Musculoskeletal Assessment

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Musculoskeletal Assessment
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History

• This is the information gathering and recording
  phase of the assessment.
• The history should give a clear idea of what
  the problem is, how to treat the condition and
  how long it will take for recovery.
• The history helps develop a rapport with the
  athlete, determine the type of person the
  athlete is and determines the athletes
  expectations and concerns about the injury.
• .

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History Questions

• Questions should be orderly and progress from
  one to the other.
• Keep questions simple and relevant. Listen
  carefully and clarify information.
• Use questions that will encourage cooperation
  and confidence as well as keep the athlete calm
  and relaxed.
• Remain professional at all times.

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Observations

• This is the looking phase of the assessment.
• Watch how the athlete moves.
• Is the athlete limping? Having difficulty
  removing shirt or other clothing?
• Have female athletes in sports bra and shorts
  and male athletes in shorts to enable you to
  look at entire person.

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What to look for

• Posture
• head position
• shoulder position
• back alignment
• pelvis position
• knee level
• ankle and foot position
• arches
• Athletes willingness to move body parts
• Facial expressions as athlete moves.

• Differences between left and right sides of the
  body.
• Deformity
• Asymmetry
• Muscle spasm
• Muscle development
• Muscle atrophy
• Limb size shape colour temperature
• Scars

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Functional Tests
This phase of the assessment determines the type
of structure that is injured through active,
passive and resisted testing. The tissues are
divided into contractile and inert. Contractile
tissues are muscle belly, tendon and their
attachment to the periosteum. Tension may be
applied to these structures by stretching or by
using resisted isometric contraction. Inert
tissues are ligament, capsule, fat pad, blood
vessels, cartilage, meniscus, nerves, skin. These
structures hove no inherent capacity to relax or
contract. Tension may be applied to these
structures by stretching during a passive
movement.
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Active Movement

• Active movements tell the therapist
• The athletes willingness to move the joint
• The athletes active range of motion
• That the muscle can move the joint and body part
• The quality of movement in the range of available
  motion
• How the joint surfaces are working or the state
  of the joint.

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Active Movement

• How to test
• Ask athlete to move the joint through as much
  of the range as possible, noting where pain
  occurs in the range
• Measure or approximate the degrees of range of
  motion at the joint
• Compare the ranges to opposite limb where
  possible
• Test each movement at the joint.
• Note any pain, location of pain, type of pain,
  sensations, sounds or abnormal movement during
  testing.

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Active Movement

• Results
•  
• Range of motion may be normal, limited or
  excessive in any one, combination of or all
  range(s) of motion at he joint.
• There may be pain throughout the range, at
  certain points in the range or at the end of
  range. There may not be pain in the range of
  motion.

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Passive Movements

• Passive movement tell the therapist
• The state of the inert structures.
• Pain at the extremes of movement indicates a
  painful structure is stretched or being squeezed.
  A painful arc indicates impingement.
• Limited range and painless indicates possible
  symptomless osteoarthritis.
• Full range and pain free indicates no inert
  structure involved.

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Passive Movements

• How to test
• The therapist gently lifts the limb through the
  full possible range of motion available without
  forcing the joint. The athlete must be relaxed.
• Measure or approximate the degrees of motion and
  compare to opposite limb.
• Test each anatomical range of motion.

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Passive Movements

• Results
• The range of motion may be limited, normal or
  excessive.
• Pain or muscle spasm may be present at any point
  in the range.
• There may be pain, limitation or both in any or
  all ranges of motion.

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Resisted Isometric Contraction
Resisted testing tells the therapist The state
of contractile structures and their nerve
supply. The degree of strength on a scale of
0-5 Gone 0 no contraction felt. Trace 1 can
feel muscle tighten but no movement
produced. Poor 2 produces movement with gravity
eliminated but can not function against
gravity. Fair 3 can raise part against
gravity. Good 4 can raise part against gravity
with outside resistance. Normal 5 can overcome a
greater amount of resistance than a good
muscle.
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Resisted Isometric Contraction

• How to test
• Position athlete so the part being tested is in
  a neutral position.
• Stabilize the body part being tested, make sure
  athlete is comfortable.
• Ask athlete to meet your resistance as you
  apply pressure against the muscle group you want
  to test.
• Use slow gradual increase in pressure until a
  maximal contraction is felt.
• Hold the contraction for five seconds and
  gradually relax.
• The limb should not move through any range of
  motion.
•  

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Resisted Isometric Contraction

• Results
• Strong and painless indicates no neurological
  deficit or lesion involving the muscle or tendon.
  
• Strong and painful indicates no neurological
  problem. There is a minor contractile tissue
  injury.
• Weak and painless indicates there may be some
  interruption of the nerve supply to the muscle or
  there may be a complete rupture of the muscle or
  tendon.
• Weak and painful indicates there may be a partial
  rupture of tendon or muscle.

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Special Tests
This phase of the assessment is used to test
specific structures that are suspected as injured
after completing functional tests. Special tests
are also used to rule out the uninjured
structures. Eg. Tap test is used to rule out
fracture and distal pulse check is used to rule
out artery interruption.  
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Palpations

• Palpations are used to
• Isolate the structures that are injured.
• Discriminate differences in tissue tension.
• Distinguish differences in tissue texture.
• Detect abnormalities in shape structure and
  type of tissues.
• Feel temperature variations.
• Note abnormal sensations.