Transcript File - mr. burkett science

HOPS
Evaluation Procedures for Athletic
Injuries
H – History
The most essential part of the process.
• Helps the athletic trainer determine what
they will do during the remainder of the
evaluation process.
• Most times a person is able to determine
what is wrong by getting a good history.
• Almost like being a detective.
H – History
During the History it is important for the
sports medicine professional to:
•
Be calm and reassuring.
•
Ask open ended questions.
•
Listen carefully to the athlete/patient’s
response for possible clues.
•
Maintain eye contact when possible.
•
Obtain the history as soon after the
injury as possible.
H – History
•
Start with understanding the mechanism of
injury.
–
–
–
–
–
–
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.
H – History
•
Next determine pain characteristics.
–
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.
H – History
•
Next determine pain characteristics.
–
Where is the pain? The deeper the injury
site, the more difficult to match the pain with
the site of trauma.
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.
H – History
•
Next determine pain characteristics.
–
Does the patient feel sensations other than
pain?
•
–
Pressure on nerve roots can produce a
sensation of “pins and needles” (paresthesia)
Ask the athlete to quantify the amount of
pain present using a pain scale of 1 to 10.
H – History
•
Determine joint responses.
– If the injury is related to the joint, is there
instability?
– Does the joint feel as though it is giving out?
– Does the joint lock and unlock?
H – History
•
Evaluate level of function.
– Were they able to keep playing after the
injury or did they come out of the game?
– Are they able to use the injured body part
normally?
•
Determine if injury is acute or chronic?
– Acute – happened in one action/event
– Chronic – progressed over time
H – History
•
Find out if there have been any previous
injuries to the area.
– Has this ever happened before? When?
There may be an underlying weakness that
caused the injury.
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.
O-Observation
Suggestions:
•
Is there obvious deformity?
•
How does the patient move?
•
Is there a limp?
•
Are movements abnormally slow, jerky, and
asynchronous?
•
Is the patient unable to move a body part?
•
Is the patient holding his or her body stiffly to protect
against pain?
•
Does the patient’s facial expression indicate pain or
lack of sleep?
•
Are there any obvious body asymmetries?
O-Observation
Suggestions:
•
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?
•
Is there a postural malalignment?
•
Are there abnormal sounds such as Crepitus
when the athlete moves?
•
Does the body area appear inflamed?
•
Is there swelling, heat or redness?
•
Are there any obvious wounds?
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
P - Palpation
•
•
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.
Bony palpation allows the athletic trainer
to feel an abnormal gap in the joint, a
swelling along a structure, a
misalignment, or a protuberance.
P - Palpation
•
Soft tissue palpation allows the athletic trainer
to detect many things.
–
–
–
–
–
–
–
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
S – Special Tests
Special Tests should be
performed by trained
professionals only.
S – Special Tests
Movement assessment – Range of Motion
•
Active Range of Motion (AROM) – Done by
the athlete
•
•
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
•
Depending on where the athlete has pain when someone
else is moving the body part may determine what is wrong
with them
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)
S – Special Tests
Manual Muscle Testing – Strength
– Done to Test the weakness of specific
muscles
S – Special Tests
Neurologic Examination
–
–
–
–
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.
S – Special Tests
•
Joint Stability Testing
– Specific tests to determine the integrity
(strength and stability) of a joint.
– Determine the severity of an injury or
sometimes what specifically is wrong.
S – Special Tests
•
Testing Functional Performance
– Sometimes done to determine if an athlete
can immediately return to play.
– Determines the functional ability of the
athlete at that immediate time.
– Can they…run, cut, plant, back pedal, block,
hit…in short, can they play their sport
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.