1. Off-the-Field Evaluation Athletic Medicine I

2. Objectives ● Know: o The organs located in each abdominopelvic quadrant. o Difference between clinical and medical dx. o The order in which evaluations are conducted. o The specifics of HOPS. o What different ROMs are testing for. o How to document injuries.

3. Evaluation of Sports Medicine Injuries ● Four distinct evaluations o Pre-participation o On-the-field o Off-the-field o Progress (during rehabilitation)

4. Diagnoses ● Athletic Trainers offer a clinical diagnosis. o Accurately identifies the pathology of injury, the limitations and possible disabilities associated with a condition. ● Physicians offer a medical diagnosis. o Use of X-rays, MRIs, CT scans, blood tests, etc. o Ultimate determination of a patient’s physical status.

5. Basic Knowledge Requirements ● Athletic trainers must have a thorough knowledge of human anatomy and its function, as well as the sport and its demands.

6. Anatomy ● Surface Anatomy ● Abdominopelvic Quadrants o Quadrants ● Musculoskeletal Anatomy o Bones o Landmarks o Muscles

7. Abdominopelvic Quadrants ●URQ o Liver o Gallbladder ●ULQ o Spleen o Stomach o Liver o Kidney

8. Abdominopelvic Quadrants ●LLQ o Colon ●LRQ o Appendix

10. Activity ● We must understand what demands specific activities place on the body. o Football vs. swimming vs. tennis.

11. Descriptive Assessment Terms ● Etiology: Cause of disease/injury. ● Mechanism: Mechanical description of the cause. ● Pathology: Structural and functional changes that result from injury. ● Sign: Indicator of disease (you can see it). ● Symptom: Change that indicates injury (athlete describes it). ● Diagnosis: Name of a specific condition. ● Prognosis: Predicted outcome of injury. ● Sequela: Condition resulting from disease or injury.

12. Off-the-Field Injury Eval Process ● HOPS o History o Observation o Palpation o Special Tests

13. History ● MOST critical aspect of the evaluation. ● Information obtained: o Mechanism o Chief complaints o Pain location, character, duration, variation, aggravation, distribution, intensity, and course. o Existing conditions.

14. History: 10 Questions ● What’s going on? ● How did it happen? ● When did it happen? ● What did you hear? ● What did you feel? ● Where does it hurt? ●What does it feel like? ●On a scale of 1-10, how bad is the pain? ●Has this happened before? ●Have you done anything for it?

17. Observation ● Usually done while taking a history. ● Things to look for: o Obvious deformity o Limp; abnormal movements o Posture o Facial expression o Edema; redness; bruising o Asymmetries o Abnormal sounds

18. Palpation ● Two types: o Bony  Can reveal abnormal gap in joint, swelling on a bone, joints that are misaligned, or abnormal protuberances associated with a joint or bone. o Soft tissue  Swelling, lumps, gaps, muscle tension, temperature variations.

19. Special Tests ● Designed to detect specific pathologies. ● To decide which tests to perform, take into account all information up to this point. ● Types of special tests: o Movement assessment o Manual muscle testing o Neurological assessment o Joint stability o Functional performance

20. Special Tests: Movement Assessment ● Active Range of Motion (AROM) o Athlete moves joint with no assistance. ● Passive Range of Motion (PROM) o Athletic trainer moves joint with no assistance from the athlete. ● Resisted Range of Motion (RROM) o Athlete moves joint through range against resistance applied by athletic trainer.

21. Special Tests: ROM ● Tells us what types of structures may be involved. o Pain with AROM, PROM and RROM: Most likely bone or ligament. o Pain with AROM and RROM, but not PROM: Most likely muscle.

22. Special Tests: Manual Muscle Testing ● Tests muscular strength ● Places athlete in different positions to test different muscles. ● Athlete holds body part in specific position while the athletic trainer provides resistance.

23. Special Tests: MMT Scale 1: Unable to move affected body part. 2: Unable to hold affected body part against gravity. 3: Able to hold the position against gravity. 4: Able to hold position against gravity and minimal resistance. 5: Able to hold position against gravity and maximal resistance.

24. Special Tests: Neurological Exam ● Five major areas: o Cerebral o Cranial nerve o Cerebellar o Sensory o Reflex ● You only need to do the first three if you suspect a head injury.

25. Special Tests: Sensory Testing ● Dermatome: Area of skin innervated by a single nerve. ● Myotome: Muscle or group of muscles innervated by a specific nerve. ● Need to test: o Superficial sensation o Superficial pain o Deep pain

27. Special Tests: Joint Stability ● Special tests used to test ligaments and cartilage. o i.e. Lachman’s for ACL; McMurray’s for meniscus. o https://www.youtube.com/watch?v=oFWjwxJJmm Q https://www.youtube.com/watch?v=oFWjwxJJmm Q

28. Injury Documentation

29. ● For documenting what we see, there is a specific way we must document. ● Why do we document? o See any changes that are occurring. o Document the treatment that we did.

30. SOAP Notes ● Used to document injuries. ● Subjective (everything the athlete tells you). ● Objective (everything you see feel and measure) ● Assessment (Diagnosis) ● Plan (what are you going to do?)

31. Subjective Pt. is complaining of sharp pain in L ankle. Recalls “rolling” it in a soccer game yesterday when she stepped on an opponent’s foot. Pt. states that pain is 5/10 with walking and 2/10 at rest. Pt. was not able to finish the game. Pt. reports feeling a pop in ankle; did not hear it. Reports spraining ankle last soccer season. After current injury, went home and iced and elevated.

32. Objective Observation: No obvious deformity. Moderate edema over L lateral malleolus. Discoloration distal to lat. mallelous and near phalanges. Walking with obvious limp. Palpation: TTP over distal L lat. malleolus and sinus tarsi. No bone tenderness. No palpable deformity, crepitus. Mild temperature difference when compared bilat. Mild palpable edema.

33. Objective ● ROM o AROM:  Plantarflex: Full when compared bilat., mild pain.  Dorsiflex: Full when compared bilat.  Inversion: Diminished when compared bilat., moderate pain.  Eversion: Full when compared bilat.; mild pain o PROM o RROM o Manual Muscle Test  Plantarflex: 5/5  Dorsiflex: 5/5

34. Objective/Assessment/Plan ● Special Tests: o (-) Bump test o (-) Compression test o (+) Anterior drawer for pain; mild laxity o (+) Talar tilt for pain ● Assessment: L Grade 2 ATFL Sprain ● Plan: RICE ~48 hours; begin ROM exercises when pain subsides.

35. Progress Notes Done periodically during rehabilitation.