Injury Assessment & Evaluation 10/8/

10/8/20152

Objectives Define assessment and determine its role Define terminology used in injury evaluation 10/8/20153

Injury classifications Acute, traumatic Overuse, mechanical 10/8/20154

Objectives Describe the events of the musculoskeletal evaluation (HOPS) Identify specific components in a history of an injury Describe what is involved in observation & inspection of an injury site Identify principles used in palpation, ROM testing, neurological testing & special tests 10/8/20155

Differential Diagnosis Diagnosis: definitive determination of disease, injury, or syndrome a person has or is believed to have Differential diagnosis: Method of diagnosing when unique S/Sx lacking 10/8/20156

Assessment Situations On-the-field assessment primary survey render a decision regarding injury severity 1. r/o fracture or dislocation 2. Check for joint stability or muscle rupture 3. Control severe bleeding 4. Test for neurological conditions 10/8/20157

Assessment Situations On-the-field assessment is immobilization &/or transportation needed? crowd control: players, coaches, officials 10/8/20158

Assessment Situations Off-the-field assessment decisions 1. Extent of injury 2. Immediate treatment (first aid) 3. Playing status 10/8/20159

Introduction to Assessment Role of the ATC when emergency care is not required 1. To determine the nature of the illness or injury 2. To determine the need for MD for further exam 3. OR treating the athlete according to routine SO’s 10/8/201510

Evaluation Techniques HOPS format 1. Consistent, systematic process 2. Format uses subjective information (history) 3. Also objective information (observation & inspection, palpation, and special tests) 10/8/201511

Assessment Terminology Etiology Mechanism of injury (MOI) Pathology Prognosis Sequela Syndrome Signs and symptoms (s/sx) 10/8/201512

History MOI – mechanism of injury How did the injury occur? Macrotrauma Microtrauma Identifies structures involved Relevant sounds or sensations 10/8/201513

History Symptoms Pain Location Type Referred Radicular Daily pain patterns Provocation and alleviation patterns Other symptoms Limitations 10/8/201514

Examination goals Rule out differential diagnosis Determine clinical diagnosis Identify impairments and functional limitations 10/8/201515

Observation & Inspection Introduction observing the injury mechanism 10/8/201516

Observation & Inspection athlete presents complaining of pain/discomfort assessment begins upon presentation/occurrence use discretion 10/8/201517

Observation & Inspection Observation - scan exam assesses general motor function  Gait  Posture  Function  Guarding  Splinting r/o injuries at other joints/areas note willingness & ability to move general posture consistency in motions 10/8/201518

Observation & Inspection Inspection of injury site Deformities – subtle or gross Swelling – effusion or edema Discoloration – redness or ecchymosis Infection signs scars general skin condition BILATERAL comparison 10/8/201519

10/8/ Palpation Rule out fracture Skin temperature Swelling Point tenderness Vascular pulses Crepitus Muscle spasm Deformity Sensory changes

Palpation strategies Sequencing strategy #1 Bones Ligaments Muscles and tendons Sequencing strategy #2 Palpate all structures Begin away from pain site and progress toward suspected injury. 10/8/201521

Palpation Procedures Hands Begin proximal to specific injury site Palpate painful area last Begin w/light touch Proceed w/deeper pressure 10/8/201522

Palpation Findings Tissue temperature Swelling Changes in tissue density Point tenderness & crepitus Trigger points Cutaneous sensation Peripheral pulses Bone palpation & fracture tests 10/8/201523

Peripheral Pulses 10/8/201524