Evaluation & Assessment

Injuries

• Primary Injury: an injury which occurs as a direct result of the stress imposed on the body during a particular sport or activity

• Secondary Injury: an injury which is caused by improper care of the original injury

Mechanical Forces

• Compression Force: A force that crushes the tissue due to the bodies in ability to absorb it– Ex. – Sprains, strains, avulsions

• Tension Force: A force that pulls or stretches the tissue– Ex. – Fractures, contusion, arthritic changes

• Shearing Force: The force moves along the parallel organization of the tissues.– Ex. – Blisters, abrasions, vertebral disc injuries

Tissues

• Muscles, in its various forms, performs four important functions for the body; it produces movement, maintains posture, stabilizes joints, and generates heat.– Skeletal Muscle: Attaches to and covers the bony

skeleton, it is responsible for overall body mobility.• Tendons: Attach muscle to bone.• Ligaments: Attach bone to bone.

Bone

• Bone is a specialized type of dense connective tissue consisting of bone cells that are fixed in a matrix, which consists of an intercellular material. The outer surface is composed of compact tissue, and the inner aspect is composed of a more porous tissue known as cancellous bone.

• Functions: body support, organ protection, movement (through joints and levers), calcium storage, and formation of blood cells.

• Types: flat, irregular, long, and short

Bones

• Structures: – Diaphysis – main shaft of the bone– Epiphysis – the ends on long bones– Periosteum – dense white fibrous membrane that

covers long bones– Medullary Cavity – the hollow inside of the diaphysis

of long bones that contain the fatty marrow in adults.– Articular Cartilage – covers the end of the long bones

protecting the epiphysis during movement and helps cushion jars and blows to the joint.

Open Wounds

• Abrasion: The skin is scrapped against a rough surface, the epidermis and the dermis are scrapped away and

• Incision: A wound in which the skin has been cut sharply.• Laceration: A wound in which the skin has been

irregularly torn. • Avulsion: Skin that is torn by the same mechanism as a

laceration to the extent that tissue is completely ripped from its source.

• Puncture: A wound cause by penetration of the skin by a sharp object.

Closed Wounds

• Contusion: When a blow compresses or crushes the skin surface and produces bleeding under the skin.

• Hematoma: Is a blood tumor, formed by the localization of the extravasted blood into clot, which becomes encapsulated by connective tissue membrane

• Blister: Continuous rubbing over surface of the skin causes a collection of fluid below or within the epidermal layer.

Fractures

• Fractures can be partial or complete interruption in a bone’s continuity; it can occur without external exposure or can extend through the skin, creating an external wound (open fracture).

Types of Fractures

• Depressed: They are cause by falling and striking the head (flat bone) on a hard immovable surface or by being hit with a hard object.

• Greenstick: Are incomplete breaks in bones that have not completely ossified, such as the bones of adolescents.

• Impacted: Can result from a fall from a height, which causes a long bone to receive, directly on its long axis, a force of such magnitude that the osseous tissue is compressed.

Types of Fractures

• Longitudinal: Are those in which the bone splits along it length.

• Spiral: Have an S-shaped separation, for example the foot is firmly planted when the body is suddenly rotated in an opposing direction.

• Oblique: Similar to the spiral, occurs when one end of the bone receives sudden torsion or twisting while the other end is fixed or stabilized.

Types of Fractures

• Serrated: The two bony fragments have a saw tooth, sharp-edged fracture line, are usually created by a direct blow.

• Transverse: Occurs in a straight line, more or less at right angles to the bone shaft.

• Comminuted: Consists of three or more fractures at the fracture site.

• Contrecoup: Occur on the side opposite to the point at which trauma was initiated.

Types of Fractures

• Blowout: Occur to the wall of the eye orbit as the result of a blow to the eye.

• Avulsion: Is a separation of a bone fragment from its cortex at an attachment of a ligament or tendon.

• Stress: Rhythmic muscle action performed over a period of time at a sub-threshold level causes the stress-bearing capacity of the bone to be exceeded.

