Transcript Off-the-Field Evaluation

Off-the-Field Evaluation
Athletic Medicine I
Objectives
● Know:
The organs located in each abdominopelvic
quadrant.
o Difference between clinical and medical dx.
o The order in which evaluations are conducted.
o The specifics of HOPS.
o What different ROMs are testing for.
o How to document injuries.
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Evaluation of Sports Medicine Injuries
● Four distinct evaluations
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Pre-participation
On-the-field
Off-the-field
Progress (during rehabilitation)
Diagnoses
● Athletic Trainers offer a clinical diagnosis.
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Accurately identifies the pathology of injury, the
limitations and possible disabilities associated with
a condition.
● Physicians offer a medical diagnosis.
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Use of X-rays, MRIs, CT scans, blood tests, etc.
Ultimate determination of a patient’s physical
status.
Basic Knowledge Requirements
● Athletic trainers must have a thorough
knowledge of human anatomy and its
function, as well as the sport and its
demands.
Anatomy
● Surface Anatomy
● Abdominopelvic Quadrants
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Quadrants
● Musculoskeletal Anatomy
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Bones
Landmarks
Muscles
Abdominopelvic Quadrants
● URQ
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Liver
Gallbladder
● ULQ
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Spleen
Stomach
Liver
Kidney
Abdominopelvic Quadrants
● LLQ
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Colon
● LRQ
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Appendix
Activity
● We must understand what demands specific
activities place on the body.
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Football vs. swimming vs. tennis.
Descriptive Assessment Terms
● Etiology: Cause of disease/injury.
● Mechanism: Mechanical description of the cause.
● Pathology: Structural and functional changes that
result from injury.
● Sign: Indicator of disease (you can see it).
● Symptom: Change that indicates injury (athlete
describes it).
● Diagnosis: Name of a specific condition.
● Prognosis: Predicted outcome of injury.
● Sequela: Condition resulting from disease or injury.
Off-the-Field Injury Eval Process
● HOPS
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History
Observation
Palpation
Special Tests
History
● MOST critical aspect of the evaluation.
● Information obtained:
Mechanism
o Chief complaints
o Pain location, character, duration, variation,
aggravation, distribution, intensity, and course.
o Existing conditions.
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History: 10 Questions
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What’s going on?
How did it happen?
When did it happen?
What did you hear?
What did you feel?
Where does it hurt?
● What does it feel
like?
● On a scale of 1-10,
how bad is the pain?
● Has this happened
before?
● Have you done
anything for it?
Observation
● Usually done while taking a history.
● Things to look for:
Obvious deformity
o Limp; abnormal movements
o Posture
o Facial expression
o Edema; redness; bruising
o Asymmetries
o Abnormal sounds
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Palpation
● Two types:
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Bony
 Can reveal abnormal gap in joint, swelling on a
bone, joints that are misaligned, or abnormal
protuberances associated with a joint or bone.
Soft tissue
 Swelling, lumps, gaps, muscle tension,
temperature variations.
Special Tests
● Designed to detect specific pathologies.
● To decide which tests to perform, take into
account all information up to this point.
● Types of special tests:
Movement assessment
Manual muscle testing
o Neurological assessment
o Joint stability
o Functional performance
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Special Tests: Movement Assessment
● Active Range of Motion (AROM)
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Athlete moves joint with no assistance.
● Passive Range of Motion (PROM)
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Athletic trainer moves joint with no assistance
from the athlete.
● Resisted Range of Motion (RROM)
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Athlete moves joint through range against
resistance applied by athletic trainer.
Special Tests: ROM
● Tells us what types of structures may be
involved.
Pain with AROM, PROM and RROM: Most likely bone
or ligament.
o Pain with AROM and RROM, but not PROM: Most
likely muscle.
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Special Tests: Manual Muscle Testing
● Tests muscular strength
● Places athlete in different positions to test
different muscles.
● Athlete holds body part in specific position
while the athletic trainer provides
resistance.
Special Tests: MMT Scale
1: Unable to move affected body part.
2: Unable to hold affected body part against gravity.
3: Able to hold the position against gravity.
4: Able to hold position against gravity and minimal
resistance.
5: Able to hold position against gravity and maximal
resistance.
Special Tests: Neurological Exam
● Five major areas:
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Cerebral
Cranial nerve
Cerebellar
Sensory
Reflex
● You only need to do the first three if you
suspect a head injury.
Special Tests: Sensory Testing
● Dermatome: Area of skin innervated by a
single nerve.
● Myotome: Muscle or group of muscles
innervated by a specific nerve.
● Need to test:
Superficial sensation
o Superficial pain
o Deep pain
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Special Tests: Joint Stability
● Special tests used to test ligaments and
cartilage.
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i.e. Lachman’s for ACL; McMurray’s for meniscus.
https://www.youtube.com/watch?v=oFWjwxJJmm
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Injury Documentation
Injury Documentation
● For documenting what we see, there is a
specific way we must document.
● Why do we document?
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See any changes that are occurring.
Document the treatment that we did.
SOAP Notes
● Used to document injuries.
● Subjective (everything the athlete tells you).
● Objective (everything you see feel and
measure)
● Assessment (Diagnosis)
● Plan (what are you going to do?)
Subjective
Pt. is complaining of sharp pain in L ankle. Recalls
“rolling” it in a soccer game yesterday when she
stepped on an opponent’s foot. Pt. states that
pain is 5/10 with walking and 2/10 at rest. Pt.
was not able to finish the game. Pt. reports
feeling a pop in ankle; did not hear it. Reports
spraining ankle last soccer season. After current
injury, went home and iced and elevated.
Objective
Observation: No obvious deformity. Moderate
edema over L lateral malleolus. Discoloration
distal to lat. mallelous and near phalanges.
Walking with obvious limp.
Palpation: TTP over distal L lat. malleolus and
sinus tarsi. No bone tenderness. No palpable
deformity, crepitus. Mild temperature difference
when compared bilat. Mild palpable edema.
Objective
● ROM
o AROM:
 Plantarflex: Full when compared bilat., mild pain.
 Dorsiflex: Full when compared bilat.
 Inversion: Diminished when compared bilat., moderate pain.
 Eversion: Full when compared bilat.; mild pain
o PROM
o RROM
o Manual Muscle Test
 Plantarflex: 5/5
 Dorsiflex: 5/5
Objective/Assessment/Plan
● Special Tests:
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(-) Bump test
(-) Compression test
(+) Anterior drawer for pain; mild laxity
(+) Talar tilt for pain
● Assessment: L Grade 2 ATFL Sprain
● Plan: RICE ~48 hours; begin ROM exercises
when pain subsides.
Progress Notes
Done periodically during rehabilitation.