Transcript Ch2(22-46) - Harrison High School

2
Principles
of Assessment
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.
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.
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
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.
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
Severity (SINS)
Indicates need for referral.
Refer the more severe injuries.
Never hesitate to refer if unsure of the
severity.
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.
Nature (SINS)
Includes type of injury and type of
structures involved.
History is important.
Confirm suspicions through objective
assessment.
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)
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)
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
History
Develop a good picture of the injury:
Current and previous injuries
Onset, type, and location of pain
Unusual sounds or sensations
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)
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.
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)
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
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.
Jendrassik’s
maneuver
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.
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
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)
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.
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
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)