Chapter 13: Off-the Field
Injury Evaluation Notes
Evaluation of Sports Injuries
Essential skill
Four distinct evaluations
1.
2.
3.
4.
Injury Evaluation vs.
Diagnosis
Basic Knowledge Requirements
General knowledge of anatomy,
biomechanics and Anatomy
Body planes and anatomical
directions
Points of reference
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
–Musculoskeletal
Anatomy
Understanding the Sport
More knowledge of sport
allows for more inherent knowledge of injuries associated with sport and better
injury assessment
Descriptive Assessment Terms
–Etiology
-
–Pathology
-
–Symptoms-
–Sign
-
–Degree-
–Diagnosis-
–Prognosis-
–Sequela
-
–Syndrome
–
Off-the-field Injury
Evaluation
Divided into 4 components
–History,
observation, palpation and special tests
–HOPS
History
Observations
–How
does the athlete move? Is there a limp?
–Are
movement abnormal?
–What
is the body position?
–Facial
expressions?
Palpation
Compare bilaterally
Look for abnormal gapping,
swelling, abnormal protuberances associated with bone or joint
Soft tissue
Special Tests
Active Range of Motion (AROM)
Passive Range of Motion
(PROM)
Abnormal
–Empty
-
–Spasm
-
–Loose
-
–Springy
block -
Throughout PROM ATC looking
for limitation in movement and presence of pain
Resisted Motions (RROM)
Evaluate status of
contractile tissue
Isometric contraction at mid
range
Different from manual muscle
test which occurs throughout ROM
Different grading systems
used to identify severity and degrees of strength (Cyriax)
Goniometric Measurements
Measure joint ROM (degrees)
Full ROM is major factor in
determining return to activity
To perform measurement
goniometer is placed on lateral aspect of extremity, with 0 or starting
position in anatomical positions
Goniometric measurement of
hip joint flexion.
Manual Muscle Testing
Used to determine vary extent
of injury to contractile tissue
Limitation in muscular
strength is generally caused by pain
Generally performed so muscle
or group of muscles can be isolated and tested through a full range while
applying manual resistance
Test 5 major areas (cerebral,
cranial nerve, cerebellar, sensory functioning, reflex testing and referred
pain)
Most musculoskeletal injuries
do not require cranial, cerebral or cerebellar assessment and exam can focus on
peripheral neurological functioning
Cerebral functioning
–Questions
assess general affect, consciousness, intellectual performance, emotional
status, sensory interpretation, thought content, and language skills
Cranial Nerve function
–Quality
assessed through assessments of smell, eye tracking, facial expressions, biting
down, balance, swallowing, tongue protrusion, and shoulder shrug
Cerebellar Function
–Control
of purposeful coordinated movement
–Touch
finger to nose, finger to finger, heel-toe walking
Sensory Testing
Determine distribution of
dermatomes and peripheral nerves
Assess
Superficial sensation
Superficial pain
Deep pressure pain
Sensitivity to temperature
Sensitivity to vibration
Position sense
€Reflex testing
–Reflex
refers to involuntary response to a stimulus
–Three
types - deep tendon, superficial and pathological
Deep tendon reflex
(somatic)
Caused by stimulation of
stretch reflex
Biceps (C5) brachioradialis
(C6) triceps (C7) patella (L4) Achilles (S1)
Superficial reflexes
Elicited by stimulation of
skin at specific sites producing muscle contraction
Upper abdominal (T7,8,9),
lower abdominal (T11, 12) cremasteric (S1, 2), gluteal (L4, S3)
Absence of reflex = lesion of
cerebral cortex
Pathological
Also superficial reflexes
Indicative of lesion in
cerebral cortex
Babinski¹s sign, Chaddock¹s,
Oppenheim¹s, Gordon¹s
Postural Examination
Many conditions can be
attributed to body malalignment
Used to look at asymmetries
by comparing body relative to grid or plumb line
–Anthropometric
Measurements
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
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)
Progress Notes
Other types of evaluations
possible
Plain Film Radiographs
(X-ray)
Arthrography
Arthroscopy
Myelography
Computed Tomography (CT scan)
Bone Scan
Ultrasonography
Magnetic Resonance Imaging
(MRI)
Echocardiography
Electroencephalography (EEG)
Electromyography (EMG)
Nerve Conduction Velocity
Synovial Fluid Analysis
Blood Test
Urinalysis