Injury Assessment Considerations PDF

Injury Assessment AT 200  Warning! Graphic Photo on next slide  Objectives To define basic terminology related to evaluations Understand the basic evaluation outline Define the administrative portion of evaluations Define the purpose of special test / additional testing ...

Injury Assessment AT 200  Warning! Graphic Photo on next slide  Objectives To define basic terminology related to evaluations Understand the basic evaluation outline Define the administrative portion of evaluations Define the purpose of special test / additional testing  Evaluation of Injuries Essential skill for athletic trainers. Preparticipation (prior to start of season). On-the-field assessment. Four distinct evaluations. Off-the-field evaluation (performed in the clinic/athletic training room). Progress evaluation.  Basic Knowledge Requirements Athletic trainer must have: general knowledge of anatomy biomechanics as well as hazards associated with particular sport. Anatomy. Surface anatomy. Understanding topographical anatomy is essential. Key surface landmarks provide examiner with indications of normal or injured structures Body planes and anatomical directions. Used as points of reference (sagittal, transverse, and coronal (frontal) planes).  Directional terms Medial Lateral Inferior Superior  Directional terms Proximal Distal  Abdominopelvic Quadrants Four corresponding regions of the abdomen. Divided for evaluative and diagnostic purposes. Understanding the Activity More knowledge of activity allows for more inherent knowledge of injuries associated with activity. Results in more accurate clinical diagnosis and rehab design with appropriate functional aspects incorporated for athlete’s return to activity. Athletic trainer must be aware of proper biomechanical and kinesiological principles to be applied in any activity. Violation of principles can lead to repetitive overuse trauma. Descriptive Assessment Terms Etiology: Cause of injury or Pathology: the science of the disease. causes and effects of diseases, especially the Mechanism: Mechanical branch of medicine that deals description of cause. with the laboratory examination Descriptive Assessment Terms 1 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. Diagnosis: Denotes name of specific condition. Prognosis: Prediction of the course of the condition.  Injury Evaluation Detailed evaluation on sideline or in clinical setting. May be the evaluation of an acute injury immediately after or several days later. Divided into four History, observation, palpation, components. and special tests (H O P S).  HIPS/HOPS Evaluation Process H = history (verbal) Subjective I/O = inspection (visual) Objective  When using HOPS, O=observation P = palpation (feeling with your hands) S = special tests (ROM, Strength, Special Tests, Neurological, Vascular, Functional Assessment)  History Obtain Inquire about See Obtain Inquire about See the injury subjective previous information injuries/illnesses relative to: that may be how injury involved as well occurred, extent of as past injury, and treatments. mechanism of injury (M O I).  History Ask the What is the problem? followin g How and when did it occur? questio ns. Did you hear or feel something? Which direction did the joint move? Characterize the pain.  Observations 1 Are there any asymmetries, postural malalignments, or deformities? How does the athlete move? Is there a limp? Are movements abnormal? What is the body position? Does the patient’s facial expressions indicate anything? Are there any abnormal sounds? Is there any swelling, heat, redness, inflammation, or discoloration?  Special Tests Palpation. Bony and soft tissue. Special tests. Used to detect specific pathologies. Compare inert and contractile tissues and their integrity. Assessment should be made bilaterally.  Special test Range of motion assessment. Active. Passive. Normal versus abnormal endpoints. Manual muscle tests. Goniometric measures versus digital inclinometers. Types of Strength Examination Isometric testing Manual muscle testing (“break” test)  Special Tests Designed to eliminate or confirm a suspected condition Reproduces symptoms or creates a comparable sign Special tests are performed on uninvolved side first  Neurologic and Circulation Assessments 1 Sensory and motor function. Dermatome. Area of skin innervated by a single nerve. Myotome. Muscle or group of muscles innervated by a specific motor nerve.  Neurological Status Determine presence of numbness, tingling, shooting, or burning pain Referred pain Sensory testing Motor testing Reflex testing  Functional Testing (If appropriate) If you suspect possible return to play / or evaluation Functional test MUST be performed Need to be able to mimic real-time participation Understand requirements of sport/position Monitor Pain Level and ability to perform tasks Consider ability to prevent further injury To injured body part, a different body part, someone else Documenting Injury Evaluation Information Complete and accurate documentation is critical. Clear, concise, and accurate records is necessary for third-party billing. Cumbersome and time- Proficient, to generate accurate consuming records  Additional Diagnostic Tests 1 There are a series of diagnostic tools that can be utilized to clearly define and determine the problem that exists.  Additional Diagnostic Tests Plain film radiographs (X-ray). Used to determine presence of fractures, bone abnormalities, and dislocations. Can be used to rule out diseases (neoplasm). Occasionally used to assess soft-tissue factors.  Additional Diagnostic Tests Computed tomography (CT scan). Penetrates body with a thin, fan-shaped X-ray beam. Produces cross-sectional view of tissues. Allows multiple viewing angles.  Additional Diagnostic Tests Bone scan. Involves intravenous introduction of a radioactive tracer. Used to image bony lesions (that is, stress fractures) in which there is inflammation.  Additional Diagnostic Tests Magnetic resonance imaging While expensive, it is (MRI). Using a powerful clearer than CT scan and is electromagnet, magnetic the test of choice for current focuses on hydrogen detecting soft-tissue atoms in water and aligns them. lesions. After current shuts off, atoms continue to spin, emitting different levels of energy depending on tissue type thereby creating different images. Magnetic Resonance Imaging  Additional Diagnostic Tests MRI arthrography. Imaging study involving injection of a contrast agent into a joint prior to MRI. Allows for more detailed assessment of the interior of a joint versus traditional MRI. Contrast agent allows highlighting of certain areas.  Additional Diagnostic Tests Musculoskeletal ultrasound. Allows for imaging and evaluation of soft-tissue structures. Complementary technique to MRI or CT. Nonpainful, noninvasive, and cost-effective.  Electrocardiography Electrocardiography (ECG / EKG). Recording of electrical activity of the heart at various stages in the contraction cycle. Assesses impulse formation, conduction, depolarization, and repolarization of atria and ventricles. Summary Knowledge: Anatomy Demands of the Sport Injury evaluation Functional rehab Systematic Process Understand Special Diagnostic Testing  Questions / Looking Ahead Quiz: Injury Assessment Thank you