Types of Fractures

• Epiphyseal: an injury which occurs at the growth plate of a bone and may result in stunted growth in young athletes

Signs and Symptoms of Fracture

1. Pain at the injury site2. Deformity3. Swelling4. Bruising5. Immobility6. A cracking sound or crepitation7. Numbness or impaired sensation8. Pale or ashen skin due to poor circulation

Dislocations

• Dislocations, which result primarily from forces causing the joint to go beyond it’s normal anatomical limits and are divided into two classes– Subluxations are partial dislocations in which an

incomplete separation between two articulating bones occurs.

– Luxations are complete dislocations, presenting a total disunion of bone apposition between articulating surfaces.

Range of Motion• Range of Motion (ROM): Refers to the distance

and direction a joint can move between the flexed and the extended positions.

• Active (AROM): Joint motion that occurs because of muscle contraction, performed by the athlete

• Passive (PROM): Movement that is performed completely by the examiner.

• Resisted ROM: Requires an isometric contraction at the midpoint in the range, athlete goes against resistance.

Sprain

• A sprain, one of the most common and disabling injuries seen in sports, is a traumatic joint twist that results in stretching or total tearing of the stabilizing connective tissues.– Grade 1: Minimal swelling , pain, and loss of function, no

abnormal motion when tested and mild point tenderness.

– Grade 2: Pain, swelling, moderate loss of function, and slight to moderate instability.

– Grade 3: Severe pain, tenderness, swelling and instability, along with loss of function.

Strain

• A strain is a stretch, tear, or rip in the muscle or adjacent tissue such as the fascia or muscle tendons.– Grade 1: Some muscle fibers have been stretched or

actually torn.– Grade 2: A number of fibers have been torn, and active

contraction of the muscle is extremely painful.– Grade 3: A complete rupture of a muscle has occurred in

the area of the muscle belly at the point at which muscle becomes tendon or at the tendinous attachment of the bone.

Muscle Injuries

• Muscle Cramp: Is a painful involuntary contraction of a skeletal muscle or muscle group.

• Muscle Spasm: Is a reflex reaction caused by trauma of the musculoskeletal system.

• Contusion: Is due to a sudden traumatic blow to the body.

• Tendonitis: Has a gradual onset, diffuse tenderness because of repeated micro traumas , and degenerative changes.

Muscle Soreness

• Acute-Onset Muscle Soreness: Accompanies fatigue, the muscle pain is transient and occurs during and immediately after exercise.

• Delayed-Onset Muscle Soreness: Appears approximately 12 hours after exercise and it becomes most intense at 24-48 hours, it gradually subsides so that the muscles becomes symptom-free after 3 to 4 days.

Joint Injuries

• Bursitis: Inflammation of the bursa at the sites of bony prominences between muscle and tendon. – Bursa is the fluid filled sac of synovial membrane found

in places at which friction might occur between body tissues.

• Osteoarthritis: A degeneration of the articular or hyaline cartilage, due to wear and tear of the joints. The cartilage may be worn away to the point of exposing, eroding, and polishing the underlying bone.

Nerve Injuries

• Hypoesthesia: Impaired or decreased sensation.

• Hyperesthesia: Abnormal increased sensitivity to stimuli of a sense (touch, sound, sight, etc)

• Paresthesia: Abnormal or morbid sensation such as itching or prickling.

• Referred Pain: Pain that is felt at a point of the body other than its origin.

Evaluation

• Objective: Is measurable evidence• Subjective: Is descriptive evidence• Sign: Something that can be measured or felt,

objective evidence• Symptom: A description of what the athlete is

feeling, subjective evidence

Evaluation

• Etiology: The cause of a disease or injury• Pathology: The changes that occur due to

injury• Mechanism: How the injury occurred.• Acute: An injury with a sudden onset and

short duration• Chronic: a recurring injury, with a long onset

and long duration.

HOPS

• Evaluation: An organized process of determining the type and severity of an injury.

• HOPS: Is a evaluation scheme that includes history, observation, palpation, and special/stress test.

HOPS

• History: A series of questions asked to determine the nature and location of the injury.– How did it happen?– Where does it hurt?– Have you hurt that body part before?

• Observation: A visual examination of the injury.– Look for deformity, discoloration, signs of pain.

