Question | Answer |
Purpose of evalto determine | what injury ath has, severity of the injury and or the priority of the injury, appropriate course of treatment |
Principles of injury eval | test uninvolved side 1st to get a baseline, increase pt confidence, decrease pt apprehension, apply over pressure with care, w/ PROM & ligamentous testing both degree & quatlity, w/ ligament testing repeat increasin stress, myotome testing hold for 5 sec |
importance of non injured side | provides immediate ref to relative dysfunction, used to demonstrate mechanism of injury, provide regerence of symmetry of bone, tissue, tissue color/temp, swelling/inflammation, ROM, strength, ligamentous laxity, neurovascular tests |
Primary survey | ABCD
Airway-chin tilt/jaw thrust
Breathing-look listen feel
Circulation-carotid pulse
Disability-wiggle fingers/toes, flex/ext arm, move foot |
Secondary survey | (head to toe exam)
vital signs:level of consciousness, pulse respiration, BP, skin color/temp, ability to move, pupil reflexes, reaction to pain |
Localized Swelling | superficial structures, bursitis, contusions, strains, sprains |
diffuse swelling | severe hematoma, dislocation, fractures |
intramuscular swelling | swelling within a muscle |
intermuscular swelling | swelling between the muscles |
immediate swelling within 2 hrs | severe injury, hemarthosis or damage to a structure with a rich blood supply, |
delayed swelling 6-24 hrs | synovial irritation, bone chips, capsular/ligament sprain |
delayed swelling post activity only | busitis, chronic synovial irritation |
Normal end feels | bone on bone-hard unyeilding painless soft-tissue approximation-yeilding compression that stops further movement tissue stretching-hard, firm, or springy w/ a slight give/elastic resistance |
Abnormal end feels | muscle spasm, capsular, bone to bone, empty spring block |
muscle spasm abnormal end feel | sudden & hard, sudden, dramatic stoppage of movment accompanied by pain |
Capsular | decrease ROM |
Bone to Bone | restriction occurs before the normal end ROM |
Empty | movement is impossible due to pain |
Spring block | similar to tissue streatch. rebound effect, decreased ROM |
Stress Tests | evaluates the structural integrity of ligament & joint capsules, determines the amount of laxity in a specific ligament and/or the amount of instability in a specific joint |
Special Test | specific procedure applied to a body part to determine the amount of damage done (ie fracture tests, muscle-tendon function tests. etc) |
Loose packed position | position of joing in ROM wher ejoint under least amount of stress & joint capsule has greatest capacity-pos of minimal congruency btween articular surfaces & joint capsule- ligaments are in greatest pos. of laxity |
Resting position of Hip | 30* of flex, 30* of abduction, slight ER |
Resting position of knee | 25 degrees of flex |
Resting position of patella femoral | full flex |
Distal Tib-fib | PF 10*, 5* of inversion |
Talocural | PF 10*, midway between inv/ev |
Subtalar | Pf 10* midway between inv/ev |
Closed Packed Position | avoid as much as poss during assessment, 2 joint surfaces fully congruent &compressed, ligament and joint capsule completely taut, joint surfaces cant b serperated w/ distraction, if injured p! increases when reaching this position. w/ swelling cant reach |
Closed packed position of hip | Lig-full ext, abduction, IR Boney- flexed 90*, slight abduction, ER |
Closed packed position of knee | full flex and ER |
Closed packed position of patella femoral | full ext |
closed packed distal tib-fib | none |
Closed packed talocural | full dorsiflexion |
closed packed of subtalar | full inversion/supination |