Injury Maintenance

1. Injury Maintenance

2. What to do once an injury occurs? • Create a medical form including everything you think needs to be included in an injury report.

3. Types of Injuries • Closed (Unexposed) Wounds • Closed soft tissue: • Contusion • Sprain • Strain • Bone and Joint Articulation (a union between two bones): • Closed Fx- Simple (no disruption of skin surface) • Traumatic (acute) Fx- Immediate pain, rapid swelling, bony tenderness, crepitus, with movement of bony fragments and possible deformity if fx is displaced • Stress Fx- onset of pain is gradual, pain or deep ache at first noticeable only during activity, may subside with rest, progressing to more constant pain if offending injury continues

4. Bone and Joint Articulation Injuries Cont… • Epiphyseal Injury – disruption or separation of the epiphysis or epiphyseal plate (Salter-Harris Fx) • Dislocation- complete disassociation of two joint surfaces • Subluxation – incomplete disassociation of two joint surfaces (may be difficult to identify) • Nerve Injuries • Neuralgia- achiness or pain along a nerve secondary to chronic irritation or inflammation • Neuroma – thickening of a nerve or “nerve tumor” secondary to chronic irritation or inflammation

5. Open (Exposed) Wounds • Open wounds – injuries that involve a disruption in the continuity of the skin caused by friction or by blunt or sharp trauma • Abrasion – “Strawberry” large surface area exposed, caused by friction • Blister – separation and accumulation of fluid or blood between superficial skin layers secondary to repetitive friction or shearing movements • Incision – a cut through all layers of the skin by a sharp object or instrument (smooth, even wound edges) • Laceration – a tearing of the skin by blunt trauma to the skin over a bony prominence, (jagged, uneven wound edges) • Puncture – a small disruption in the skin caused by sharp penetrating object • Avulsion – a tearing off or complete disassociation of a portion of skin • Compound fx/dislocation- disruption of the skin surface secondary to penetration by a displaced fx fragment or joint dislocation (Fx = Fracture)

6. Principles of Examination • Assessment – a procedure through which the clinician determines the severity, irritability, nature and stage of an injury • Evaluation – is the systematic process that allows the clinician to make a clinical judgment • Primary Survey- ABCs • Secondary Survey- rapid examination of the seriousness of the injury before the athlete is moved

7. Stages of Assessment • SOAP Notes • Subjective • Objective • Assessment • Plan • Subjective = history • Severity, irritability, nature of the injury, MOI, only as good as the questions you ask • What questions should be asked? • Objective = tests • Comparable sign= reproducing the problem • Bilateral Comparison • Observation • Palpation • Range of Motion (ROM) • Strength • Special Tests (any body know any tests?) • Neurological Status • Vascular Status • Functional Testing

8. Functional testing Lower Body • Balance in standing (Stork or tandem stand) • Walking forward • Walking up and down stairs (practicality?) • Jogging Forward • Running Forward • Sprinting Forward • Hopping Forward • Jogging, running, sprinting backward • Jogging, running, sprinting side to side • Hopping alternate feet • Hopping involved leg only • Skipping forward and backward, side to side • Jumping forward, backward • Sport Specific Activities

9. Functional Testing Upper Extremity • Tossing • Throwing • Pitching • Hitting • Batting • Catching • Receiving • Standing on hands • Supporting body weight on arms • Sport Specific Activities • Anything else?

10. Taking a History • Chief Complaint- what’s wrong?, where does it hurt?, what happened? • Mechanism of Injury (MOI)- how the injury occurred • Compressive force • Tensioning force • Twisting force • Shearing force • Nature of illness or injury • Events surrounding the injury

11. Acute History Questions • What happened and how did it happen? • What position were you in when the injury happened? (How they landed) • Did you hear or feel any unusual sounds or sensations at the time of injury? (snap, pop, or click) • Do you feel any unusual sensations now? (numbness, tingling, burning) • Where is the pain? Point with one finger • Can you describe the pain? • Quality of pain (Sharp, dull, achy) • Intensity (Pain scale 0-10) • Localized or diffuse • Referral of pain to other segments • Changes in pain from when it started (intensified or lessened) • When does it hurt? • What is the previous history? • What is the previous hx for the opposite side? • Are there any other medical conditions to be aware of?