HOPS

• Palpation: A hands on approach where the examiner feels for deformity or other abnormal findings.– Palpate bones, muscles, ligaments, and tendons

• Stress Test: A series of tests to specific structures to determine the type and severity of the injury.– PROM, AROM, Functional Activities, Sport Specific

History

• To establish the history, use the MAPPS pneumonic:

• M = mechanism of injury• A = acute or chronic• P = previous history of injury• P = pain (type & location)• S = sounds heard or felt at the time of injury or since

Observation

• Compare the uninvolved side with the involved side look for:

• Swelling• Deformity / dislocation• Discoloration• Bleeding• Break(s) in the skin• Scars from previous surgeries• Muscle atrophy (decreased size)• Loss of movement• Is the athlete limping?• Did the athlete need assistance to get up?• Is the athlete protecting the injured extremity?

Palpation

• Areas to be palpated:– Bones, Muscles, Ligaments, Tendons– Palpate for:• Bony deformities• Muscle spasms• Pulse (where applicable)• Breaks in the skin (injury to underlying structures)• Changes in temperature• Changes in sensation• Pain

Stress Test

• Check for the following:• Active ROM, Passive ROM, Resisted ROM

• Additional tests as indicated by the location & type of injury:– Anterior drawer test - ACL– Posterior drawer test - PCL– Modified Lachman’s – ACL– Godfrey’s test - PCL– Appley compression & distraction – meniscus– McMurray’s test – meniscus– Ober’s test – IT band

SOAP Note

• Subjective: Anything the athlete, coach, or teammate has to say about the injury

• Objective: Anything that is observed or measured during the evaluation.

• Assessment: The evaluators opinion about the injury

• Plan: The short-term and long-term goals for the athlete, rehab plan/treatment.

SOAP Note Tips

• Once the initial form has been completed, continue to add progress notes to track the athlete’s progress

• Length and details will vary with the type of injury

• Be thorough and concise

Why use SOAP Notes?

1. It’s easy to record the findings of an injury evaluation.2. It’s an organized way to share information with other health professionals.3. It’s a good way to record an individual’s progress over time.4. It may be used as evidence to protect you in the case of a lawsuit.

Vital Signs

• Vital signs are a measure of the body’s functions that are necessary for life, such as breathing, heart rate and body temperature– Heart Rate– Respiration Rate– Blood Pressure– Body Temperature

Heart Rate

• A way to measure the function of the heart and circulatory system– Normal Range for adults is 60 to 80 bpm.– It is measured at the pulse points, where the

artery is close to the skin.• Carotid artery (either side of the throat)• Radial artery (thumb side of the wrist)

Respiration Rate

• Respiration, or breathing, is a way to measure the body’s ability to take in oxygen and get rid of carbon dioxide

• One breath consists of an inspiration and an expiration

• All of the cells of the body need oxygen to function

• Loss of breathing leads to cell death

Respiration Rate

• How is breathing measured?– After measuring the radial pulse, keep the athlete’s

arm across the chest and count one inspiration and one expiration as one breath.

– Don’t tell the patient you are monitoring their breathing.

– Count the number of breaths during a 60-second period.

• Normal breathing rates:– 12-20 breaths/minute

Blood Pressure

• Blood Pressure is:– A measure of the pressure put on the walls of the

arteries by the blood– Recorded with 2 numbers (i.e., 120/80)

• Top number is systolic (blood pressure when the heart contracts)

• Bottom number is diastolic (blood pressure when the heart is at rest)

– Normal ranges:• Systolic – 110 mm Hg• Diastolic – 65 to 80 mm Hg

Body Temperature

• What is core temperature?– A measure the body’s internal temperature

• How is it regulated?– The hypothalamus regulates body temperature by

measuring the temperature of the blood.– When the temperature of the blood decreases, the

hypothalamus causes blood vessels to constrict to conserve heat, and the muscles create heat by shivering.

– When too much heat is produced by the body, the blood vessels dilate and the sweat glands are stimulated to release heat.

Body Temperature

• What is the normal body temperature?– 98.6 degrees Fahrenheit

• How is it measured?– Temperature can be measured at a number of

different sites, including the mouth under the tongue (oral), ear (tympanic), armpit, or rectally.

– Most accurate reading is from the ear or rectum.