Transcript Injury Evaluation

Athletic Training
Mr. Fluck
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Injury History
Inspection and Observation
Pain and Palpation
Range of Motion
Manual Muscle Testing
Special Test
Functional Testing
Physical Referral / Diagnostic Tests
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Who? What? When? How?
Asking questions to find out what injury occurred.
A good thorough Injury History will often tell you
what the injury is without physically touching the
individual
With an acute injury, it is important to get an accurate
Injury History right away…Why?
What are some questions you should ask during injury
history?
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Questions that would help you figure out what is wrong
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What happened or How did it happen?
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Injury mechanism
When did it happen?
Did this injury ever happen before?
Are you taking any medications?
Any relevant surgeries?
Is this your dominant side?
What sport do you play or even what position do you play?
Do you have any pain anywhere else on your body?
Do you have any allergies?
Did you hear or feel a anything (“pop”)
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Signs and symptoms
Signs
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Swelling
Echymosis
Deformity
Carrying Angle
Bleeding
Discoloration
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Symptoms
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Dizziness
Headache
Nausea
Memory loss
 Retrograde
 Post-traumatic
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***Bilateral Comparison
– to know what is
normal for that person
you compare the
injured part of the body
to the uninjured part
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Palpate specific anatomical structures
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distal / proximal to the injury
Pain on bone = contusion, fracture or maybe dislocation /
subluxation
Pain on ligament = contusion or sprain
Pain on muscle or tendon = contusion, strain, tendonitis or
perhaps bursitis
Pain
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Type of pain: burning, stinging, tingling, etc…
Grade your pain on a scale of 1 to 10
 Remember pain is relative to each individual
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Does the pain change with: movement, weight bearing,
exertion, etc…
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Active AROM
Passive PROM
Goniometer – quantify the ROM (put an exact
measurement or number to it)
Bilateral Comparison
Joint Clearing – check the joint immediately
distal and immediately proximal to the
“injured” joint
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Manual assessment of strength
You apply steady resistance throughout the
ROM to assess muscular strength.
Scale
5/5 full ROM against a full resistance
 4/5 full ROM against a partial resistance
 3/5 full ROM against gravity
 2/5 full ROM with gravity eliminated
 1/5 no ROM but signs of muscle contraction
 0/5 no ROM and no signs of contraction
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***Bilateral Comparison
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Very specific test that assess certain injuries
Example: Thompson Test – assess Achilles
tendon rupture
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http://www.youtube.com/watch?v=AmDi08rlR3I
http://www.youtube.com/watch?v=HN4guig3u-o
http://www.youtube.com/watch?v=gkHgY-Y45VY
http://www.youtube.com/watch?v=uzzV5BRWlIc
&feature=related
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Special tests for fracture
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Tap test
Longitudinal compression test
http://www.youtube.com/watch?v=0kPjh1nTf-U&feature=BFa&list=PLA8677004E806402F&lf=results_video
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Progression of activities that get more
challenging
Lower body –
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Walk straight ahead, jog straight ahead, jumping or
hopping, sprint straight ahead, running figure eights
(big and small), cutting, side shuffles, cross-over
running, sport specific activities
Sport Specific activities are specific to the sport
and even to the position within that sport
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Basketball – lay-up drills, rebounding drills,
“suicides”, defensive shuffles, pivoting
Football Lineman – 5 yard bursts, footwork drills,
monkey rolls, blocking drills
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By law, only a physician can diagnose an injury
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Physician can give “standing orders”
Only a physician can refer for diagnostic
testing
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X-ray
MRI
CT scan
Blood Work
Bone Scan
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Lateral Ankle Sprain
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http://www.youtube.com/watch?v=RP42cEbqUD0
http://www.youtube.com/watch?v=_KBYLBuAym
c
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Injury mechanism: excessive inversion or
excessive plantarflexion with inversion
History of ankle sprains would make the
person more likely to sprain the ankle again
Type of sport, footwear, playing surface could
predispose someone to sprain their ankle
They will sometimes hear or feel a “pop”
Person usually says “they landed on something
or landed in a hole or an uneven surface”
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Swelling and possibly echymosis in either over
or just below the lateral malleolus
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Possible even distal to the ankle joint
Possible deformity (indicating fracture)
Point tender to the touch: specifically over the
three ligaments on the medial side of the ankle
Carrying angle for ankle injuries: Limping on
your heel or unable to bear weight at all
**Bilateral Comparison will tell me what is
normal for that person
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Pain will depend on the severity of the injury
and the person tolerance for pain
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The pain will increase will weight-bearing
 Especially going up and down stairs and changing
directions
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Limited AROM and PROM in all motions.
Especially Plantarflexion, Dorsiflexion and
Inversion
Goniometric measurements
Joint clearing- check the toes and foot as well as
the knee
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A simple squat would clear all joints
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Acutely – 0/5 -1/5
Within a few hours to a few days – 2/5 – 4/5
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Take the patient through the functional test
noting at what level they are immediately
following the injury
Throughout the rehabilitation process and at
the end of the rehab process you will retake
them through the progression to make sure
that they are improving and can ultimately
return to activity
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Fracture tests –tap, see-saw, longitudinal
compression
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Diagnostic tests needed:
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X-ray – to rule out fracture
Possible MRI to assess ligamentous damage