| EVALUATION OF SPORTS INJURIES 1. Preparticipation examination; done prior to the start of preseason practice 2. On-the-filed injury assessment; done immediately after acute injury to determine the immediate course of acute care, necessary first aid, and handling of emergency situations 3. Off-the-field injury assessment; done in the training room, clinic, emergency room, or physician’s office after appropriate first aid has been rendered 4. Progress evaluation; done periodically throughout the rehabilitative process for determining the progress and effectiveness of a specific treatment regimen. INJURY EVALUATION VERSUS DIAGNOSIS - Athletic trainers recognize and evaluate sports injuries, but by law they cannot make diagnoses. BASIC KNOWLEDGE REQUIREMENTS The examiner of sports injuries must have a thorough knowledge of human anatomy and its function and of the hazards inherent in sports. NORMAL HUMAN ANATOMY Surface Anatomy (topographical anatomy) Body planes and anatomical directions Midsagittal plane Transverse plane Frontal (or coronal) plane Abdominopelvic quadrants Musculoskeletal System Anatomy Standard Musculoskeletal terminology for bodily positions and deviations Biomechanics Biomechanics = Application of mechanical forces to living organisms Pathomechanics = Mechanical forces that are applied to a living organism and adversely change the body’s structure and function. Understanding the Sport Kinesiological and biomechanical principles should be applied. Descriptive Assessment Terms Etiology = Cause of disease Pathology = Structural and functional changes that result from injury Symptom = Change that indicates injury or disease Sign = Indicator of a disease Grade – 1,2, or 3 / mild, moderate, or severe Diagnosis = Name of a specific condition Prognosis = Predicted outcome of an injury Sequela = Condition resulting from disease or injury Syndrome = Group of symptoms that indicate a condition or disease THE OFF-THE-FIELD INJURY EVALUATION PROCESS HOPS - History - Observation - Palpation - Special tests History Past Present Injury location Pain characteristics Nerve pain = sharp, bright, or burning Bone pain = localized and piercing Vascular pain = poorly localized, aching, and referred Muscle pain = dull, aching, and referred Joint responses Determining whether the injury is acute or chronic Observation Palpation Bony palpation Soft-tissue palpation Dysesthesia = Diminished sensation Anesthesia = Numbness/loss sensation Hypersthesia = Increased sensation Paresthesia = Numbness, tingling or burning sensation Hypethesia = Decreased tactile sensation Special Tests Movement assessment Active range of motion (AROM) Passive range of motion (PROM) Normal endpoints Soft Soft-tissue approximation Firm Muscular stretch Capsular stretch Ligamentous stretch Hard Bone contracting bone Abnormal endpoints Soft Normally firm or hard Firm Normally soft or hard Hard Normally soft or firm Empty Resisted motions (RROM) Strong and painless = normal muscle Strong and painful = minor contractile soft tissue injury Weak and painless = Neurologic deficit or chronic contractile soft tissue injury Weak and painful = Significant contractile soft tissue injury Pain on repetition = a single lesion of contractile tissue All muscles painful = serious emotional or psychological problem Goniometric measurement of joint range Manual muscle testing Neurologic examination Cerebral function = General affect, level of consciousness, intellectual performance, emotional status, thought content, sensory interpretation (visual, auditory, tactile), and language skills Cerebeller function = Coordinated movement Cranial nerve function = Sense of smell, eye tracking, imitation of facial expressions, biting down, balance, swallowing, tongue protrusion, and strength of shoulder shrugs. Sensory testing Reflex testing Absence of a reflex 0 Areflexia Diminished reflex 1 Hyporeflexia Average reflex 2 Exaggerated reflex 3 Hyperreflexia Clonus 4 Spasmodic alteration of muscle contraction and relaxation, indicating a nerve irritation Determining projected referred pain Testing joint stability Testing accessory motions Testing functional performance Functional examination - Determines if the athlete has full strength, joint stability, and coordination and if the part is pain free. Postural examination Anthropometric measurement Volumetric measurements PROGRESS EVALUATION History Observation Palpation Special Tests DOCUMENTING INJURY EVALUATION INFORMATION SOAP Notes Subjective Objective Assessment Plan Progress Notes ADDITIONAL DIAGNOSTIC TESTS USED BY A PHYSICIAN Imaging Techniques Plain Film Radiography (X rays); fractures and dislocations (Don’t show internal derangement) Arthrography; disruption of soft tissue and loose bodies in the joint Arthoscopy (Fiber-optic arthoscope); joint surgeon Myelography; tumors, nerve root compression, disk disease Computed Tomography (CT); Bone Scanning; inflammation, stress fractures Magnetic Resonance Imaging (MRI); soft-tissue lesions Ultrasonography; Echocardiography; cardiac valves Other Diagnostic Tests Electrocardiography (ECG); electrical activity of the heart Electroencephalography (EEG); electrical potentials produced in the brain Electromyography (EMG); muscle contraction Nerve Conduction Velocity; neuromuscular conditions Synovial Fluid Analysis; Musculoskeletal infection, Blood Testing; complete blood count (CBC) - Leukocyte (white blood cell) count is between 4000 and 10000/cu mm Urinalysis Sphygmomanometer: indirectly determine arterial blood pressure Skin-fold; Body fat are routinely taken from biceps & triceps areas, & suprailiac and subscapular areas Vital capacity; Maximum amount of air that can be expired after a maximum inspiration - It is often difficult to identify the time of injury to subchondral bone and articular cartilage because those structures are insensitive (no pain receptors) - Dermatomes – An area of skin supplied by a single nerve root - Myotomes – A group of muscles primarily innervated by a single nerve root - Reflexes – Action involving stimulation of a motor neuron by a sensory neuron in the spinal cord without involvement of the brain |
| Off-the-Field Injury Evaluation |