Off-the-Field Injury Evaluation Detailed evaluation on sideline or in clinic setting May be the evaluation of an acute injury or one several days later following acute injury Divided into 4 components History, observation, palpation and special tests HOPS

Evaluation of Injuries Essential skill for athletic trainers Four distinct evaluations Pre-participation (prior to start of season) On-the-field assessment Off-the-field evaluation (performed in the clinic/training room…etc) Progress evaluation

Clinical Evaluation & Diagnosis Diagnosis Use of clinical or scientific methods to establish cause and nature of patient’s illness or injury and subsequent functional impairment due to pathology Forms basis for patient care Physicians make medical diagnosis Ultimate determination of patient’s physical condition

Understanding the Activity More knowledge of activity allows for more inherent knowledge of injuries associated with activity resulting in more accurate clinical diagnosis and rehab design with appropriate functional aspects incorporated for return to activity Must be aware of proper biomechanical and kinesiological principles to be applied in activity Violation of principles can lead to repetitive overuse trauma Increased understanding = better assessment and care

Descriptive Assessment Terms You will need to know Etiology - cause of injury or disease Mechanism – mechanical description of cause Pathology - structural and functional changes associated with injury process Symptoms- perceptible changes in body or function that indicate injury or illness (subjective) Sign - objective, definitive and obvious indicator for specific condition Degree- grading for injury/condition Diagnosis- denotes name of specific condition

Terms you will need to know Prognosis- prediction of the course of the condition Sequela - condition following and resulting from disease or injury (pneumonia resulting from flu) Syndrome - group of symptoms and signs that together indicate a particular injury or disease Differential diagnosis – systematic method of diagnosing a disorder Refers to a list of possible causes Prioritizing of possibilities Also referred to as hypothesis or working diagnosis Utilize skills to make decision regarding condition

Off-the-field Injury Evaluation Detailed evaluation on sideline or in clinic setting May be the evaluation of an acute injury or one several days later following acute injury Divided into 4 components History, observation, palpation and special tests HOPS

History Obtain subjective information relative to how injury occurred, extent of injury, MOI Inquire about previous injuries/illnesses that may be involved as well as past treatments Ask the following questions What is the problem? How and when did it occur? Did you hear or feel something? Which direction did the joint move? Characterize the pain

Observations Asymmetries, postural mal-alignments or deformities? How does the athlete move? Is there a limp? Are movements abnormal? What is the body position? Facial expressions? Abnormal sounds? Swelling, heat, redness, inflammation, swelling or discoloration?

Palpation Bony & soft tissue Special Tests Used to detect specific pathologies Compare inert and contractile tissues and their integrity Assessment should be made bilaterally Range of Motion Assessment Active Passive Normal vs. Abnormal end points Manual muscle tests Goniometric measures vs. Digital inclinometers

Documenting Injury Evaluation Information Complete and accurate documentation is critical Clear, concise, accurate records is necessary for third party billing While cumbersome and time consuming, athletic trainer must be proficient and be able to generate accurate records based on the evaluation performed

SOAP Notes Record keeping can be performed systematically which outlines subjective & objective findings as well as immediate and future plans SOAP notes allow for subjective & objective information, the assessment and a plan to be implemented S (subjective) Statements made by patient - primarily history information and patient’s perceptions including severity, pain,

SOAP O (Objective) Findings based on athletic trainer’s evaluation A (Assessment) Athletic trainer's professional opinion regarding impression of injury May include suspected site of injury and structures involved along with rating of severity P (Plan) Includes first aid treatment, referral information, goals (short and long term) and examiner’s plan for treatment

Additional Diagnostic Tests Due to the need to diagnose and design specific treatment plans, physicians have access to additional tools to acquire additional information relative to an injury There are a series of diagnostic tools that can be utilized in order to more clearly define and determine the problem that exists

Additional Diagnostic Tests Plain Film Radiographs (X-ray)  Used to determine presence of fractures bone abnormalities and dislocations  Can be used to rule out disease (neoplasm)  Occasionally used to assess soft tissue Arthrography  Visual study of joint via X-ray after injection of dye, air, or a combination of both  Shows disruption of soft tissue and loose bodies Arthroscopy  Invasive technique, using fiber-optic arthroscope, used to assess joint integrity and damage  Can also be used to perform surgical procedures

X-Ray

Myelography ◦ Opaque dye injected into epidural space of spinal canal (through lumbar puncture) ◦ Used to detect tumors, nerve root compression and disk disease and other diseases associated with the spinal cord Computed Tomography (CT scan) ◦ Penetrates body with thin, fan-shape X-ray beam ◦ Produces cross sectional view of tissues ◦ Allows multiple viewing angles Bone Scan ◦ Involves intravenous introduction of radioactive tracer ◦ Used to image bony lesions (i.e. stress fractures) in which there is inflammation

CT Scan

Bone Scan and DEXA Scan DEXA Scan Dual energy X-ray absorptiometry Used to measure bone mineral density Greater mineral density = greater signal picked up Documents small changes in bone mass Used on both spine and extremities Less expensive, less radiation exposure More sensitive and accurate for measuring subtle bone density changes over time

Magnetic Resonance Imaging Magnetic Resonance Imaging (MRI) ◦ Using powerful electromagnet, magnetic current focuses hydrogen atoms in water and aligns them ◦ After current shut off, atoms continue to spin emitting different levels of energy depending on tissue type, creating different images ◦ While expensive, it is clearer than CT scan and the test of choice for detecting soft tissue lesions MRI Arthrography ◦ Imaging study involving injection of contrast agent into joint prior to MRI ◦ Allows for more detailed assessment of joint vs. traditional MRI ◦ Contrast agent allows for highlighting of certain areas