Exam 1: Injury Evaluation/Lab Exam/SOAP Flashcards
What are the Objective tests in SOAP?
- Physical Inspection/Observation
- Palpation: bones, muscles/tendons, ligaments
- AROM & PROM (Active/Passive)
- Goniometric Measurement
- Sensory (light touch) test
- Reflex (DTR) test
- Girth measurement
- Manual Muscle Tests
- Stress Tests
What is SOAP?
In Western medicine... Subjective questioning Objective Tests Assessment Plan
2 parts of Assessment section of evaluation
- Short term goals
- long term goals
Plan section of evaluation
- first aid principles
- rehabilitation program
- functional test for return to activity
What are the 8 Personal Evaluation Skills?
- know the athlete
- know the sport
- be alert-watch the game
- remain calm
- comprehensive evaluation
- use good judgement
- don’t jump to conclusions
- know when to refer
5 Principles of On-Field Injury Evaluation
- determine what is wrong
- determine the seriousness of the injury
- determine the type of first aid and immobilization
- determine if injury warrants immediate referral to Dr or hospital
- determine the manner of transport from injury site
6 Principles of Subjective Questioning
- allow athlete to describe what happened in own words
- listen attentively
- ask non-leading questions
- clarify information
- question witnesses
- remain calm and reassuring
8 Subjective questions
1) What’s wrong? Chief complaint?
2) When did the injury occur?
3) Have you ever injured this part before?
4) What was the mechanism of injury?
5) Did you hear or feel anything?
6) Was there immediate or delayed swelling and/or disability?
7) Rate your level of pain (0-10)
8) Does your pain radiate? Where?
Information gained from observation
- obvious deformity
- bleeding
- swelling
- skin appearance
- discoloration
- symmetry of body parts
- signs of trauma
- facial expression
- gait/functional ability
- observe how the athlete removes clothes
- observe how the athlete holds/supports the injured body part
6 Principles of Palpation
- understand underlying anatomy
- visualize anatomy
- encourage relaxation
- avoid causing unnecessary pain
- begin palpation away from suspected injury area
- compare contralateral areas
Information gained from palpation
- painful body structures
- deformity
- muscle spasm
- crepitation
- swelling
- sensory function
- skin temperature & moisture
- pulse rate
- respiratory rate
What is AROM/PROM?
Active Range of Motion - Injured move own body - can help gain info about where pain is
Passive Range of Motion - movement by another person
Primary parts of Goniometer
- Axis
- Compass (0-360)
- Stable arm
- Moving arm
Average articular ROM for ankle
- plantar flexion (0-50)
- Dorsiflexion (0-20)
- Inversion (0-35)
- Eversion (0-15)
Sensational Testing
1) superficial testing
- light touch
- sharp/dull pain
- temp
- 2 point discrimination
2) Deep Sensation
- proprioception
- pain
- vibration
Dermatone
Area of skin supplied with afferent nerve fibers from a single nerve root
myotone
group of muscles innervated from single spinal nerve root
scleratone
Bone innervated from a single nerve
Common Dermatones
C5 - Lateral Upper arm, Posterior midline to anterior midline
T2 - Medial upper arms, anterior across chest inferior to clavicle & posterior across back/scapulas
L4 - Medial lower leg, inferior to knee down to heel but not the base of the foot
S1 - plantar surface of foot, excluding medial metatarsals, including dorsal surface of foot and lateral metatarsals
Reflexes
- superficial
- deep tendon reflexes
- visceral reflexes
- pathological reflexes
Superficial reflexes
- mucous membrane reflexes: pharyngeal-gag
- skin reflexes: cremasteric reflex
Deep tendon reflexes
Biceps brachii - C5 Brachioradialis - C6 Triceps brachii - C7 Patellar Ligament (tendon) - L4 Gastrocnemius - S1
Visceral reflexes
pupillary
pathological reflexes
Babinski
Reflex grading system
- Normal
- Increased - UMNL - brain or spinal injury
- decreased
- Absent
- decreased/absent - LMNL - lower motor lesion
Deep Tendon Reflex Pathway ***
-
IMPORTANT*
1) Nerve receptor
2) Afferent (sensory) nerve
3) spinal cord
4) Efferent (motor) nerve
5) muscle
6) response
Girth measurement Key Concepts
- accuracy
- consistency
- measurements from fixed landmarks
MMT grading scale
5 - full ROM, against gravity, max resistance at end of range
4 - full ROM, against gravity, light to heavy resistance at end of range
3 - 50-100% ROM against gravity & all from 2
2 - Partial to full ROM without gravity or less than 50% ROM against gravity
1 - Evidence of contraction from palpation but no joint motion
0 - no muscle contraction
Principles of stress testing
1) explain what you’re doing
2. get them to calm down
3. get them to relax
4. try not to cause pain - test injured part last
5. based on subjective questions, test injured side last
6. begin slow and gentle
7. test injured side first if apprehensive
Info gamed from stress testing
- laxity - instability
- pain
- crepitation
