EVALUATIONS
SUBJECTIVE QUESTIONING (HISTORY)
Chief complaint?
Date of injury/When did it happen? (acute vs. chronic)
Previous history of injury?
Mechanism of injury/How did injury happen?
Did athlete hear or feel anything?
- “snap” and/or “crack” fracture and/or dislocation
- “pop” muscle/ligament injury
- clicking and/or catching loose bodies
- grating and/or crepitus degeneration/osteoarthritic changes
Deformity present? Did it reduce spontaneously or with help?
Immediate or delayed disability or swelling?
- localized swelling = superficial structures; bursitis, contusion, strain, sprain
- diffuse swelling = severe hematoma; dislocation, fracture
- intramuscular swelling = swelling within a muscle
- intermuscular swelling = swelling between muscles
- immediate swelling = under 2 hrs; severe injury; damage to structure with rich
blood supply
- delayed swelling = 6-24 hrs; synovial irritation; capsular/ligament sprain
- delayed swelling = post-activity only; bursitis, chronic synovial irritation
What type of pain is it?
- cramping, dull, aching muscle
- sharp, shooting nerve root
- deep, nagging, dull, localized bone
- sharp, bright, burning nerve
- throbbing, diffuse, aching, poorly localized vasculature
- pain/stiffness improves with activity chronic inflammation
- morning pain acute injury
- pain that escalates as day progresses aggravating injury
- night pain pathologic problem
- constant pain
- pain only with repeating mechanism of injury
- immediate pain
- pain of gradual onset overuse syndrome
What does the condition currently feel like?
Any numbness and/or tingling?
When and where does it hurt? (show with 1 finger)
What is the level of pain? (0-10 scale)
Does the pain radiate? If so, where?
What makes it feel better or worse?
Are you taking any medications? Any allergies to medications?
What was functional status prior to injury? Dominant hand/leg?
PHYSICAL OBSERVATION (INSPECTION)
Athlete’s gait/movement patterns
Athlete’s posture
How athlete is carrying injured body part
Bilateral joint/body contour symmetry
Obvious deformity – malalignment, fracture/dislocation
Muscle atrophy
Swelling
Skin color/texture
Open wounds/external bleeding
Scars
Athlete’s facial expressions
Athlete’s ability and willingness to use the injured body part
PALPATION (PERFORM BILATERALLY)
Perform in a specific sequence – beginning away from pain site
Perform bony and soft tissue palpation
Note – point tenderness, crepitus, symmetry, tissue temperature
When palpating, note:
Differences in tissue tension and texture
Differences in tissue thickness
Abnormalities/deformities
Tenderness
Temperature variations
Abnormal sensation
Swelling/inflammation
Range of Motion (active, active-assisted, passive) – PERFORM BILATERALLY
Active first unless contraindicated by fractures or recently repaired tissue
Observe movement patterns, facial expressions, painful arcs
Manual Muscle Testing (PERFORM BILATERALLY)
Isometric resistive muscle testing (break test)
Resisted full range of motion testing
Special Tests (PERFORM BILATERALLY)
- Stress tests: evaluates the structural integrity of ligaments and joint
capsules; determines the amount of laxity in a specific ligament and/or
the amount of instability in a specific joint
- Special tests: specific procedures applied to a body part to determine
the amount of damage done
Neurological tests (dermatomes, myotomes, reflexes) PERFORM BILATERALLY
- Dermatome (sensation) – area of skin innervated by a single nerve root
- Myotome (motor) – group of muscles supplied by a specific nerve root
- Deep tendon reflex – involuntary muscle contraction initiated by the
stretching of receptors within a tendon
ANKLE/LOWER LEG
PALPATIONS
_medial malleolus
_deltoid ligament
_navicular
_calcaneous
_1-5 metatarsals
_styloid process 5th metatarsal
_lateral malleolus
_ATF, CF, PTF ligaments
_tibialis anterior
_extensor digitorum
_extensor hallucis longus
_Achilles tendon
_tibialis posterior
_flexor digitorum
_flexor hallucis longus
_gastroc/soleus
_shaft of tibia
_shaft of fibula
_peroneal
LIGAMENT/SPECIAL TESTS
_Anterior Drawer _Heel Tap
_Talar tilt _Compression
_Kleiger’s _Metatarsal Glides
_Navicular Drop _AROM/PROM
(PF,DF,IN,EV)
_Tuning fork _MMT
KNEE/THIGH
PALPATIONS
_patella _quadriceps tendon
_tibial tubercle _Biceps Femoris tendon
_medial joint line _Semimembranosis/Semitendinosis
_lateral joint line _IT band
_adductor tubercle _pes anserine insertion
_lateral epicondyle _medial collateral ligament
_medial epicondyle _lateral collateral ligament
_head of the fibula _patella tendon
LIGAMENT/SPECIAL TESTS
_AROM/PROM
_Patella tracking
_Isometric resistive muscle testing
_Valgus 0º /30º
_Varus 0º /30º
_Lachman test
_Anterior Drawer test (neutral, internal, external rotation)
_Posterior Sag test (Gravity Drawer test)
_Patellar grind test
_Patellar apprehension test for subluxation
_MMT
_Apley’s compression/distraction
SHOULDER/UPPER TRUNK EVALUATION
PALPATION
_sternoclavicular joint _biceps brachii long head
_clavicle _biceps brachii
_acromioclavicular joint _deltoid
_coracoid process _trapezius
_acromion _triceps brachii
_head of the humerus _rhomboid
_bicipital groove _latissimus dorsi
_spine of the scapula _serratus anterior
_vertebral border of the scapula _axilla
_axillary border of the scapula _supraspinatus
_sternoclavicular (SC) joint _sternocleidomastoid
_acromioclavicular (AC) joint _pectoralis major
_coracoacromial ligament _glenohumeral ligaments
SPECIAL TESTS
_AROM/PROM
_MMT
_sulcus sign
_biceps long head (speed’s test)
_impingement (Hawkins, neers)
_bicipital tendonitis and subluxation test
_empty can test (supraspinatus)
_check movement of clavicle
_apprehension test
BACK INJURY
PALPATION
_spinous processes _iliac crest
_transverse processes _erector spinae
_L4, L5 _latissimus dorsi
_PSIS standing _int./ext. oblique
_PSIS seated _rhomboid
_ASIS _iliopsoas
_piriformis _sacral base
SPECIAL TESTS
_Leseque's sign (SLR)
_Bowstring Test (sciatic nerve irritation)
_Straight Leg Test (sciatic nerve irritation)
_Slump test
_Figure 4 Test (FABERs)
_SI joint testing (forward flexion, gillette’s, supine to long sit)
_reflexes
achilles, patella tendon, biceps, brachioradialis, triceps