1. primary evaluation: on field
2. secondary evaluation: off-field
3. follow up:
- post game
- later... refer... wait & see
mechanism of injury (force, angle, contact, overuse, etc.)
signs & symptoms
Severity: 1st degree or Grade I
mild/ slight stretching of tissue
little loss of ROM & strength
Severity: 2nd degree or Grade II
ROM loss up to 50%
strength loss up to 50%
Severity: 3rd degree or Grade III
rupture of tissue
strength loss > 50%
intense pain initially, then subsides
immediate Tx protocol
-can "see"/touch, asses (directly)
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
-acute or chronic condition?
-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?
-life/limb threatening? Fx or dislocation?
-athlete condition? panic, fear, altered consciousness
-obvious deformity? Fx or dislocation/ laceration?
-bleeding? internal or external
-guarding (holding arm) or limping? protecting?
-light -> firm
-start away; move towards
-abnormalities? Fxs or dislocations
-pain? pinpoint or diffuse? inside or outside? type; sharp, burning, dull ache?
Range of Motion (ROM):
-Active ROM 1st.
-Passive ROM if able- pain limited
-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
injury evaluation review
primary survey always 1st
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
Basic ortho assessment/ decision tree: -see injury, calm, stabilize
-see injury, calm, stabilize
-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
-"as they lay"
-carrying self: protecting? favoring?
Basic ortho assessment/ decision tree: 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?
Basic ortho assessment/ decision tree: initial management decision
remove from field
- after follow-up and get info a 2nd time
Basic ortho assessment/ decision tree: sideline assessment
-gradual, Fnxl testing
-when do you refer to play?
Evaluation Process Overview
-immediate care protocols:
*PRICE (first 72 hours most important
-follow-up as necessary
-following initial evaluation and throughout the process
-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
-shearing (golf swing)
injuries to skin: soft tissue and skin
effected tissues & injuries: skeletal muscle injuries
-muscle tissues & tendons
-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
-atrophy: loss of muscle
effected tissues & injuries: connective tissue
effected tissues & injuries: joint injuries
-subluxations & dislocations
-chronic joint injurie
-reservoir for calcium
-formation of blood cells
types of bone
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
-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
*apophyseal avulsion: little leaguer's elbow and shoulder
*rotators cuff tendonitits
*low back pain