Injury Evaluation Process Color of the Day

Why have a process for evaluation?

Injury Evaluation Process  Symptom: Athletes perception of his or her injury.  Sign: Objective, measurable physical finding regarding the individuals condition.  HOPS- History Observation Palpation Special tests  SOAP- Subjective Objective Assessment Plan.

On-Field Assessment  Goals and Purposes  Rule out life-threatening/serious injuries  Determine the location and severity  Determine the method of transport

On-Field Assessment  Primary Survey  Check ABCs  Try to arouse if unconscious  Treat for neck injury if you did not see the injury Breathing Airway Circulation

On-Field Assessment  Secondary Survey  Mechanism of injury  Location of the injury  Severity of injury

On-Field Assessment  Secondary Survey  Strange body Positions  How they react to the injury?  Observe for internal injuries  Deformity, swelling, or discoloration of the extremities.

Off-Field Athletic Injury Assessment  HOPS  History of the injury  Check life threatening situations  History of the injury  History of the individual  Observation and Inspection  Visual inspection  Palpation  Hands on inspection  Special Tests  Test structural integrity  Functional activity tests

HOPS—History History of Injury  Location of Pain  Where does it hurt? (have athlete point to it)  When did it happen?  Sudden or gradual  Associated sounds (snap, crack, pop) Most underrated and overlooked aspect of evaluation  Mechanism of Injury  How did it happen?  If hit, how?  Position of body part when, and after, it happened?

HOPS—History  History of the individual  Former injuries? (when, how occurred, see physician, what rehab, etc.)  Level of training? (when start, when and how much increase)

HOPS—Observation  Observation: Measurable objective signs.  Position of body  Appearance  Symmetry  General Motor Function  Posture and Gait  Look for  Swelling  Deformity  Skin color  Muscle spasm  Facial expression  Scars  General skin condition

HOPS—Palpation  Palpation  Tell athlete it may hurt  Begin gently and gradually increase pressure  Correlate athletes reactions to structures palpated  Start away from suspected injury and gradually work toward it

HOPS—Palpation  Palpation  Rule out FX (fracture)  Skin temperature  Swelling  Point tenderness  Crepitus  Deformity  Muscle spasm  Cutaneous Sensation (nail bed refill)  Pulse

HOPS—Special Tests  Functional Tests  Musculoskeletal – look for abnormal range of motion and/or pain in and around both injured and surrounding joints.  Active ROM – athlete’s voluntary movements  Passive ROM – athletic trainer provides movement  Resistive Manual Muscle Test ROM – athletic trainer provides resistance  Stress Tests  Ligamentous Instability Tests  Special Tests

HOPS—Special Tests  Neurologic Tests  Dermatomes  Myotomes  Reflexes  Peripheral Nerve Testing  Circulation  Feel pulse in injured body part

HOPS—Special Tests  Sport-Specific Functional Testing  Proprioception and Motor Coordination  Sport-Specific Skill Performance  Throw the football, baseball, softball, javelin...  Kick the soccer ball, football, opponent…  Macarena, Cabbage Patch, Mash Potato

HOPS—Special Tests  Sport Specific Tests  Use only for mild injuries  Use the injured body part to perform skill  Begin with very simple skills to complex  Begin at half speed and progress to full speed  Do not allow any activity that causes pain  Determine if athlete can perform normally  Observe performance, looking for smooth, fluid motion  Question athlete concerning pain or other abnormal feeling.

SUMMARY OF THE ATHLETIC INJURY EVALUATION PROCESS  Make a decision concerning the nature and severity of the injury  Draw together all of the previous evidence  Based on the decision, use any or all of the following procedures that are dictated by the situation.

SUMMARY OF THE ATHLETIC INJURY EVALUATION PROCESS After the Initial Evaluation ? Apply emergency first aid ? Allow to continue participation ? C.E.M. ? Refer to Physician

Physician Ordered Tests  Blood Test  Radiographs  Computed Tomography  Magnetic Resonance Imaging (MRI)  Radionuclide Scintigraph (Bone Scan)  Ultrasonic Imaging  Electromyography

SUMMARY OF THE ATHLETIC INJURY EVALUATION PROCESS  Re-evaluate  Throughout rehabilitation  Record Findings  SOAP

SOAP- Subjective  Subjective: Attitude, mental condition, and perceived physical state  Stated by the athlete  Primary Complaint  Mechanism of Injury  Characteristics of the Symptoms  Limitations  Past History

SOAP- Objective:  Observation: Measurable objective signs.  Appearance  Symmetry  General Motor Function  Posture and Gait  Deformity, swelling, discoloration, scars, and general skin condition

SOAP- Objective  Palpation  Rule out FX (fracture)  Cutaneous Sens.  Skin temperature  Pulse  Swelling  Point tenderness  Crepitus  Deformity  Muscle spasm

SOAP- Objective  Special Tests  Functional Tests  Active Range of Motion (AROM)  Passive Range of Motion (PROM)  Resisted Manual Muscle Testing (RROM)  Stress Tests  Ligamentous Instability Tests  Special Tests

SOAP- Objective  Special Tests  Neurologic Tests  Dermatomes  Myotomes  Reflexes  Peripheral Nerve Testing  Sport-Specific Functional Testing  Proprioception and Motor Coordination

SOAP- Objective  Special Tests  Sport-Specific Skill Performance  Throw the football, baseball, softball, javelin...  Kick the soccer ball, football, opponent…  Macarena, Cabbage Patch, Mash Potato

SOAP- Assessment  Assessment: Analyze and assess the individual’s status and prognosis  Set Goals  Suspected injury Site  Damaged Structures Involved  Severity of Injury  Progress Notes

SOAP- Plan  Plan: How to treat and heal injury to return to play 1. Immediate treatment given 2. Frequency and duration of treatments and modalities and evaluation 3. On-going patient education 4. Criteria for discharge/return to play