft: musc to musc
- hard: bone to bone
- firm: tissue stretch i.e. supination/pronation
abnormal end feels
- musc spasm i.e. tightening prevents extension
- bony block: early hard end feel
- empty: no end feel i.e. ACL lachman’s test
- capsular: soft end feel too early
special tests
test the integrity and involvement of certain structures
conducted once have index of suspicion and differential diagnosis
palpations
start away from injury site
IDs pt tenderness, swelling, TEMP CHANGES, crepitus, deformity, circulation
feedback on cutaneous sensation….dermatomes
- no feeling = nerve
myotomes
cervical nerve suppling a GROUP of muscles
c4 = scapular elevation
c5 = shoulder abduction
c6 = elbow flex or wrist extend
c7 = elbow extend or wrist flex
c8 = thumb extension and ulnar devi
t1 = ab/adduction of hand intrinsics
test 5x for 5sec each…test for fatigue i.e. cannot contract by 5th time
brachial plexus
innervates the arm
branches can be tested via dermatomes, myotomes, reflexes
dermatome
patch of SKIN supplied by cervical nerve
sharp/dull, hot/cold, general sensation
perform directly to skin
reflexes
cervical nerve supplying a TENDON
biceps c5-c6: thumb on biceps tendon, use hammer on thumb (force travels)
brachioradialis c5-c6: thick end of hammer, see if hand jerks up
triceps c7: extend shoulder and bend elbow, arm jolts
