Download Chapter 13: Off-the Field Injury Evaluation

Chapter 13: Off-the-Field
Injury Evaluation
© 2011 McGraw-Hill Higher Education. All rights reserved.
Evaluation of Injuries
• Essential skill for athletic trainers
• Four distinct evaluations
– Pre-participation (prior to start of season)
– On-the-field assessment
– Off-the-field evaluation (performed in the
clinic/training room…etc)
– Progress evaluation
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Clinical Evaluation &
Diagnosis
• Diagnosis
– Use of clinical or scientific methods to
establish cause and nature of patient’s illness
or injury and subsequent functional
impairment due to pathology
– Forms basis for patient care
• Physicians make medical diagnosis
– Ultimate determination of patient’s physical
condition
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• Athletic trainers and other health care
professionals use evaluation skills to
make clinical diagnoses
– Clinical diagnosis identifies pathology and
limitations/disabilities associated with
pathology
• Athletic trainers have academically-based
credential and in many states some form
of regulation which recognizes ability and
empowers clinician to make accurate
clinical diagnosis
© 2011 McGraw-Hill Higher Education. All rights reserved.
Basic Knowledge Requirements
• Athletic trainer must have general knowledge
of anatomy and biomechanics as well as
hazards associated with particular sport
• Anatomy
– Surface anatomy
• Topographical anatomy is essential
• Key surface landmarks provide examiner with
indications of normal or injured structures
– Body planes and anatomical directions
• Points of reference (midsagittal, transverse, and frontal
(coronal) planes)
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– Abdominopelvic Quadrants
• Four corresponding regions of the abdomen
• Divided for evaluative and diagnostic purposes
• A second division system involves the
abdomen being divided into 9 regions
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– Musculoskeletal Anatomy
• Structural and functional anatomy
• Encompasses bony and skeletal musculature
• Neural anatomy useful relative to motion,
sensation, and pain
– Standard Terminology
• Used to describe precise location of structures and
orientation
• Biomechanics (foundation for assessment)
– Application of mechanical forces which may
stem from within or outside the body to living
organisms
– Pathomechanics - mechanical forces applied
to the body due to structural deviation leading to faulty alignment (resulting in
overuse injuries)
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• Understanding the Activity
– More knowledge of activity allows for more
inherent knowledge of injuries associated
with activity resulting in more accurate clinical
diagnosis and rehab design with appropriate
functional aspects incorporated for return to
activity
– Must be aware of proper biomechanical and
kinesiological principles to be applied in
activity
– Violation of principles can lead to repetitive
overuse trauma
– Increased understanding = better
assessment and care
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• Descriptive Assessment Terms
– Etiology - cause of injury or disease
– Mechanism – mechanical description of
cause
– Pathology - structural and functional
changes associated with injury process
– Symptoms- perceptible changes in body or
function that indicate injury or illness
(subjective)
– Sign - objective, definitive and obvious
indicator for specific condition
– Degree- grading for injury/condition
– Diagnosis- denotes name of specific
condition
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– Prognosis- prediction of the course of the
condition
– Sequela - condition following and resulting
from disease or injury (pneumonia resulting
from flu)
– Syndrome - group of symptoms and signs that
together indicate a particular injury or disease
– Differential diagnosis – systematic method of
diagnosing a disorder
•
•
•
•
Refers to a list of possible causes
Prioritizing of possibilities
Also referred to as hypothesis or working diagnosis
Utilize skills to make decision regarding condition
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Off-the-field Injury Evaluation
• Detailed evaluation on sideline or in clinic
setting
• May be the evaluation of an acute injury
or one several days later following acute
injury
• Divided into 4 components
– History, observation, palpation and special
tests
– HOPS
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• History
– Obtain subjective information relative to
how injury occurred, extent of injury, MOI
– Inquire about previous injuries/illnesses
that may be involved as well as past
treatments
– Ask the following questions
•
•
•
•
•
What is the problem?
How and when did it occur?
Did you hear or feel something?
Which direction did the joint move?
Characterize the pain
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• Observations
– Asymmetries, postural mal-alignments or
deformities?
– How does the athlete move? Is there a
limp?
– Are movements abnormal?
– What is the body position?
– Facial expressions?
– Abnormal sounds?
– Swelling, heat, redness, inflammation,
swelling or discoloration?
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• Palpation
– Bony & soft tissue
• Special Tests
– Used to detect specific pathologies
– Compare inert and contractile tissues and their
integrity
– Assessment should be made bilaterally
• Range of Motion Assessment
– Active
– Passive
• Normal vs. Abnormal end points
• Manual muscle tests
• Goniometric measures vs. Digital inclinometers
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Figure 13-4 A & B
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• Neurologic and circulation assessments
– Brain
• Cerebral, cranial nerve function, cerebellar function
– Sensory & motor function
• Dermatome
– Area of skin innervated by a single nerve
• Myotome
– Muscle or group of muscles innervated by a specific
motor nerve
– Reflex testing
• Involuntary response to a stimulus
– Deep tendon – caused by stimulation of stretch reflex
– Superficial – stimulation of skin which causes reflexive
muscle contraction
– Pathological – superficial reflex indicative of upper motor
neuron lesion
» Babinski’s sign, Chaddock’s, Oppenheim’s Gordon’s
– Referred pain
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Figure 13-5
© 2011 McGraw-Hill Higher Education. All rights reserved.
•
•
•
•
Motor Testing
Testing Joint Stability
Testing Accessory Motions
Testing Functional Performance
– Used to determine athletes readiness to
participate or continue participation
• Other tests
– Postural
– Anthropometric
– Volumetric
Figure 13-6
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Documenting Injury Evaluation
Information
• Complete and accurate documentation
is critical
• Clear, concise, accurate records is
necessary for third party billing
• While cumbersome and time
consuming, athletic trainer must be
proficient and be able to generate
accurate records based on the
evaluation performed
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• SOAP Notes
– Record keeping can be performed
systematically which outlines subjective &
objective findings as well as immediate and
future plans
– SOAP notes allow for subjective &
objective information, the assessment and
a plan to be implemented
– S (subjective)
• Statements made by patient - primarily history
information and patient’s perceptions including
severity, pain, MOI
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– O (Objective)
• Findings based on athletic trainer’s evaluation
– A (Assessment)
• Athletic trainer's professional opinion regarding
impression of injury
• May include suspected site of injury and
structures involved along with rating of severity
– P (Plan)
• Includes first aid treatment, referral information,
goals (short and long term) and examiner’s
plan for treatment
© 2011 McGraw-Hill Higher Education. All rights reserved.