Principles of Assessment

1. 2 Principles of Assessment

2. On-Field Assessment: Goals Rule out life-threatening and serious injuries. Determine the nature and severity of the injury. Ascertain the most appropriate method of transporting the athlete off the field.

3. On-Field: Primary Survey Survey the scene (observe surrounding environment) and conduct primary assessment for life-threatening conditions. Establish level of consciousness. Check for ABCs. Assume spinal injury if you did not witness. Check for and control severe bleeding.

4. On-Field: Secondary Survey History (quickly determine mechanism, location, and severity of injury) Observation (determine level of consciousness; if athlete unconscious, suspect head or neck injury) Shock assessment (wet, white, weak) Musculoskeletal screen

5. Musculoskeletal Screen Initial screen should give information sufficient for determining extent and severity of injury. Observe for swelling, discoloration, deformities. If you suspect spinal injury, stabilize spine and perform bilateral neurological assessment. Palpate for fractures and dislocations. Test for neurovascular compromise. Assess range of motion.

6. Nonemergency Assessment Subjective (used to form hypothesis about nature and extent of injury) History Athlete’s impression Observation Objective (special tests to establish severity and nature of injury) Comparable sign: reproduction of the athlete’s symptoms Bilateral comparison

7. Severity (SINS) Indicates need for referral. Refer the more severe injuries. Never hesitate to refer if unsure of the severity.

8. Irritability (SINS) Relates to the stage and extent of injury, the structures injured, and athlete’s pain tolerance. History can give initial impression. Important to know prior to objective assessment. The less irritable the injury, the more complete the evaluation.

9. Nature (SINS) Includes type of injury and type of structures involved. History is important. Confirm suspicions through objective assessment.

10. Stage (SINS) Injuries fall into three stages: Acute (first 7-10 days following onset) Subacute (4-6 weeks following onset) Chronic (at least 6-8 weeks in duration)

11. Sideline Assessment Evaluate in the following order: 1. History 2. Observation 3. Palpation 4. Special tests 5. ROM 6. Strength 7. Neurovascular tests 8. Functional tests (if appropriate)

12. Off-Field Assessment Evaluate in the following order: 1. History 2. Observation 3. ROM 4. Strength 5. Neurovascular 6. Special tests 7. Joint mobility 8. Palpation 9. Functional tests

13. History Develop a good picture of the injury: Current and previous injuries Onset, type, and location of pain Unusual sounds or sensations

14. Observation Begins during subjective assessment. Clues from facial expressions and eyes General posture Holding or protecting injured area Visual inspection of injured area (note swelling, deformity, discoloration; compare bilaterally)

15. Differential Diagnosis The process of delineating possible causes and eliminating as many factors as possible. Include in off-field assessment if injury is not obvious. Rule out adjacent joints. Eliminate referral segments.

16. ROM Test uninvolved side first to obtain athlete’s normal motion. Active (assesses integrity of the active or contractile tissue; performed before passive) Passive (assesses inert structures around the joint; identifies problems that present with capsular pattern of movement)

17. Strength Assesses level of pain, resistive capabilities, neuromuscular integrity in the tissue. 1. Isometric or “break” tests performed with joint in neutral midrange position; build to maximum resistance in 3-5 s 2. Manual muscle tests to define which specific muscle is causing the weakness

18. Neurovascular Tests Neurological exam performed if nerve injury is suspected and symptoms include radiating numbness, tingling, or pain. Assessment includes sensory, motor, and reflex testing. Circulatory tests assess integrity of vascular system. Assessment includes palpation of distal pulse and observation of skin color.

19. Jendrassik’s maneuver

20. Special Tests Used to eliminate or confirm a suspected condition, as well as to define the integrity of the structure. Tests allow athletic trainer to grade abnormal responses or injury severity and reproduce athlete’s symptoms.

21. Joint Mobility Physiological motion: active motion of joint in the planes of motion Accessory motion: subtle passive motion between the joint’s inert structures Necessary for full physiological motion Assess if physiological motion is limited

22. Joint Mobility Techniques Distraction or traction (longitudinal force to separate the proximal and distal parts; assesses general capsular mobility) Glide maneuvers (anterior-posterior, medial lateral; assesses mobility of capsule, joint structures)

23. Palpation Reveals information regarding tension, thickness, texture of soft tissue; swelling, temperature, moisture, pulses, muscle fasciculations; and general contours of bony and soft tissue. Use a systemtic approach (superficial to deep); athlete should be relaxed.

24. Functional Tests Assess athlete’s ability to safely return to participation, as well as athlete’s confidence and physical readiness. Specific tasks and controlled skills Sport and position specific

25. Documentation: SOAP Notes Subjective (chief complaint, mechanism of injury, reported signs and symptoms) Objective (observations and results from objective assessment) Assessment (impression of the injury) Plan (immediate treatment and referral plans)