
Chapter 5

Symptom vs. Sign/ Acute vs. Chromic Injury:

Symptom- Information provided by the injured individual regarding his or her perception of the
problem.

Sign- An objective, measurable physical finding regarding the individual’s condition. What the
evaluator hears, feels, sees, or smells when assessing the patient.

Acute (Macrotrauma) vs. Chronic Injury (Microtrauma)

Chapter 5

Symptom vs. Sign/ Acute vs. Chromic Injury:

Symptom- Information provided by the injured individual regarding his or her perception of the
problem.

Sign- An objective, measurable physical finding regarding the individual’s condition. What the
evaluator hears, feels, sees, or smells when assessing the patient.

Acute (Macrotrauma) vs. Chronic Injury (Microtrauma)

Chapter 5
S.O.A.P notes: Subjective

Subjective: Hx part, includes primary complaint; MOI, S/S, medical Hx, location, severity, onset,
surface, direction of force, where, when how. Where does it hurt the most? Radiating pain?
Scale from 1-10 pain scale? Description of pain dull, sharp, aching?

Chronic conditions- When does pain begin, sitting, standing, walking, night, morning, exercises?
How long does pain last? Is the pain worse before, during or after activities? Does it wake you
up at night? Has the pain changed better or worse?

Characteristics of a Symptom: Somatic pain- arises from skin, ligaments, muscle, bones, and
joints (musculoskeletal injuries). People classified this pain into two types:

(1) Deep somatic pain- diffuse and nagging, last longer indicates severe
tissue/bone/muscle/joint damage.

(2) Superficial somatic pain- Sharp/prickly tends to be brief injuries from skin
(dermis/epidermis).

Visceral pain- arises from disease or injury to an organ in the thoracic or abdominal cavity,
perceived as deeply located, nagging and pressing it is accompanied by nausea and vomiting.

Referred pain- (type of visceral pain) Pain is perceived at one point but the brain perceives it at
another point (heart attacks, spleen, liver).

Chapter 5
Objective:

Objective: Observation part, you are looking for redness, ecchymosis, swelling, cuts, scars
(Keloids), deformations, ROM, scanned visually, for any abnormalities, antalgic gait (abnormal
gait), infection (pus, redness, red streaks, swollen lymph nodes), skin reactions (oily, dry,
blotchy, sores, hives), skin discoloration (blue, red, black/blue, yellow).

Palpation is touching and ID anatomical structures. By palpating you can detect 8 physical
findings: (1)Temperature (2)swelling (3)point tenderness (4)crepitus (5)deformity (6)muscle
spasms (7)sensation (8)pulse.

Chapter 5
Assessment:

Assessment: This section encompass AROM, PROM feeling some type of end feels; end feels
come in 3 normal and 4 abnormal: 3 normal end feels are:

(1) Soft- soft-tissue approximation (Elbow flexion)

(2) Firm- muscular/capsular/ligamentous stretch (Hip extension, External rotation, Forearm
supination)

(3) Hard- Bone-to-bone (Elbow extension). The 4 Abnormal end feels are:

(1) Soft- stops before normal ROM or pass ROM (swelling, edema)

(2) Firm- stops before normal ROM or pass ROM (Capsular/muscular/ligamentous shorting)

(3) Hard- stops before normal ROM or pass ROM (Loose bodies, fx, chondromalacia, myositis
ossificans

(4) Empty- no end feel cause ROM is never reach ( Fx, acute joint inflammation).

Muscle Testing: Muscle testing is graded by a 5-0 scale; 5=normal, 4=Good, 3=fair, 2=Poor,
1=Trace, 0=Zero.

Chapter 5
Assessment:

Neurologic Testing: 2 types:

Myotome (Muscle group that is innervated by a single nerve root)

Dermatome (Skin group that are innervated by a single nerve root)
Abnormal sensations:

Hypoesthesia- decreased tactile.

Hyperesthesia- excessive tactile.

Anesthesia- loss of sensation.

Paresthesia- numb, tingling, burning sensation.

Special Testing: Any test that may need to be performed for that body part.

Chapter 5
Plan:

Plan: Doctor’s visit, rehab, treatment plan, evaluation conclusion.

Chapter 5
Abnormal Vital Signs

Pulse:

Rapid, Weak- Shock, internal hemorrhage, hypoglycemia, heat exhaustion, or hyperventilation.

Rapid, Bounding- Heat stroke, fright, fever, hypertension, apprehension, hyperglycemia, or
normal exertion.

Slow, Bounding- Skull fx, stroke, drug use, certain cardiac problems, or some poisons.

No Pulse- Blocked artery, low blood pressure, or cardiac arrest.

Chapter 5
Abnormal Vital Signs

Respiratory Rate and Quality

Shallow Breathing- Shock, heat exhaustion, insulin shock, chest injury, or cardiac problems.

Irregular Breathing- Airway obstruction, chest injury, diabetic coma, asthma, or cardiac
problems.

Rapid, Deep- Diabetic coma, hyperventilation, some lung diseases.

Frothy blood- Lung damage, such as puncture wound to the lung from an fx rib or other
penetrating object.

Slowed Breathing- Stroke, head injury, chest injury, or use of certain drugs.

Wheezing- Asthma

No Breathing- Cardiac arrest, poisoning, drug abuse, drowning, head injury, or death.

Chapter 5
Abnormal Vital Signs

Blood Pressure

Diastolic: <100mm- Hypotension caused by shock, hemorrhage, heart attack, internal injury, or
poor nutrition.

Systolic: >140- Hypertension caused by certain medications, oral contraceptives, anabolic
steroids, amphetamines, chronic alcohol use, and obesity.

Chapter 5
Abnormal Vital Signs

Skin Temperature

Dry, cool- Exposure to cold or cervical, thoracic, or lumbar spine injuries.

Cool, clammy- Shock, internal hemorrhage, trauma, anxiety, or heat exhaustion.

Hot, dry- Disease, infection, high fever, heat stroke, or overexposure to environmental heat.

Hot, moist- High fever

Isolated hot spots- Localized infection.

Cold appendage- Circulatory problem.

“Goose pimples”- Chills, communicable disease, exposure to cold, pain, or fear.

Chapter 5
Abnormal Vital Signs

Skin Color

Red- Embarrassment, fever, hypertension, heat stroke, carbon monoxide poisoning, diabetic
coma, alcohol abuse, infectious disease, inflammation, or allergy.

White or ashen- Emotional stress (fright, anger), anemia, shock, heart attack, hypotension, heat
exhaustion, insulin shock, or, insufficient circulation.

Blue or cyanotic- Heart failure, some severe respiratory disorders, some poisoning. In dark
individuals, a bluish cast can be seen in the mucous membranes (mouth, tongue, and inner
eyelids), lips, and nail beds.

Yellow- Liver disease or jaundice.

Chapter 5
Abnormal Vital Signs

Pupils

Constricted- Individual is using opiate-based drug, or has ingested a poison.

Unequal- Head injury or stroke.

Dilated- Shock, hemorrhage, heat stroke, use of a stimulant drug, coma, cardiac arrest, or death.