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athletic injuries 2036 > Lecture 7: Soft tissue assessment > Flashcards

Lecture 7: Soft tissue assessment Flashcards

1
Q

what are the two types of assessments?

A
  1. on field assessment
  2. sideline/ clinical assessment
  • you must understand both of them and why we are doing it
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2
Q

on field assessment

A
  • concise assessment used to get general idea of how bad it is and how we are going to remove them. (pretty much to see how bad the injury is)
  • usually takes 2 minutes
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3
Q

sideline/clinical assessment

A
  • more of a in-depth, routine protocol
  • usually takes about 20 minutes
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4
Q

SOAP notes

A

Subjective
objective
analysis/assessment
plan/program

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5
Q

subjective (SOAP)

A
  • single most important aspect of the evaluation
  • includes statements provided by the patient regarding their symptoms
  • from this history, you develop your assessment plan/strategy
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6
Q

subjective assessment why?

A

why:
- interviewing is the “art” in contrast to the “science” of medicine
- most clinicians rate the medical history as having greater diagnostic value than the physical exam or results of lab investigation

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7
Q

subjective assessment how?

A
  • used to develop a strategy for further examination
  • asking open ended questions
  • active listening (eye contact, non-verbal cues)
    (you have to make sure we are not filling our thoughts and not focusing on what we think we will see because then you will miss what you need to or actually see.)
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8
Q

subjective (history)

A

basic information needed
- primary complaint
- history of injury
- Mechanism of injury (MOI)
- symptoms/pain profile
symptom - organic

manifestation which only the patient is aware of

  • patient medical history
    • MSK injuries
    • medical conditions
    • Red flags
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9
Q

Subjective history swelling

A

fast (<4hr) hemarthrosis(bleeding into a joint cavity)
slow (4-8hrs) capsular swelling

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10
Q

subjective history (describing your pain)

A

dull = thinking more muscular
sharp = thinking more bone
shooting, bright = thinking more nerve

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11
Q

objective

A
  • observable physical phenomenon indicative of a conditions presence
  • planning on what you want to do from there
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12
Q

order of assessment

A

1: subjective
2: observation/ visual inspection
3: AROM (active range of motion)
4: PROM (passive range of motion)
5: Resisted movements
6: Nero (sensation/reflex)
7: Special tests
8: palpation

all of the above are components of OBJECTIVE information

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13
Q

how do you set up a clinical examination?

A

doing an order of assessment

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14
Q

observation/visual inspection

A
  • we need to assess their general demeanour
    • expression (pain, tired, angry)
    • tone of voice
  • posture
    • protective postures, guarding, stiff, etc
      -obvious deformity/asymmetry
  • signs of inflammation
    -swelling, redness, bruising
    -quality of movement
    • how are they moving
    • speed, quality (smooth, jerky) amount of movement
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15
Q

what is the best way of observing someone?

A
  • asking them to go walk to a chair and watching them when they do not realize
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16
Q

theory of selective tissue tension

A
  • Dr. James Cyriax developed a method for locating and identifying a lesion by applying tension selectively to each of the structures that might produce pain.
  • tissues classified as either contractile or Inert

intert:
- ligaments
- bursa
- capsules
- fascia
- nerve roots
- dura mater

contractile:
- muscles
- tendons
- tenoperiosteal insertion (where the tendon attaches to the bone)

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17
Q

Cyriax theory

A
  • when tension is applied to an injured tissue, it will give rise to pain
  • when you pull on it, it is going to hurt
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18
Q

contractile tissue

A
  • increases in tension when the tissue is both contracted or stretched
  • active motion in one direction and passive motion in the opposite
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19
Q

how can you apply tension to a muscle?

A

1: having the patient contact the muscle
2: having the patient stretch the muscle

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20
Q

inert tissues

A
  • increase in tension when they are stretched ONLY
  • will elicit pain on active and passive movement in ONE direction only
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21
Q

active range of motion

A
  • movement assessment should begin with Active range of motion (AROM)
  • active movements which cause pain do not specifically indicate either an inert or contractile lesion
    • muscle tension and joint movement causing contractile and inert tension to both occur!
    • agnosit contract
    • antagonist stretch
    • inert tension in only one direction
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22
Q

active range of motion movements

A
  • give us some important information
    • where they are sore
    • willingness to move
    • quality of movement
    • amount of available ROM
      these give us clues on how we handle them
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23
Q

passive range of motion
(PROM)

A
  • patient must relax completely and allow therapist to move the extremity
  • look for limitation and presence of pain
  • specific attention should be paid to how they feel at the end of range of motion
    (pain prior to end of range usually signifies inflammation or possibly the presence of a red flag)
  • can be used to detect lesions in inert tissues
  • this stretching of the inert tissue will cause pain
  • allows us to assess “end feel”
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24
Q

end feel (normal)

A

1: soft tissue approximation
2: bony or bone to bone
3: capsular

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25
Q

soft tissue approximation (end feel)

A
  • normal
    -elbow/knee flexion
  • soft spongy gradual painless stop when two muscle bellies meet
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26
Q

bony or bone to bone (end feel)

