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Chapter 11 Assessment and Evaluation of Sports Injuries Objectives Explain the difference between assessment, evaluation, and diagnosis of an injury. Describe the various factors that influence the type and severity of athletic injuries. Evaluate an athletic injury using the systematic approach. Explain the different methods and reasons for documenting injuries Assessment Assessment: orderly collection of objective and subjective data on the athlete’s health status Collect medical history Objective vs Subjective Palpation ROM Special Tests Diagnosis Diagnosis: Using information from assessment and physical examination findings to establish the cause and nature of the athlete’s injury or disease Made only by physician or other licensed health care provider Must remember to work in scope of practice Influencing Factors Anthropomorphic Data: size, weight, body structure, gender, strength, and maturity level College vs High School Mechanism of Force: all forces involved at the time of impact Direction, intensity, duration, position of body Influencing Factors Speed: influence type and severity of injury Greater speed usually equals greater chance of injury Athletes should compete against athletes of similar level Influencing Factors Protective Equipment: better equipment has helped keep number of injuries down. Make sure equipment is worn properly Skill Level: beginners are at a greater risk for injury due to being unfamiliar with basic techniques Primary Injury Survey Check for serious, life-threatening injuries Activate EMS if needed CAB’s Circulation: Check for pulse, coughing, movement Airway: Open airway using head tilt/chin lift or jaw thrust Breathing: Listen, look and feel for signs of breathing Head Tilt vs Jaw Thrust Head tilt, chin-lift is used to open airway of an unconscious person Jaw thrust opens the airway when a spinal injury is suspected Secondary Injury Survey Secondary injury survey is a thorough, methodical evaluation of an athlete’s overall health to reveal additional injuries beyond the initial injury HOPS History Observation Palpation Special Tests History What happened? When did injury occur? Did you hear a sound? Where is the pain? What type of pain? Pain Scale? Neurological function? Prior history? Observation What do you see? Compare injured to uninjured side Deformity? Swelling? Bleeding? Bruising or ecchymoses? Palpation Palpation is the touching of the injured athlete Examine uninjured side first Palpate firmly enough to produce pain if present Watch for facial expressions or wincing Palpate one joint above and below injury Special Tests Active range of motion: athlete moves body part through range Passive ROM: examiner moves body part through range Strength: isometric and through ROM Stability: ligament laxity tests Special Tests Activity Functional activity: level of movement the athlete can comfortably participate in Run, hop, sprint, cut, twist Sport-specific activity: movements related to a particular sport Volleyball spike Basketball shot Soccer kick Return to Play 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. Soft Tissue Injury Abrasions: occurs when several layers of skin are torn loose Laceration: tear in the skin Stitches if more than ¼ inch deep and ½ inch long Soft Tissue Injury Avulsion: injury where skin is torn off Keep skin flap if possible Puncture: caused by sharp, pointed objects High risk of infection Care of Soft Tissue Injuries Clean wound Make sure it is free of dirt and debris Apply antibiotic ointment Help prevent infection and keeps dressing from sticking to wound Apply bandages or non-adherent pad Check for signs of infection Signs of Infection Swelling Heat Angry Redness Pus Streaks Injury to Muscle Strain: caused by twisting or pulling a muscle Overuse or acute Signs and symptoms: pain, spasm, weakness May feel deficit in severe strains RICE Rehab to increase flexibility and strength Injury to Ligaments Sprain: results from a fall, sudden twist, or blow to the body that forces a joint out of its normal position S/S: pain, swelling, bruising, loss of ROM Severity is classified by grades Grade I: Mild Grade II: Moderate Grade III: Severe Tendonitis Tendon: fibrous tissue that connects muscle to bone Tendonitis: inflammation of the tendon Typically worse after activity and at night Caused by overuse Treat with rest, ice, NSAIDs, ultrasound, rehab Bursitis Bursa: located throughout the body to decrease friction between two surfaces Bursitis: inflammation of a bursa Joint pain with movement and at night Contusions Direct blow that does not break the skin Usually includes ecchymosis or bruising Myositis Ossificans Documentation of Injuries SOAP note Subjective, Objective, Assessment, Plan Daily Injury Report Communication between coaches on status of athletes AT room treatment log Athletes receiving treatments should be logged in