Injury Evaluation

1. Injury Evaluation Athletic Training Mr. Fluck

2. The Step by Step Injury Evaluation Process • Injury History • Inspection and Observation • Pain and Palpation • Range of Motion • Manual Muscle Testing • Special Test • Functional Testing • Physical Referral / Diagnostic Tests

3. Injury History • Who? What? When? How? • Asking questions to find out what injury occurred. • A good thorough Injury History will often tell you what the injury is without physically touching the individual • With an acute injury, it is important to get an accurate Injury History right away…Why? • What are some questions you should ask during injury history? • Questions that would help you figure out what is wrong

4. Injury History Questions • What happened or How did it happen? • Injury mechanism • When did it happen? • Did this injury ever happen before? • Are you taking any medications? • Any relevant surgeries? • Is this your dominant side? • What sport do you play or even what position do you play? • Do you have any pain anywhere else on your body? • Do you have any allergies? • Did you hear or feel a anything (“pop”)

5. Inspection and Observation • Signs and symptoms • Signs • Swelling • Echymosis • Deformity • Carrying Angle • Bleeding • Discoloration • Symptoms • Dizziness • Headache • Nausea • Memory loss • Retrograde • Post-traumatic • ***Bilateral Comparison – to know what is normal for that person you compare the injured part of the body to the uninjured part

6. Pain and Palpation • Palpate specific anatomical structures • distal / proximal to the injury • Pain on bone = contusion, fracture or maybe dislocation / subluxation • Pain on ligament = contusion or sprain • Pain on muscle or tendon = contusion, strain, tendonitis or perhaps bursitis • Pain • Type of pain: burning, stinging, tingling, etc… • Grade your pain on a scale of 1 to 10 • Remember pain is relative to each individual • Does the pain change with: movement, weight bearing, exertion, etc…

8. Range of Motion (ROM) • Active AROM • Passive PROM • Goniometer – quantify the ROM (put an exact measurement or number to it) • Bilateral Comparison • Joint Clearing – check the joint immediately distal and immediately proximal to the “injured” joint

9. Manual Muscle Testing • Manual assessment of strength • You apply steady resistance throughout the ROM to assess muscular strength. • Scale • 5/5 full ROM against a full resistance • 4/5 full ROM against a partial resistance • 3/5 full ROM against gravity • 2/5 full ROM with gravity eliminated • 1/5 no ROM but signs of muscle contraction • 0/5 no ROM and no signs of contraction • ***Bilateral Comparison

10. Special Tests • Very specific test that assess certain injuries • Example: Thompson Test – assess Achilles tendon rupture • http://www.youtube.com/watch?v=AmDi08rlR3I • http://www.youtube.com/watch?v=HN4guig3u-o • http://www.youtube.com/watch?v=gkHgY-Y45VY • http://www.youtube.com/watch?v=uzzV5BRWlIc&feature=related

11. Special tests for fracture • Tap test http://www.youtube.com/watch?v=0kPjh1nTf-U&feature=BFa&list=PLA8677004E806402F&lf=results_video • Longitudinal compression test

12. Functional Test • Progression of activities that get more challenging • Lower body – • Walk straight ahead, jog straight ahead, jumping or hopping, sprint straight ahead, running figure eights (big and small), cutting, side shuffles, cross-over running, sport specific activities • Sport Specific activities are specific to the sport and even to the position within that sport • Basketball – lay-up drills, rebounding drills, “suicides”, defensive shuffles, pivoting • Football Lineman – 5 yard bursts, footwork drills, monkey rolls, blocking drills

13. Physician Referral • By law, only a physician can diagnose an injury • Physician can give “standing orders” • Only a physician can refer for diagnostic testing • X-ray • MRI • CT scan • Blood Work • Bone Scan

14. Injury example • Lateral Ankle Sprain • http://www.youtube.com/watch?v=RP42cEbqUD0 • http://www.youtube.com/watch?v=_KBYLBuAymc

15. Injury History • Injury mechanism: excessive inversion or excessive plantarflexion with inversion • History of ankle sprains would make the person more likely to sprain the ankle again • Type of sport, footwear, playing surface could predispose someone to sprain their ankle • They will sometimes hear or feel a “pop” • Person usually says “they landed on something or landed in a hole or an uneven surface”

19. Inspection and Observation • Swelling and possibly echymosis in either over or just below the lateral malleolus • Possible even distal to the ankle joint • Possible deformity (indicating fracture) • Point tender to the touch: specifically over the three ligaments on the medial side of the ankle • Carrying angle for ankle injuries: Limping on your heel or unable to bear weight at all • **Bilateral Comparison will tell me what is normal for that person

23. Pain and Palpation • Pain will depend on the severity of the injury and the person tolerance for pain • The pain will increase will weight-bearing • Especially going up and down stairs and changing directions

25. Range of Motion • Limited AROM and PROM in all motions. Especially Plantarflexion, Dorsiflexion and Inversion • Goniometric measurements • Joint clearing- check the toes and foot as well as the knee • A simple squat would clear all joints

26. Manual Muscle Testing • Acutely – 0/5 -1/5 • Within a few hours to a few days – 2/5 – 4/5

27. Functional Test • Take the patient through the functional test noting at what level they are immediately following the injury • Throughout the rehabilitation process and at the end of the rehab process you will retake them through the progression to make sure that they are improving and can ultimately return to activity

28. Special Tests • Fracture tests –tap, see-saw, longitudinal compression

29. Physician Referral • Diagnostic tests needed: • X-ray – to rule out fracture • Possible MRI to assess ligamentous damage