Chapter 1 The Injury Evaluation Process
Introduction Accurate initial assessment is essential for successful management and rehabilitation of an injury Evaluation process is ongoing throughout all phases of recovery A systemic and methodical evaluation model leads to efficiency and consistency in the evaluation process
Systemic Evaluation Technique Figure 1-1, page 2 The Role of the Noninjured Paired Structure – Table 1-1, page 3
Clinical Evaluations History Most Important portion of examination Most Important portion of examination Communication is key Communication is key Cultural Considerations, page 4, Box 1-1 Cultural Considerations, page 4, Box 1-1 Information that should be obtained: Information that should be obtained: Mechanism of injuryMechanism of injury Relevant sounds/sensations at time of injuryRelevant sounds/sensations at time of injury Location of symptomsLocation of symptoms Onset and duration of symptoms (Table 1-2, Pg 5)Onset and duration of symptoms (Table 1-2, Pg 5) Description of symptomsDescription of symptoms
Information that should be obtained cont.: Information that should be obtained cont.: Changes to symptomsChanges to symptoms Previous historyPrevious history Related history to the opposite body partRelated history to the opposite body part General medical healthGeneral medical health NCAA Guideline 1B – page 6, Box 1-2 NCAA Guideline 1B – page 6, Box 1-2
Inspection Gross deformity Gross deformity Swelling (Girth measurement pg 9, volumetric measurement pg 10) Swelling (Girth measurement pg 9, volumetric measurement pg 10) Bilateral symmetry Bilateral symmetry Skin (figure 1-4, page 10) Skin (figure 1-4, page 10) Infection Infection
Palpation Point tenderness Point tenderness Trigger points Trigger points Change in tissue density Change in tissue density Crepitus Crepitus Symmetry Symmetry Increased tissue temperature Increased tissue temperature
Range of Motion Bilateral comparison, normative data Bilateral comparison, normative data Goniometric evaluation – pg 11, Box 1-4 Goniometric evaluation – pg 11, Box 1-4 Planes of the body Planes of the body Active range of motion (AROM) Active range of motion (AROM) Passive range of motion (PROM) Passive range of motion (PROM) Resisted range of motion (RROM) Resisted range of motion (RROM) Break testsBreak tests Manual muscle testingManual muscle testing End -feelsEnd -feels
Ligamentous and Capsular Tests Grading System – pg 15, Table 1-7 Grading System – pg 15, Table 1-7 Laxity vs. instability Laxity vs. instability Special Tests Neurologic Tests Sensory Testing Sensory Testing Motor Testing Motor Testing Reflex Testing Reflex Testing Activity-Specific Functional Testing
On-Field Evaluation of Athletic Injuries Ambulatory vs. athlete-down On-field evaluation must rule out: Inhibition of the cardiovascular and respiratory systems Inhibition of the cardiovascular and respiratory systems Life-threatening trauma to the head or spinal column Life-threatening trauma to the head or spinal column Profuse bleeding Profuse bleeding Fractures Fractures Joint dislocation Joint dislocation Peripheral nerve injury Peripheral nerve injury Other soft tissue trauma Other soft tissue trauma
Disposition of condition Communication plan/emergency action plan Sport specific rules
On-Field History Relatively brief Relatively brief On-Field Inspection Is athlete moving? Is athlete moving? Position of athlete Position of athlete Primary/secondary survey Primary/secondary survey On-Field Palpation Findings may warrant transporting athlete to hospital Findings may warrant transporting athlete to hospital
On-Field Range of Motion Testing AROM first AROM first Weight-bearing status Weight-bearing status On-Field Ligamentous Testing On-Field Neurologic Testing Removal of Athlete From the Field
Termination of the Evaluation Table 1-9, page 25 Standard Precautions Against Bloodborne Pathogens Table 1-10, page 26
The Roles of Different Health Care Professionals Athletic Trainer Physical Therapist School Nurse Emergency Medical Technician Physician Documentation