Assessment and Evaluation of Injuries

Assessment/Evaluation An important proficiency for everyone on the athletic care team

Athletic Injuries Assessment refers to the orderly collection of objective and subjective data on the athlete’s health status. Diagnosis uses information from the assessment and physical examination to establish the cause and nature of the athlete’s injury; it may be made only by a physician or licensed health care provider.

Factors Influencing Athletic Injuries Anthropomorphic data, which includes statistics on an athlete’s size, weight, body structure, gender, strength, and maturity level, provides essential information to health care providers.

Factors Influencing Athletic Injuries (cont.) Mechanism of force involves an evaluation of all the forces involved at the time of an impact (direction, intensity, duration, activity, and body/ body part position). Speed at which the injury occurred affects the extent and severity of the injury.

Factors Influencing Athletic Injuries (cont.) Protective equipment can reduce the severity of injury and prevent injury. The athlete’s skill level may also play a role; beginners are more prone to injury than more advanced athletes.

Primary Injury Survey The first focus of those on the scene of an injury involves assessment of life-threatening emergencies and management of the airway, breathing, and circulation.

Is the patient having difficulty breathing? Airway and  Arterial Bleeding Is the patient having difficulty breathing? Are there mandibular fractures interfering with the airway? Has a wound disrupted the larynx or trachea? Is subcutaneous emphysema present? Is there evidence of arterial hemorrhage? Breathing Is the patient in respiratory distress? What is the color of the mucous membranes? Does the respiratory distress worsen with positional changes? Is there evidence of thoracic penetration or a flail chest? Are the peripheral veins distended?

Circulation Is there evidence of hemorrhage? Is there an extremity fracture?  How much swelling is present? Are the mucous membranes pale and tacky? Are the femoral pulses weak and rapid? Does the heart rate match the pulse rate? Are the extremities cold? Is the capillary refill time prolonged? Is the pulse pressure weak? Is the person anemic or excessively hemodiluted? Disability Is there evidence of a neurological injury? What is the motor posture of the person? Is the person bright, alert and responsive? Does the person respond to painful stimuli? Are the pupils dilated, constricted, of equal size, and responsive to light? Is there an extremity fracture that might threaten a peripheral nerve? Examination Are there lacerations? Is there bruising and is the bruising getting worse? Are there multiple fractures? Is the abdomen painful? Is there evidence of debilitation or concurrent disease?

Head-Tilt vs. Jaw-Thrust The head-tilt, chin-lift maneuver should be used to open the airway only if there is no suspicion of spinal injury; otherwise, the jaw-thrust maneuver (right) should be used.

Secondary Injury Survey A thorough, methodical evaluation of an athlete’s overall health to reveal additional injuries beyond the initial injury. The HOPS approach is common to the secondary injury survey: History, Observation, Palpation, and Special tests.

Pain Evaluation A scale can be used to evaluate how much pain the injured athlete is in: 0 No pain 1-3 Minimal pain 4-6 Moderate pain 7-9 Severe pain 10 Emergency room pain

Palpation Palpation refers to touching the athlete during examination to determine the extent of injury. Palpation should be firm enough to produce pain if injury is present. Too light a touch may result in overlooking a significant injury.

Active/Passive Motion Active motion is movement by the athlete through the range of motion during examination. Passive motion is movement done by the examiner through the range of motion while the athlete relaxes the muscles.

Activity Functional activity refers to the level of movement at which the athlete can comfortably work and participate. Sport-specific activity involves particular types of movement and actions that are needed in or related to a particular sport.

Return-to-Play Criteria The athlete must exhibit 100% strength in the injured area. The athlete must be free from pain. Skill performance tests must be taken to determine the athlete’s ability to return to play. The athlete must exhibit emotional readiness to return to the chosen activity.

SOAP Notes This is a particular format for recording information regarding treatment procedures: Subjective notes include subjective statements made by the injured athlete Objective notes include the certified athletic trainer’s visual inspection, palpation, and assessment of active, passive, and resistive motion.

SOAP Notes (cont.) Assessment of the injury is the certified athletic trainer’s professional judgment and impression as to the nature and extent of injury. Plan refers to First Aid treatment rendered and the sports therapist’s intentions as to disposition (what is to be done next).

Daily Sideline Report Tracks each athlete who participates in a sport Tracks injuries, missed practices, and limited practice abilities May reveal injury patterns that should be addressed with the athlete

Training-Room Treatment Log Anyone receiving attention from the ACT is logged. Log data includes name, date, injury, treatment provided, and follow-up care required.

Daily Red Cross List Documentation used to inform coaches of the status of their athletes’ health and injuries.