12. NonAcute History Questions • What happened and how? (did it come on gradually and when did they appear) • What activities aggravate the injury now? • What makes it feel better? • When you work out, when do the symptoms come on and for how long? • Do the symptoms interfere with daily activities, and if so, what activities? • Can you describe the pain? • Quality of pain (sharp, dull, achy) • Intensity (0-10 scale) • Localized or diffuse • Referral to other segments • Changes in pain from when it started (intensified or lessened over time) • Does the pain wake you up at night? • Is there anytime during the day that the pain is worse or less or is the pain activity related? • What treatments if any have you self-administered?

13. Chronic History • What hurts? • When did this occur? • Was it sudden onset or gradual? • Can you describe the pain? • When does it hurt? • Is the pain constant or intermittent? • How long does the pain last? • What makes it worse? • Have you made any abrupt or significant changes in training? • Change in intensity, duration, training surface, type of activity • Change in training implements • Shoes, rackets, bat grips, etc. • What is the previous hx for the body region? • Are there any medical conditions to be aware of? • Change in diet or weight? • Recent illness? • Other signs and symptoms? • Existing medical conditions? • Taking any medications or receiving treatment?

14. Signs and Symptoms • Current signs and symptoms • Vs. • Previous history and contributing factors

15. Observation • Initial/overall impression on the field/clinical setting • Observation of body type • Ectomorph- low to normal body fat, low muscle mass (underweight) • Mesomorph – low to normal body fat, high muscle mass • Endomorph – high fat and muscle mass and is overweight • Observation of Posture and Gait • Observation of Injured Segment • What would you be looking for?

16. Palpation • Need anatomical knowledge • Personal skills • Keep patient comfortable • Technique • Rolling and strumming • Movement when palpating still structures • Stillness when palpating moving structures • Movement of a limb as a palpation tool • Structures to palpate • Skin • Use back of hand to palpate for moisture and temperature • Fascia • Superficial fascia has spongy soft end feel (when moving skin the resistance you feel is superficial fascia) • Muscle • Bone • Joint Structures • Neurovascular Tissue • Lymph Nodes

17. Palpable Bony Structures • Shaft- body of a long bone • Head or condyle – rounded end of a long bone that articulates with the joint • Epicondyle – the prominent aspect of the bone, proximal to the condyle • Groove – a narrow, longitudinal depression in a bone (passage for a tendon) • Ridge or crest – raised surface on bone • Tubercle – small and rounded projection • Tuberosity– A more prominent and large rounded projection • Apophysis– A small projection on a bone that serves as the attachment for a tendon • Epiphyseal Plate – area of growth between shart and end of bone • Notch – indentation in the end of a bone (ligaments, nerves, arteries, tendon)

18. Palpable Joint Structures • Synovial Capsule – a well-defined membranous connective tissue that surrounds and encloses the structures of a synovial joint • Articular Cartilage – smooth, cartilage that covers the articular surface of a bone • Bursa - fluid filled sac that contains synovium to reduce friction between structures • Joint Line – a palpable separation between two articulating bones • Ligament – a taut, cordlike or bandlike fibrous connective tissue that connects bone to bone

23. CrossWord Puzzle

24. Range of Motion • Range of Motion – the arc of motion through which a segment moves • Active ROM • Passive ROM • Resistive ROM • 1-5 Grading Scale • Goniometer – measuring tool for ROM

25. Practice ROM • With a partner practice moving them through PROM • Shoulder flex/ext/abd/add/int/ext rot • Knee flex/ext • Elbow flex/ext • Pronation/Supination

26. Strength Tests

27. Practice Break Tests • With a partner • Perform a break test on their: • Quadricep • Shoulders • Bicep • Hip Flexor

28. Neurovascular Testing • Myotomes vs. Dermatomes

29. Vascular Testing • Check Pulse • Capillary Refill

30. Assessment • What do you think the injury is? • Your diagnosis?

31. Plan • What do you plan to do next? • Referral? • Treatments/Modalities