A
  • normal
    -elbow extension
  • distinct abrupt endpoint/un-yielding
  • painless (abnormal if painful)
  • this is where you feel the bony stop
27
Q

capsular (end feel)

A
  • normal
    -hip rotation
  • abrupt firm endpoint with a little give
  • a leathery feeling
  • if you push past you can stretch it a little more like stretching a belt
28
Q

end feel (abnormal)

A

1: springy block
2: spasm/ stretch
3: abnormal capsular
4: empty

29
Q

springy block (end feel)

A
  • abnormal
    -internal issue of the joint (probably a meniscus that has been folded over)
30
Q

spasm/stretch (end feel)

A
  • abnormal
  • hamstrings
  • involuntary contraction that prevents motion secondary to pain (guarding)
  • more of a rubbery feel prior to expected end of range
31
Q

abnormal capsular (end feel)

A
  • abnormal
  • occurs prior to expected end of range
32
Q

empty (end feel)

A
  • abnormal
  • did not reach the end feel
  • when considerable pain is produced by movement
  • no mechanical resistance detected (no resistance at all)
  • significant soft tissue injury, bursitis or neoplasm
    (could be a tumour)
33
Q

what do we need for resisted testing?

A
  • contraction of only target tissue
  • no stretch on antagonist
  • no movement through joint or stretch on surround inert tissues
34
Q

information gained through resisted testing

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

how do you just contract the target tissue?

A
  • use isometric contraction
  • if you do it mid range then you are just tuning on the muscle
36
Q

resistance movements

A
  • isometric and neutral mid range
  • allows us not to have to worry about inert or antagonist parts
37
Q

interpreting resisted movements

A

finding strong - painless (nerve= normal, muscle = normal )

finding strong - painful (nerve = normal, muscle = minor problem)

finding weak - painless (nerve = possible nerve lesion, muscle = old/complete rupture)

finding weak-painless (nerve = possible nerve lesion, muscle = acute/significant tear)

38
Q

how to test resisted movement?

A
  • position the athlete with the muscle being tested in the neutral position… why? so that nothing else is on stretch
  • position yourself to maximize mechanical advantage
  • ask them to hold that position (ISOMETIC)
  • slowly increase the force in the opposite direction until you feel movement or pain is elicited. slowly decrease force
39
Q

making a decision

A
  • is it inert, contractile or both?
    • pain with PROM only = Inert tissue
  • pain/weakness with isometric contraction = contractile tissue
  • pain with PROM and isometic contraction could be a combination
40
Q

pain with PROM only

A

inert tissue

41
Q

pain with PROM and isometric contraction

A

contractile tissue

42
Q

Neurological testing

A

1: reflexes
2: sensation
3: key muscles

43
Q

Neurological testing (Reflexes)

A
  • biceps/braidchoradialis (C5- C6)
  • triceps (C7- C8)
  • knee jerk (L3)
  • achilles (S1)
44
Q

Neurological testing (sensation)

A
  • dermatomes
    • cutaneous area receiving the greater part of its innervation from a single spinal nerve
45
Q

Neurological testing (Key muscles)

A
  • myotomes
    • a muscle receiving the greater part of its innervation from a single spinal nerve
    • isometric contraction held for at least 5 seconds
      - fatigable weakness vs. no strength for peripheral nerve
46
Q

C2 (Neurological testing)

A

Neck flexion

47
Q

C3 (Neurological testing)

A

neck side flexion

48
Q

C4 (Neurological testing)

A

shoulder shrug

49
Q

C5 (Neurological testing)

A

shoulder abduction

50
Q

C6 (Neurological testing)

A

elbow flexion, wrist etc

51
Q

C7 (Neurological testing)

A

elbow extension wrist flexion

52
Q

C8 (Neurological testing)

A

thumb extension

53
Q

T1 (Neurological testing)

A

spread fingers

54
Q

L1 (Neurological testing)

A

hip flexion

55
Q

L2 (Neurological testing)

A

hip flexion

56
Q

L3 (Neurological testing)

A

knee extension

57
Q

L4 (Neurological testing)

A

ankle dorsiflexion

58
Q

L5 (Neurological testing)

A

1st toe extension

59
Q

S1 (Neurological testing)

A

plantar flexion

60
Q

S2 (Neurological testing)

A

knee flexion

61
Q

S3 (Neurological testing)

A

intrinsics of foot

62
Q

special tests

A
  • “special tests” help in the differential diagnosis of the patients injury
  • includes manual muscle testing specific “special” muscle and ligament tests
  • these are an indication of “how bad it is”
63
Q

testing and recording strength of muscle

A

manual muscle testing (oxford scale)

0 = nothing happens
1- twitch or flicker only. no movement
2 = able to move but not against gravity
3 = able to move the joint fully against gravity
4 = movement with some resistance
5 = full movement with resistance equal to opposite side

64
Q

what is the difference between resistance and muscle testing

A

resistance testing is isometric, trying to turn on the muscle and seeing if it is sore (tells you what tissue is most likely at fault)

muscle testing is trying to see how the muscles moves, allows us to grade the injury, and tells you how bad the injury is

athletic injuries 2036 (20 decks)

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