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Injury Evaluation Process: Chapter 1

Injury Evaluation Process: Chapter 1. Foundations of Evaluation . Know normal anatomy & biomechanics Systematic standardized approach triage re-eval Compare uninjured to injured. Evaluation Styles --p.2. Systematic HIPS, HOPS, HOPE p.2 : 7 steps Settings: clinical on-field

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Injury Evaluation Process: Chapter 1

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  1. Injury Evaluation Process:Chapter 1

  2. Foundations of Evaluation • Know normal anatomy & biomechanics • Systematic standardized approach • triage • re-eval • Compare uninjured to injured

  3. Evaluation Styles--p.2 • Systematic • HIPS, HOPS, HOPE • p.2 : 7 steps • Settings: • clinical • on-field • Table 1-1, p. 3 • Box 1-1, p.4

  4. Evaluation Settings--p.3, 19 • Clinical Evaluation—p.3 • Determine fully severity and scope of injury • Controlled environment • Usually involves evaluation tools • Greater time involvement • On-Field Evaluation—p.19 • Determine severity & mobility status • Extended triage • Evaluate participation status • Shortened process • May be ambulatory or non-ambulatory

  5. History (Hx)--p.20 • Most important aspect of evaluation • Use open-ended questions • Learn of PMH • questions & documentation • past injuries & treatment/surgeries • Symptoms/complaints • Location of pain (may not = site of injury) • Localized vs. diffuse pain • On-field: bystanders/witnesses available

  6. Observation/Inspection--p. 7/21 • Look for signs of injury & injury severity • Primary & secondary surveys • On-field eval: moving? Conscious? ABC’s? secondary survey? • Look for: • Gross deformity • Signs of trauma • Functional status/Gait • posture/presentation • Attitude

  7. Palpation--p.8/21 • Observation using the hands • Detecting tissue damage using touch • Note: • point tenderness • crepitus • symmetry • temperature changes • sensation/numbness • On-field evaluation: • helps to focus the eval when time is limited • assesses the mobility of the athlete

  8. Assessment of motion & ability to perform necessary actions Note any apprehension/hesitation Determine weightbearing status Functional Testing--p. 10/21 • Ranges of Motion (ROM) • Strength grades (MMT)

  9. Range of Motion Testing—p. 10 • ROM: • AROM--tested first • PROM-- • RROM--break test/strength test • Goniometry • Box 1-4, p.11

  10. Girth Measurement—p.9 • Identify differences in size caused by: • Atrophy • Hypertrophy • Edema • Always measure bilaterally • Only part of the puzzle • Girth Measurement • Box1-3, p. 9 • Volumetric Measurement • Fig. 1-3, p.10

  11. Strength Testing—p. 14 • Table 1-5, p. 14 • MMT/RROM • Subjective testing • Stabilize joint while stressing muscle • Interpersonal variability • 0-5 scale • NML=5/5 • Compare bilaterally

  12. Ligamentous/Capsular Testing--p. 14/22 • Severity grading • On-field evaluation: perform quickly but efficiently before symptoms are masked by swelling/pain • Uninvolved assessed first(?). • Endfeel assessment: Tables 1-3 & 1-4, p. 13 • Assessment of integrity in non-contractile tissues • Assess bilaterally • Proper positioning crucial to valid results (+/-) • Congenital laxity • Fig. 1-8, 15 • Know Your Athletes! • Laxity vs. Instability(?)

  13. Neurological Testing--p.15/22 • Upper/lower quarter screening • Assessment of sensation/motor function/DTR’s • Especially important with spinal cord injuries • Bilateral assessment • Box 1-5, 1-6

  14. Removing an athlete from the field--p. 22 • Decision based on objective data, not the situation • Immobilization may be necessary--Fig. 1-14, p. 23 • Methods of removal--p. 24

  15. Injury vs. Illness • History • Observation • Palpation • Functional Testing • Special Testing • Neurological Testing

  16. Conclusions: • Know your Anatomy! • Anatomy->function->pathology->treatment • Thorough yet practical & efficient • Reassess often • Bilateral comparisons • Obtain a good history! • Table 1-9, p.25: When to Refer Immediately

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