Injury Assessment & Evaluation

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http://www.youtube.com/watch?v=VFN90gkKHu4

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Objectives

• Define assessment and determine its role

• Define terminology used in injury evaluation

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Injury classifications

• Acute, traumatic

• Overuse, mechanical

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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

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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

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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

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Assessment Situations

• On-the-field assessment• is immobilization &/or transportation needed?• crowd control: players, coaches, officials

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Assessment Situations

• Off-the-field assessment• decisions

1. Extent of injury

2. Immediate treatment (first aid)

3. Playing status

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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

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Evaluation Techniques

• HOPS format1. Consistent, systematic process

2. Format uses subjective information (history)

3. Also objective information (observation & inspection, palpation, and special tests)

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Assessment Terminology

• Etiology

• Mechanism of injury (MOI)

• Pathology

• Prognosis

• Sequela

• Syndrome

• Signs and symptoms (s/sx)

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History

• MOI – mechanism of injury• How did the injury occur?

• Macrotrauma• Microtrauma

• Identifies structures involved

• Relevant sounds or sensations

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History

• Symptoms• Pain

• Location• Type• Referred• Radicular• Daily pain patterns• Provocation and alleviation patterns

• Other symptoms

• Limitations04/21/23 14

Examination goals

• Rule out differential diagnosis

• Determine clinical diagnosis

• Identify impairments and functional limitations

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Observation & Inspection

• Introduction• observing the

injury mechanism

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Observation & Inspection

• athlete presents complaining of pain/discomfort

• assessment begins upon presentation/occurrence

• use discretion

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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

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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

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Palpation

Rule out fractureRule 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.

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Palpation Procedures

• Hands

• Begin proximal to specific injury site

• Palpate painful area last

• Begin w/light touch

• Proceed w/deeper pressure04/21/23 22

Palpation Findings

• Tissue temperature• Swelling• Changes in tissue density• Point tenderness & crepitus• Trigger points

• Cutaneous sensation• Peripheral pulses• Bone palpation & fracture tests

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Peripheral Pulses

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