Download Injury Evaluation - Mr. Frey

Injury Evaluation
Athletic Training
Mr. Frey
The Step by Step Injury Evaluation
Process
Injury History
Inspection and Observation
Pain and Palpation
Range of Motion
Manual Muscle Testing
Special Test
Functional Testing
Physical Referral / Diagnostic Tests
Injury History
Who? What? When? How?
Asking questions to find out what injury occurred.
A good thorough Injury History will often tell you
what the injury is without physically touching the
individual
With an acute injury, it is important to get an
accurate Injury History right away…Why?
What are some questions you should ask during
injury history?
– Questions that would help you figure out what is wrong
Injury History Questions
What happened or How did it happen?
– Injury mechanism
When did it happen?
Did this injury ever happen before?
Are you taking any medications?
Any relevant surgeries?
Is this your dominant side?
What sport do you play or even what position do you play?
Do you have any pain anywhere else on your body?
Do you have any allergies?
Did you hear or feel a anything (“pop”)
Inspection and Observation
Signs and symptoms
Signs
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Swelling
Echymosis
Deformity
Carrying Angle
Bleeding
Discoloration
Symptoms
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Dizziness
Headache
Nausea
Memory loss
Retrograde
Post-traumatic
***Bilateral
Comparison – to know
what is normal for
that person you
compare the injured
part of the body to the
uninjured part
Pain and Palpation
Palpate specific anatomical structures
– distal to proximal to the injury
– Pain on bone = contusion, fracture or maybe dislocation
/ subluxation
– Pain on ligament = contusion or sprain
– Pain on muscle or tendon = contusion, strain, tendonitis
or perhaps bursitis
Pain
– Type of pain: burning, stinging, tingling, etc…
– Grade your pain on a scale of 1 to 10
Remember pain is relative to each individual
– Does the pain change with: movement, weight bearing,
exertion, etc…
Range of Motion (ROM)
Active AROM
Passive PROM
Goniometer – quantify the ROM (put
an exact measurement or number to
it)
Bilateral Comparison
Joint Clearing – check the joint
immediately distal and immediately
proximal to the “injured” joint
Manual Muscle Testing
Manual assessment of strength
You apply steady resistance throughout
the ROM to assess muscular strength.
Scale
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5/5
4/5
3/5
2/5
1/5
0/5
full ROM against a full resistance
full ROM against a partial resistance
full ROM against gravity
full ROM with gravity eliminated
no ROM but signs of muscle contraction
no ROM and no signs of contraction
***Bilateral Comparison
Special Tests
Very specific test that assess certain
injuries
Example: Thompson Test – assess Achilles
tendon rupture
Special tests for fracture
– Tap test
– Longitudinal compression test
– See-saw test
Functional Test
Progression of activities that get more
challenging
Lower body –
– Walk straight ahead, jog straight ahead,
jumping or hopping, sprint straight ahead,
running figure eights (big and small), cutting,
side shuffles, cross-over running, sport specific
activities
Sport Specific activities are specific to the
sport and even to the position within that
sport
– Basketball – lay-up drills, rebounding drills,
“suicides”, defensive shuffles, pivoting
– Football Lineman – 5 yard bursts, footwork
drills, monkey rolls, blocking drills
Physician Referral
By law, only a physician can diagnose an
injury
– Physician can give “standing orders”
Only a physician can refer for diagnostic
testing
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X-ray
MRI
CT scan
Blood Work
Bone Scan
Injury example
Lateral Ankle Sprain
Injury History
Injury mechanism: excessive inversion or
excessive plantarflexion with inversion
History of ankle sprains would make the
person more likely to sprain the ankle
again
Type of sport, footwear, playing surface
could predispose someone to sprain their
ankle
They will sometimes hear or feel a “pop”
Person usually says “they landed on
something or landed in a hole or an
uneven surface”
Inspection and Observation
Swelling and possibly echymosis in either
over or just below the lateral malleolus
– Possible even distal to the ankle joint
Possible deformity (indicating fracture)
Point tender to the touch: specifically over
the three ligaments on the medial side of
the ankle
Carrying angle for ankle injuries: Limping
on your heel or unable to bear weight at
all
**Bilateral Comparison will tell me what is
normal for that person
Pain and Palpation
Pain will depend on the severity of
the injury and the person tolerance
for pain
– The pain will increase will weigh-bearing
Especially going up and down stairs and
changing directions
Range of Motion
Limited AROM and PROM in all
motions. Especially Plantarflexion,
Dorsiflexion and Inversion
Goniometric measurements
Joint clearing- check the toes and
foot as well as the knee
– A simple squat would clear all joints
Manual Muscle Testing
Acutely – 0/5 -1/5
Within a few hours to a few days –
2/5 – 4/5
Functional Test
Take the patient through the
functional test noting at what level
they are immediately following the
injury
Throughout the rehabilitation process
and at the end of the rehab process
you will retake them through the
progression to make sure that they
are improving and can ultimately
return to activity
Special Tests
Fracture tests –tap, see-saw,
longitudinal compression
Anterior drawer, posterior drawer,
inversion stress test
Physician Referral
Diagnostic tests needed:
– X-ray – to rule out fracture
– Possible MRI to assess ligamentous
damage