Transcript HOPS - Cathedral Catholic

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HOPS
The Off-the-Field Injury Evaluation Process
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H – History
The most essential part of the process.
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Helps the athletic trainer determine what they will do during
the remainder of the evaluation process.
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Most times a person is able to determine what is wrong by
getting a good history.
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Almost like being a detective.
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H – History
During the History it is important for the sports medicine
professional to:
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Be calm and reassuring.
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Ask open ended questions.
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Listen carefully to the athlete/patient’s response for
possible clues.
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Maintain eye contact when possible.
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Obtain the history as soon after the injury as possible.
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H – History
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Start with understanding the mechanism of
injury. (MOI)
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What is the problem?
How did it occur?
When did it occur?
Did you fall? How did you land?
Which direction did your joint or body part
move?
Did the athlete hear any abnormal sounds or feel
any abnormal sensations? Key sounds. Sounds
occurring at the time of injury can provide
valuable information about the type and severity
of the injury. Cracks, pops, snaps or tears.
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H-History
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Injury Location
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The AT should ask the patient to locate the area of complaint by
pointing to it with 1 finger only.
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If patient CAN point to a specific pain site, the injury is probably
localized.
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If the exact pain site CANNOT be indicated, the injury may be
generalized.
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H – History
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Next determine pain characteristics.
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What type of pain is it?
 Nerve pain is sharp, bright or burning.
 Bone pain tends to be localized and
piercing.
 Vascular system pain tends to be poorly
localized, aching and referred from
another area.
 Muscular pain is often dull, aching and
referred to another area.
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H – History
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Pain Characteristics Continued.
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Where is the pain? The deeper the injury site, the
more difficult to match the pain with the site of
trauma.
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Does the pain move? Does pain increase at night?
 Pain the subsides during activity usually
indicates chronic inflammation
 Pain that increases throughout the day indicates
progressive increase in edema.
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H – History
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Pain Characteristics Continued.
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Does the patient feel sensations other than
pain?
 Pressure on nerve roots can produce a
sensation of “pins and needles”
(paresthesia)
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Ask the athlete to quantify the amount of pain
present using a pain scale of 1 to 10.
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H – History
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Determine joint responses.
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If the injury is related to the joint, is there
instability?
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Does the joint feel as though it is giving out?
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Does the joint lock and unlock?
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H – History
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Evaluate level of function.
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Were they able to keep playing after the
injury or did they come out of the game?
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Are they able to use the injured body part
normally?
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Determine if injury is acute or chronic?
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Acute – happened in one action/event
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Chronic – progressed over time
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H – History
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Find out if there have been any previous
injuries to the area.
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Has this ever happened before? When?
There may be an underlying weakness that
caused the injury.
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O-Observation
This is often modified by the complaint of the
athlete/patient.
Here we are looking at the athlete and the injury and
visually inspecting them. Often comparing the
injured body part to the non-injured side.
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O-Observation
Suggestions:
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Is there obvious deformity?
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How does the patient move?
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Is there a limp?
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Are movements abnormally slow, jerky, and
asynchronous?
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Is the patient unable to move a body part?
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Is the patient holding his or her body stiffly to protect
against pain?
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Does the patient’s facial expression indicate pain or
lack of sleep?
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Are there any obvious body asymmetries?
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O-Observation
Suggestions:
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Does soft tissue appear swollen or wasted
as a result of atrophy?
Are there unnatural protrusions or lumps such as
occur with a dislocation or fracture?
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Is there a postural malalignment?
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Are there abnormal sounds such as Crepitus
when the athlete moves?
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Does the body area appear inflamed?
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Is there swelling, heat or redness?
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Are there any obvious wounds?
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P - Palpation
Both the injured and non-injured sites should
be palpated (touched) and compared.
The athletic trainer is looking for an
abnormality in structures that may not be
observed but may be felt
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P - Palpation
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Evaluate away from the injured area first. This
helps to gain the athletes confidence and you
will be less likely to miss secondary areas of
pain and injury.
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Bony palpation allows the athletic trainer to feel
an abnormal gap in the joint, a swelling along a
structure, a misalignment, or a protuberance.
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P - Palpation
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Soft tissue palpation allows the athletic
trainer to detect many things.
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Swelling, lumps, gaps, and abnormal muscle
tension
Skin temperature variation.
Torn ligaments and tendons.
Muscle twitching and tremors.
Excessive skin dryness or wetness.
Abnormal skin sensations
Variations in structure shapes, tissue
tightness and textures
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S – Special Tests
Special Tests should be performed by
trained professionals only.
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S – Special Tests
Movement assessment – Range of Motion
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Active Range of Motion (AROM) – Done by
the athlete
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Depending on where the athlete has pain when
moving the body part may determine what is wrong
with them.
Passive Range of Motion (PROM) – Done by
the health care professional
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Depending on where the athlete has pain when
someone else is moving the body part may
determine what is wrong with them
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S – Special Tests
Movement assessment – Range of Motion
 Muscle
strain – pain with active contraction and
passive stretch.
 Ligament
– pain with movement and stretching.
 End Points Normal
 Cartilage Tear
 Muscle Spasm
 Ligament Sprain (ACL)
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S – Special Tests
Manual Muscle Testing – Strength
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Done to Test the weakness of specific
muscles
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S – Special Tests
Neurologic Examination
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Typically done when there was a head injury.
Deals with Cerebral function, cranial nerve
function, and cerebellar function.
Sensory Testing - Sometimes done when there is
a sensory loss in the musculoskeletal system and
test by dermatome (area of skin innervated by a
single nerve) or myotome (muscle or groups of
muscles innervated by a specific motor nerve).
Referred pain testing
Motor testing – like manual muscle testing.
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S – Special Tests
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Joint Stability Testing
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Specific tests to determine the integrity
(strength and stability) of a joint.
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Determine the severity of an injury or
sometimes what specifically is wrong.
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S – Special Tests
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Testing Functional Performance
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Sometimes done to determine if an athlete
can immediately return to play.
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Determines the functional ability of the
athlete at that immediate time.
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Can they…run, cut, plant, back pedal, block,
hit…in short, can they play their sport
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Medical Referral
When immediate diagnosis by a physician is not available, the
athletic trainer or coach must assume responsibility for
evaluating the injury. Determine if the injury is of a serious
or non-serious nature. If the injury appears to be more
serious, referral to a physician is indicated.
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What you will do
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Complete HOPS worksheet
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Research 3 different Special Tests
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Choose different parts of anatomy
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Use this website:
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http://ahn.mnsu.edu/athletictraining/spata/
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Get general info from this site and then look up a YouTube
video demonstrating the special test
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Give a brief summary of the special test
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What is the test looking for?
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How is the test performed?