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Chapter 13: Off-the-Field Injury Evaluation

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Evaluation of Injuries

• Essential skill for athletic trainers

• Four distinct evaluations– Pre-participation (prior to start of season)– On-the-field assessment– Off-the-field evaluation (performed in the

clinic/training room…etc)– Progress evaluation

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Clinical Evaluation & Diagnosis

• Diagnosis– Use of clinical or scientific methods to establish

cause and nature of patient’s illness or injury and subsequent functional impairment due to pathology

– Forms basis for patient care

• Physicians make medical diagnosis– Ultimate determination of patient’s physical

condition

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• Athletic trainers and other health care professionals use evaluation skills to make clinical diagnoses– Clinical diagnosis identifies pathology and

limitations/disabilities associated with pathology

• Athletic trainers have academically-based credential and in many states some form of regulation which recognizes ability and empowers clinician to make accurate clinical diagnosis

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Basic Knowledge Requirements

• Athletic trainer must have general knowledge of anatomy and biomechanics as well as hazards associated with particular sport

• Anatomy– Surface anatomy

• Topographical anatomy is essential

• Key surface landmarks provide examiner with indications of normal or injured structures

– Body planes and anatomical directions• Points of reference (midsagittal, transverse, and frontal (coronal)

planes)

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– Abdominopelvic Quadrants• Four corresponding regions of the abdomen• Divided for evaluative and diagnostic purposes• A second division system involves the

abdomen being divided into 9 regions

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– Musculoskeletal Anatomy• Structural and functional anatomy• Encompasses bony and skeletal musculature• Neural anatomy useful relative to motion,

sensation, and pain– Standard Terminology

• Used to describe precise location of structures and orientation

• Biomechanics (foundation for assessment)– Application of mechanical forces which may

stem from within or outside the body to living organisms

– Pathomechanics - mechanical forces applied to the body due to structural deviation - leading to faulty alignment (resulting in overuse injuries)

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• Understanding the Activity– More knowledge of activity allows for more

inherent knowledge of injuries associated with activity resulting in more accurate clinical diagnosis and rehab design with appropriate functional aspects incorporated for return to activity

– Must be aware of proper biomechanical and kinesiological principles to be applied in activity

– Violation of principles can lead to repetitive overuse trauma

– Increased understanding = better assessment and care

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• Descriptive Assessment Terms– Etiology - cause of injury or disease– Mechanism – mechanical description of

cause– Pathology - structural and functional

changes associated with injury process– Symptoms- perceptible changes in body or

function that indicate injury or illness (subjective)

– Sign - objective, definitive and obvious indicator for specific condition

– Degree- grading for injury/condition– Diagnosis- denotes name of specific

condition

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– Prognosis- prediction of the course of the condition

– Sequela - condition following and resulting from disease or injury (pneumonia resulting from flu)

– Syndrome - group of symptoms and signs that together indicate a particular injury or disease

– Differential diagnosis – systematic method of diagnosing a disorder

• Refers to a list of possible causes• Prioritizing of possibilities• Also referred to as hypothesis or working diagnosis• Utilize skills to make decision regarding condition

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Off-the-field Injury Evaluation

• Detailed evaluation on sideline or in clinic setting

• May be the evaluation of an acute injury or one several days later following acute injury

• Divided into 4 components– History, observation, palpation and special

tests– HOPS

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• History– Obtain subjective information relative to

how injury occurred, extent of injury, MOI– Inquire about previous injuries/illnesses

that may be involved as well as past treatments

– Ask the following questions• What is the problem?• How and when did it occur?• Did you hear or feel something?• Which direction did the joint move?• Characterize the pain

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• Observations– Asymmetries, postural mal-alignments or

deformities?– How does the athlete move? Is there a

limp?– Are movements abnormal?– What is the body position?– Facial expressions?– Abnormal sounds?– Swelling, heat, redness, inflammation,

swelling or discoloration?

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• Palpation– Bony & soft tissue

• Special Tests– Used to detect specific pathologies– Compare inert and contractile tissues and their

integrity– Assessment should be made bilaterally

• Range of Motion Assessment– Active– Passive

• Normal vs. Abnormal end points• Manual muscle tests• Goniometric measures vs. Digital inclinometers

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Figure 13-4 A & B

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• Neurologic and circulation assessments– Brain

• Cerebral, cranial nerve function, cerebellar function– Sensory & motor function

• Dermatome– Area of skin innervated by a single nerve

• Myotome– Muscle or group of muscles innervated by a specific

motor nerve

– Reflex testing• Involuntary response to a stimulus

– Deep tendon – caused by stimulation of stretch reflex– Superficial – stimulation of skin which causes reflexive

muscle contraction– Pathological – superficial reflex indicative of upper motor

neuron lesion» Babinski’s sign, Chaddock’s, Oppenheim’s Gordon’s

– Referred pain

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Figure 13-5

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• Motor Testing• Testing Joint Stability• Testing Accessory Motions• Testing Functional Performance

– Used to determine athletes readiness to participate or continue participation

• Other tests– Postural– Anthropometric– Volumetric

Figure 13-6

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Documenting Injury Evaluation Information

• Complete and accurate documentation is critical

• Clear, concise, accurate records is necessary for third party billing

• While cumbersome and time consuming, athletic trainer must be proficient and be able to generate accurate records based on the evaluation performed

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• SOAP Notes– Record keeping can be performed systematically

which outlines subjective & objective findings as well as immediate and future plans

– SOAP notes allow for subjective & objective information, the assessment and a plan to be implemented

– S (subjective)• Statements made by patient - primarily history information

and patient’s perceptions including severity, pain, MOI

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– O (Objective)• Findings based on athletic trainer’s evaluation

– A (Assessment)• Athletic trainer's professional opinion regarding

impression of injury• May include suspected site of injury and structures

involved along with rating of severity

– P (Plan)• Includes first aid treatment, referral information, goals

(short and long term) and examiner’s plan for treatment