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3 evaluations

1. primary evaluation: on field
2. secondary evaluation: off-field
3. follow up:
- post game
- later... refer... wait & see

MOI

mechanism of injury (force, angle, contact, overuse, etc.)

S/S

signs & symptoms

Pathology

injury type

Severity: 1st degree or Grade I

mild/ slight stretching of tissue
small inflammation
little loss of ROM & strength

Severity: 2nd degree or Grade II

partial tear
more inflammation
ROM loss up to 50%
strength loss up to 50%

Severity: 3rd degree or Grade III

rupture of tissue
marked inflammation
strength loss > 50%
intense pain initially, then subsides

immediate Tx protocol

PRICE

Signs (objective)

-can "see"/touch, asses (directly)
-deformity
-redness
-bleeding
-swelling
-fever
-sweating
-cyanosis

Symptoms

-something "described"
-nausea
-headache
-pain
-numbness
-tingling
-weakness

when you arrive on the scene...

-calm tyself and the crowd around you
-calm athlete: touch and talk
-stabilize injury (leg, arm, head/neck, etc.): assume "bad at this point

HOPS

-History (Hx)
-Observation
-Palpation
-Stress

History

-acute or chronic condition?
-what happened?
-hear, feel snap, crack or pop?
-how happened? establish MOI
-where does it hurt? can you point with 1 finger?
-has it happened before?
-what activities are limited?

Observation

-life/limb threatening? Fx or dislocation?
-athlete condition? panic, fear, altered consciousness
-obvious deformity? Fx or dislocation/ laceration?
-swelling?
-bleeding? internal or external
-guarding (holding arm) or limping? protecting?

Palpation

-light -> firm
-start away; move towards
-abnormalities? Fxs or dislocations
-pain? pinpoint or diffuse? inside or outside? type; sharp, burning, dull ache?
-swelling?
-pulse?
-temperature?

Stress

Range of Motion (ROM):
-Active ROM 1st.
-Passive ROM if able- pain limited

functional tests

-maybe most important part; often overlook
-full ROM & strength do not guarantee full function
-ask athlete to demonstrate functional, sport activities

-for example, after an ankle injury:
bilateral toe raises
unilateral toe raises
hopping
jogging
running
figure 8s
cutting

injury evaluation review

primary survey always 1st

HOPS:

H = Hx
-What happened? (MOI)
-How? When? Previous history?
-Type of pain, feel/hear anything
-Hurts more when you...?

O = Observation
-Gait, ROM, facial expression, guarding
-Deformity, discoloration, swelling

P = Palpation
-Bony + soft tissue landmarks
-Light to firm
-Start away & more toward pain

S = Structural Integrity/ Special Tests
-AROM & PROM
-Strength tests/ MMT
-Functional tests
-Neurological

Basic ortho assessment/ decision tree: -see injury, calm, stabilize

-see injury, calm, stabilize
-establish MOI
-ask "snap, crackle, pop"? (Hx)

--Yes -> assume Fx/Disl/Ligament rupture
*unlikely to show "willingness to move" (AROM)
*may observe abnormal anatomy (bilateral view)
*stabilize, refer, activate EAP/911

--No -> breathe easier, safe to proceed
*no deformity (observed)
*willingness to move? (AROM): yes, proceed to palpate

Basic ortho assessment/ decision tree: observation

Observation:
-"as they lay"
-movement?
-gait?
-carrying self: protecting? favoring?

Face:
-significant pain
-fear
-apprehension

Basic ortho assessment/ decision tree: palpation

Palpation

Rules of palpation:
-away -> towards
-soft -> deep

Deformity, deficit, void, gap?
-grade 3 tissue damage, Fx?

Pain level 1-10
≥7 = significant/ concerned

Pinpoint or diffuse pain?

Sharp, lancing pain?

Crepitus?

Apprehensive?

Basic ortho assessment/ decision tree: initial management decision

remove from field
-stabilize
- after follow-up and get info a 2nd time

Basic ortho assessment/ decision tree: sideline assessment

sideline assessment
-gradual, Fnxl testing
-safe RTP
-when do you refer to play?

Evaluation Process Overview

Management Decision/Action
-immediate care protocols:
*activate EAP/911
*PRICE (first 72 hours most important
-referral?
*timing?

Re-evaluate
-follow-up as necessary
*that night
*next morning

Record Keeping
-following initial evaluation and throughout the process
*keep notes!
-it not written down, it didn't happen

Tissue Properties: Load

external or intenral forces acting on body

Tissue Properties: mechanical stress

internal response and change in dimensions
-health and age

Tissue Properties: viscoelastic properties

amount of resistance to stress

Tissue Properties: yield point

elasticity reaches max. limits -> mechanical failure
-the point you straign
-pulling it to its max. end range

types of forces

-tension
-stretching
-compression (back)
-shearing (golf swing)
-bending

injuries to skin: soft tissue and skin

-friction blister
-abrasion
-bruise
-laceration
-skin avulsion
-incision
-puncture

effected tissues & injuries: skeletal muscle injuries

-muscle tissues & tendons
-muscle cramps
-contusions
-muscle soreness (DOMS) & stiffness

effected tissues & injuries: chronic MT injuries

-myositis/fascitis: inflammation & degeneration of the MT

-"tendinitis": inflammation, irritation, and swelling of a tendon
*tendinopathies
*tenosynovitis

-atrophy: loss of muscle

effected tissues & injuries: connective tissue

Joint Capsule:
-ligament sprains
-articular cartilage

Fibroid Cartilage:
-meniscii
-labrum

effected tissues & injuries: joint injuries

-subluxations & dislocations
-chronic joint injurie
-arthritis
-bursitis

bone functions

-body support
-organ protection
-movement
-reservoir for calcium
-formation of blood cells

types of bone

-flat
-irregular
-short
-long

bone injuries

occur most where bone changes shape

types of bone injuries

-periostitis: "shin splints" ulna & medial shin
-depressed Fx: flat bone
-greenstick Fx: divit
-impacted Fx: crushed
-longitudinal Fx: long
-spiral Fx: up & around
-transverse Fx: sideways
-comminuted Fx: blown
-blowout Fx: eye socket
-avulsion Fx: something pulled off
-stress Fx: overuse

Neuropraxia

-direct flow to nerve
- temporary loss of motor and sensory function due to blockage of nerve conduction

signs: prolonged neuritis can lead to paralysis

microtrauma & overuse syndrome

-caused by repetitive stress to tissue
-friction, pressure, volume of activity, biomechanics

microtrauma & overuse syndrome examples

*achilies tendinitis
*shin splints
*stress Fxs
*osgood-schlatter's disease
*jumper's knee
*patellar chondromalacia
*apophyseal avulsion: little leaguer's elbow and shoulder
*rotators cuff tendonitits
*impingement syndrome
*golfer's elbow
*tennis elbow
*low back pain

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