Lecture 2 Flashcards
Basic Steps of Assessment
History Observations Rule Outs -looking at the joints above and below Functional Tests -to determine what type of tissue is injured Special Tests Palpations
General Assessment Guidelines
Bilateral observation & functional assessment
Try to gain an understanding of MOI
- Compare ranges of motion, end feels and muscular strength
- Try to arrange your testing so the most painful test is done last
Functional and special testing is influenced by the history, observations and rule outs that you perform
Assessment: Introduction
Be professional
- Start observations of patient from the moment that they walk in
- Patient should be at eye level
- Develop a rapport with the patient
Wow factor! -First impressions
What is included in Personal History questions?
Name
Age
Address
Phone(home, work, cell)
Family physician
Referral contact
Occupation
General Assessment Guidelines - why do you start with unaffected side first?
Begin with the unaffected side first -If you start with injured site you are increasing their pain etc. right off the bat, start off with unaffected side to ease the patient into what you are doing and save the pain to the end
General Assessment Guidelines -why do the painful tests last?
Why? -You want to rule out via other tests first and save the painful ones that you suspect for last
General Assessment Guidelines -Why 3 IOS?
-Athlete may have given you partial info and you may be treating based upon that -May be awaiting imaging to confirm/rule out IOS
Why should you Always support the injured limb securely
-Gain confidence -Patient comfort -Prevent secondary complications
When taking a medical history and asking the question How can I help you? How must it be phrased and what key elements are you looking for?
Must be an open ended question.
Listen to their major concerns
May be several pathologies present
May relate to ADL’s
Listen to degree of concern
Injury History: MOI questions
Amount of force
Description of force
Other:
Date of injury
Sport
Level of Sport
Training schedule
Position
Warm-up
Injury History: Pain - Timing of pain questions
Was it immediate
More painful later
Beginning, middle or end of workout
Injury History: Pain - Description of pain questions
Sharp/dull
Referred
Spasmotic
Aching
Throbbing
Burning
Injury History: Pain - Location of pain questions
Superficial
Deep
Local
Diffuse
Vague
Injury History: Pain - Degree of pain questions
Grade 1-10
Injury History: Pain - when is it painful?
All the time
Serious or inflamed
With movement
Musculoskeletal
At rest
Visceral, inflamed
Night
Infection,
systemic disorder,
cancer,
bursal
On waking
Poor support at night
Injury History: Pain - quality of pain
Shooting = neural
Tingling = neural or circulatory
Heavy = circulatory
Twinges = pinching, mechanical
Shifting = meniscus or disc
Burning = neural
Dull ache = deep lesion, neural, visceral
Cramping = muscle spasm
Throbbing = vascular, inflammatory
Injury History: how quickly did it swell?
immediate
6-24 hours
next day
Injury History: swelling questions
Amount of Swelling
Initially & now
When does it swell?
Is it reoccurring?
Type of Swelling
Synovial Hemarthrosis
Pitting Edema
Temperature of swelling -Inflamed -Infection -Arthritic
Injury History: function at the time of injury
WB,
PWB,
NWB
Could continue playing
Immediate movement loss
injury history: function now
ADLs
Weakness with or without pain
Giving way or locking of the joint
Aggravating/Relieving Factors
how does establishing aggravating and relieving factors help rehab?
Help you design rehabilitation
Helps to control signs and symptoms
Use for home program and education
injury history: instability questions
Immediately? Giving way? Chronic?
injury history: sensation questions
Snap
Crack
Pop
Tear
Click
Grating
Catching
Warmth/Cold
Numbness, paresthesia
injury history: particular questions
Previous injury
Previous rehab? -What worked, what didn’t work?
Recovery period?
X-ray, MRI, CAT Scan, Bone Scan -Result!
MD or other allied health personnel
Medications
History taking general health problem questions
Fallen on buttocks or tailbone
Previous sprains, strains or fractures
Previous head injuries
Headaches
Digestion
Food sensitivities
Bowel and Bladder problems
Respiratory problems
Pneumonia, bronchitis, asthma
Immune System
Nutrition
Heart problems
BP, cholesterol, arrhythmias
Medications
Fitness level
Major dental work
At the completion of history taking the athletic therapist should know…
3 IOS for the pathology
The structure or structures implicated
The stage of healing
The cause(s) of the condition
Degree of pain
The general nature of the patient - Introverted, extroverted, uncomfortable
The function of the injured site
The immediate care and rehab done to date
The general health and welfare of the patient
