OBJECTIVE OBSERVABLE physical phenomenon indicative of a condition's presence - bleeding, bruising, ROM, strength, reflexes, pain on palpation, etc

1. Subjective 2. Observation/visual inspection 3. AROM 4. PROM 5. Resisted ROM 6. Neuro/Sensation Reflex 7. Special tests 8. Palpation 2-8: OBJECTIVE information

Increase in tension only when STRETCHED will cause pain in ONE direction only - ligaments - bursa - capsules - fascia

(2) Lecture 7: Soft Tissue Assessment Flashcards by Dami Ade

Types of assessments

Field assessment
Sideline/clinical assessment

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Field assessment

CONCISE assessment to get a GENERAL idea of how bad injuries are and how we’re going to remove it

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Sideline assessment

a.k.a. clinical assessment

more IN-DEPTH, ROUTINE protocol

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SOAP

Subjective (history)
Objective
Analysis/Assessment `S(working diagnosis)
Plan/Program

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S of SOAP

Subjective - HISTORY

single MOST IMPORTANT aspect of eval

includes statements provided by the PATIENT regarding their symptoms

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Why is the Subjective Assessment done?

The medical history (subjective assessment) is often more valuable than a physical exam

Interviewing must be done properly

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How is the Subjective Assessment done?

ask OPEN-ENDED questions
ACTIVE listening (eye contact, non-verbal cues)
used to develop a strategy for further examination

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Symptom

what the PATIENT tells you about

organic manifestation which only PATIENT is aware of

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Questions to ask during history

what happened? MOI
when did it happen?
were you able to continue?
swelling? yes/no; fast/slow
describe pain (dull, sharp, shooting, numbness, tingling)

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Speed of swelling

Fast (<4hrs): hemarthrosis
Slow (4-8 hrs): capsular swelling
- extracapular

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Sign

OBJECTIVE

OBSERVABLE physical phenomenon indicative of a condition’s presence

bleeding, bruising, ROM, strength, reflexes, pain on palpation, etc

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Order of Assessment

Subjective
Observation/visual inspection
AROM
PROM
Resisted ROM
Neuro/Sensation Reflex
Special tests
Palpation

2-8: OBJECTIVE information

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What is included in Selective Tissue Tension Testing?

Includes
- AROM
- PROM
- Resisted movements

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Observation/Visual Inspection

assess their general demeanour (expression, tone of voice)
posture (protective postures, guarding)
obvious deformity/asymmetry
signs of inflammation (swelling, redness, bruising)
quality of movement (speed, quality - smooth, jerky)

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Theory of Selective Tissue Tension

Dr. James Cyriax developed a method for LOCATING+ IDENTIFYING A LESION by applying tension selectively to each of the structures that might produce pain

Tissues are classified as either CONTRACTILE or INERT

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Contractile tissues

Increases tension when tissue is BOTH contracted or stretched

active motion in one direction + passive motion in the opposite

muscles
tendons
tenoperiosteal insertion

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Inert tissues

Increase in tension only when STRETCHED

will cause pain in ONE direction only

ligaments
bursa
capsules
fascia

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Cyriax’s Theory

Theory of Selective Tissue Tension

When tension is applied to an injured tissue, it will give rise to pain

Tension in the bicep

contraction = lifting something up
stretch = straightening arm out

Active Range of Motion

movement assessment should begin w/ AROM
active movements which cause pain do not differentiate btwn an inert/contractile lesion

causes contractile and inert tension to BOTH occur

does NOT give a lot of info about the injury

What does AROM tell us?

where they are sore
willingness to move
quality of movement
amount of available ROM

Clues on how to HANDLE them

Passive ROM

patient must RELAX completely and allow therapist to move the extremity
look for limitation + presence of pain
pay attention to feel at END of ROM
(pain before end of range = inflammation or a red flag)

Whar does PROM tell us?

used to detect lesions in INERT tissues
helps us assess END FEEL

Normal End Feel

soft tissue approximation
bony or bone to bone
capsular

Soft tissue approximation end feel

soft, spongy gradual painless stop when two muscle bellies meet Ex. elbow/knee flexion

Bony or bone to bone end feel

- distinct ABRUPT endpoint/unyielding - painless (abnormal if painful) - like 2 pieces of wood being put together Ex. elbow extension

Capsular end feel

- abrupt firm endpoint w/ LITTLE GIVE - LEATHERY feeling Ex. hip rotation

Abnormal end feel

- springy block - spasm/stretch - abnormal capsular - empty

Springy block end feel

- INTERNAL issue of the jt. - rebound at end/some point thru ROM - bouncy like compressing a spring Ex. common w/ meniscal injury

Spasm/stretch end feel

- involuntary contraction that prevents motion secondary to pain (guarding) - more of a rubbery feel prior to expected end of range Ex. hamstrings

Abnormal capsular end feel

occurs prior to expected end of range Ex. knee extension

Empty end feel

did NOT reach the end feel - when considerable pain is produced by the movement - no mechanical resistance - significant soft tissue injury, bursitis

What do we need for resisted testing?

- contraction of ONLY target tissue - isometric contraction (no stretch) - NO stretch on antagonist - NO movement thru jt or stretch on surrounding inert tissues

What does resisted testing tell us?

- will tell us about pain in a contractile tissue - will give us an indication of how the nerve is working

Interpreting resisted movements

Strong-painless: normal nerve, normal muscle Strong-painful: normal nerve, minor muscle problem Weak-painless: possible nerve lesion, old/complete muscle rupture Weak-painful: possible nerve lesion, acute/significant muscle tear

Neurological Testing

- reflexes - sensation - key muscles

Reflexes

C5-6: Biceps/Brachioradialis C7-8: Triceps L3: Knee jerk S1: Achilles

Myotomes

- MUSCLE receiving the greater part of its innervation from a single spinal nerve - isometric contraction held for at least 5 seconds

Dermatomes

sensation CUTANEOUS AREA receiving the greater part of its innervation from a single spinal nerve

Special Tests

help in differential diagnosis of the patient's injury indication of "HOW BAD IT IS" includes manual muscle testing specific "special" muscle and ligament tests

Analysis/Assessment

- should have an idea of contractile, inert or both - neuro, special tests and palpation should give a good idea of degree of injury - from there, form a clinical opinion or diagnosis

Grading Strains

Grade 1 - 0-20% of torn fibres - some pain - strength: 4/5 (Oxford Scale) - near full ROM Grade 2 - 20-80% of torn fibres - significant pain - strength: 2/3 (Oxford Scale) - significant decrease in ROM w/ pain near end Grade 3: - 80-100% of torn fibres - variable to no pain - strength: 0/1 (Oxford Scale) - PROM only may have little pain on stretch

Grading Sprains

Grade 1 - 0-50% of fibres torn - some pain - no laxity - firm endpoint Grade 2 - 50-80% of fibres torn - significant pain - laxity - firm endpoint Grade 3 - 80-100% of fibres torn - variable to no pain - gross laxity - no endpoint

Review Injury Chart