Principles of an Evaluation

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Principles of an Evaluation
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ATHLETIC INJURY ASSESSMENT

• Primary Survey
• Takes precedence over all other aspects of
  assessment
• Used to correct any life-threatening situations
• Airway
• Breathing
• Circulation
• Excessive Bleeding

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ATHLETIC INJURY ASSESSMENT

• Secondary Survey HIPS principle
• Once life-threatening issues have been ruled out,
  this stage takes a closer look at the injury
  sustained.
• Uncovers problems that do not pose an immediate
  threat to life
• Recognize vital signs - Pulse, Respiration, BP,
  Temperature, Skin Color, Pupils, Consciousness,
  Movement

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The Evaluation Process

• Be systematic on your assessment, but do not have
  a cookbook approach.
• Be calm even though you may be trembling inside!
• Be confident!
• Listen to your patient!
• Do NOT overstep your bounds.
• If you dont know something, do not be hesitant
  to ask others for assistance.

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Seven Attributes of a Symptom

• Location Where is it? Does it radiate?
• Quality What is it like?
• Quantity or Severity How bad is it? (pain
  scale)
• Timing When did (does) the pain start? How long
  did (does) the pain last? How often did (does)
  the pain occur?
• Setting in which it occurs Personal activities,
  emotional reactions, environmental factors
• Remitting or exacerbating factors Does anything
  make it better or worse?
• Associated Manifestations Have you noticed
  anything else that accompanies it?

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History

• USE OPEN-ENDED QUESTIONS
• Depending on the injury, you may have to ask
  specific questions regarding equipment, shoes,
  and/or clothing.

• Chief Complaint (CC)
• Mechanism of Injury (MOI)
• Onset (acute vs. chronic)
• Unusual noises/sensations heard/felt
• Previous history
• Where is the pain (point to where it hurts the
  most)
• What does the pain feel like? Description of
  symptoms (sharp, dull, achy, throbbing, etc.)
• Pain (1-10 scale)
• What can you do/not do with this injury?
  (functional abilities)
• General medical health
• Other associated symptoms, social activities
• Level of consciousness
• Preexisting conditions and medications

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INSPECTION

• Appearance
• What does it look like, skin appearance, signs of
  trauma
• Bilateral symmetry
• Bleeding
• Color/Discoloration
• Deformity
• Edema/Swelling
• Expressions denoting pain
• Gait
• Infection

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INSPECTION

• Mental Alertness
• Posture
• Respiration

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PALPATION

• Begin away from the pain move towards the
  injury
• Pain Point tenderness
• Crepitus
• Swelling
• Malalignment of joint/bone
• Other types of deformities
• Tissue temperature Circulatory status

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FUNCTIONAL TESTS

• Looking for ROM, strength, painful arcs
• Active Range of Motion (AROM)
• Passive ROM (PROM)
• Resistive ROM (RROM)/Manual Muscle Tests (MMT)

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MUSCLE GRADING CHART FOR MANUAL MUSCLE TESTS

• Muscle Gradations Description
• 5 Normal Complete ROM against gravity w/
• FULL resistance
• 4 Good Complete ROM against gravity w/
• SOME resistance
• 3 Fair Complete ROM against gravity
• 2 Poor Complete ROM w/ gravity
  eliminated
• 1 Trace Evidence of slight contractility
• 0 Zero No evidence of contractility

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LIGAMENTOUS CAPSULAR TESTS

• Instability Endpoints
• End feel (Starkey Tables 1-3, 1-4, p. 13)
• Relative ligament laxity (Starkey, Table 1-7, p.
  15)

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OTHER SPECIAL TESTS

• Girth measurements
• Goniometric measurements
• Urine Analysis, Body Temperature, etc.

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NEUROLOGICAL TESTS

• Sensation, Motor function, Reflexes
• Dermatomes
• Two-point Discrimination Test
• Sharp-Dull Discrimination Test
• Hot-Cold Discrimination Test
• Myotomes
• Manual Muscle Test (MMT) or Break Test
• Reflexes
• Deep Tendon Reflex Grading (Starkey, Table 1-8,
  p. 19)

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SPORT SPECIFIC FUNCTIONAL TESTS

• Jumping
• Pivoting
• Backpedaling
• Starts
• Change of direction
• Throwing other shoulder activities
• Core activities

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SPECIAL TESTS

• X-rays
• MRI
• CT scan
• Bone scan
• Blood tests other body system work-ups

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On-Field vs. Off-Field Evaluation

• On-field quick inspection evaluation
• What is the seriousness of injury?
• Is first aid immobilization needed?
• Does the injury need immediate referral?
• What is the manner of transportation from the
  injury site?
• Off-field longer and more in depth

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Final Thoughts for the Evaluation

• Establish a rapport with the patient.
• Make it an inviting environment.
• Be reassuring.
• Develop ways to deal with the anxious, crying,
  hysterical, confusing, angry, culturally
  different and/or language barrier patient.