Injury Exam Process

LE Evaluation

clinical assessment vs. acute evaluations

clinical: severity and injured structures

acute: real time RTP

• r/o catastrophic

• privacy

pain

• location

• type

• referred

• radicular

• daily pain patterns

• provocation/ alleviation

joint and muscle function assessment

• AROM

• MMT

• PROM

• joint stability

• joint play

AROM

• ease of movement

• ROM achieved (ppainful arc?)

• compensation

5/5

pt resist against max pressure

4/5

pt resist against mod presssure

3/5

pt can move body part against gravity through full ROM

2/5

pt can move body part in gravity-minimized position through full ROM

1/5

pt cannot produce mvmt by muscle contractiohn is palpable

0/5

no contraction felt

PROM > AROM

suspect muscular weakness or tissue lesion

PROM = AROM and are deficient

suspect capsular adhesions or joint tightness

laxity

clinical sign of the amount of “give” within a joint; identified by stress testing

instability

joint’s inability to function under the stresses of function activity

firm end-feel

• Slight stretching of the ligament with little, if any, tearing of the fibers.

• Pain is present, but the degree of laxity roughly compares with that of the opposite extremity.

soft end-feel

• Partial tearing of the fibers.

• There is increased play of the joint surfaces upon one another or the joint line “opens up” significantly when compared with the opposite side

empty end-feel

• Complete tearing of the ligament.

• The motion is excessive and becomes restricted by secondary restraints, such as tendons.

dermatome

area of skin innervated by a spinal nerve root

if muscle weakness is noted during neurologic screening…

test another muscle innervated by the same nerve root

upper motor neuron lesion

increased response w DTR

lower motor neuron lesion

decreased resonse w DTR

Jendrassik maneuver

squeeze hands, cross arms

0 DTR

no reflex

1+ DTR

hyporeflexia: Reflex elicited with reinforcement (precontracting the muscle)

2+ DTR

normal response

3+ DTR

hyperreflexia (brisk)

4+ DTR

hyperactive with clonus