The Assessment Process

1
The Assessment Process

• Principles Concepts

2
Overview

• HIPS HOPS
• Patient history
• Observation/inspection
• Palpation
• Special tests

3
HIPS HOPS

• Standardized assessment technique
• Designed to lead you through the examination
  logically
• Considered sequential and helps ensure no
  injury/condition is overlooked

4
Patient History

• Comprises significant portion of time during
  clinical exam
• Four general categories
• Patient information
• Mechanism of injury
• Signs and symptoms/pain
• Previous injury(ies)
• Be aware of Red Flag responses

5
Patient History

• Red Flags
• Cancer
• Persistent night pain
• Constant pain
• Unexplained weight loss
• Loss of appetite
• Unusual lumps or growths
• Unwarranted fatigue

6
Patient History

• Red Flags
• Cardiovascular
• SOB
• Dizziness
• Chest pn
• Pulsating pn
• Lower leg pn
• Discolored or pnful feet
• Swelling s injury

7
Patient History

• Red Flags
• GI/Genitourinary
• Abdominal pn
• Frequent heartburn
• Frequent nausea
• Persistent UTIs
• Menstrual irregularities

8
Patient History

• Red Flags
• Neurological
• Hearing or vision problems
• Balance problems
• Headaches
• Problems swallowing
• Speech difficulties
• Fainting spells
• Sudden weakness

9
Patient History

• Red Flags
• Other/Misc.
• Fever or night sweats
• Emotional disturbances
• Swelling or redness s injury
• Pregnancy

10
Patient History

• Red FlagRefer!
• Try not to lead your patient
• Does this increase your pain?
• Does this alter your pain?
• Only ask one question at a time

11
Patient History

• Patient information
• Age
• Occupation
• Special conditions
• Chief complaint

12
Patient History

• Mechanism of injury
• Sudden (acute) or gradual (chronic) onset
• Predisposing factors
• Posture
• Movement patterns
• Genetics
• Patient positioning/form

13
Patient History

• Signs and symptoms/pain
• VAS
• 1-10 most common
• Level
• 1 Pn after activity
• 2 Pn after activity resolved c w/u
• 3 Pn during after s performance influence
• 4 Pn during after c performance influence
• 5 Pn c ADLs
• 6 Constant pn s sleep disturbance
• 7 Constant pn c sleep disturbance

14
Patient History

• Signs and symptoms/pain
• Description
• Constant, periodic, episodic, or occasional?
• Sharp or dull?
• Muscle cramping or aching
• Nerve root sharp, shooting
• Nerve Sharp, bright, electric
• Bone deep, nagging, dull
• Vascular throbbing, diffuse
• Localized or diffuse?

15
Patient History

• Signs and symptoms/pain
• Area of pn
• Progression
• Exacerbating or alleviating practices
• Possibility of referred pn

16
Patient History

• Previous injury(ies)
• Past surgeries
• Past treatment/rehab
• Injections?
• Medications?
• X-rays, MRI, bone scans, etc?

17
Observation/Inspection

• Can occur concurrently with history section for
  experience evaluators, but typically best if
  practiced independently
• Modesty precautions
• Observe general patient posturing immediately
• Look and see!

18
Observation/Inspection

• Alignment
• Gross deformity
• Contours symmetry
• Limb positioning
• Color texture of skin
• Scars
• Signs of infection
• Willingness to move?

19
Observation/Inspection

• Dermatomes
• Area of skin supplied by a single nerve root
• Myotomes
• Groups of muscles supplied by the same nerve root
• Sclerotomes
• Area of bone or fascia supplied by a single nerve
  root

20
Observation/Inspection

• Look for faulty movement patterns, also check for
  normal range of motion
• PROM (passive)
• AROM (active)

21
Special Tests

• Some tests are for PAIN PROVOCATION, others are
  for STABILITY
• Range of motion
• RROM (resisted)
• PROM with overpressure
• Be sure to note endfeel

22
Special Tests

• Endfeel
• Normal
• Bone-to-bone
• Soft tissue approximation
• Tissue stretch
• Abnormal
• Muscle spasm
• Capsular (hard or soft)
• Bone to-bone
• Empty
• Springy block

23
Special Tests

• Capsular patterns
• Pattern of limitation or restriction
• Usually due to muscular spasm and capsule
  contraction
• Non-capsular pattern
• Internal derangement
• Extra-articular lesions
• Constant length phenomenon

24
Special Tests

• Inert tissues
• Everything else that is not contractile or
  neurological in nature
• Break tests or MMT
• Resisted isometric tests to determine mm strength

25
Functional Tests

• ADLs
• Activities of daily living
• Examples?
• IADLs
• Instrumental activities of daily living
• Examples?
• Body part specific testing
• Sport specific drills testing

26
Activity

• With a partner, passively move each of the
  following, noting endfeel
• Elbow extension
• Elbow flexion
• Shoulder internal rotation at 90 degrees flexion
• Shoulder internal rotation at 90 degrees abduction

27
Activity

• With a partner, perform a MMT or break test on
  the following
• Biceps brachii
• Triceps brachii
• Common wrist extensors
• Common wrist flexors
• Deltoid