INJURY MAINTENANCE

WHAT TO DO ONCE AN INJURY OCCURS?

Create a medical form including everything you think needs to be included in an injury report.

TYPES OF INJURIES

Closed (Unexposed) Wounds Closed soft tissue:

Contusion Sprain Strain

Bone and Joint Articulation (a union between two bones): Closed Fx- Simple (no disruption of skin surface) Traumatic (acute) Fx- Immediate pain, rapid swelling,

bony tenderness, crepitus, with movement of bony fragments and possible deformity if fx is displaced

Stress Fx- onset of pain is gradual, pain or deep ache at first noticeable only during activity, may subside with rest, progressing to more constant pain if offending injury continues

BONE AND JOINT ARTICULATION INJURIES CONT…

Epiphyseal Injury – disruption or separation of the epiphysis or epiphyseal plate (Salter-Harris Fx)

Dislocation- complete disassociation of two joint surfaces

Subluxation – incomplete disassociation of two joint surfaces (may be difficult to identify)

Nerve Injuries Neuralgia- achiness or pain along a nerve secondary to

chronic irritation or inflammation Neuroma – thickening of a nerve or “nerve tumor”

secondary to chronic irritation or inflammation

OPEN (EXPOSED) WOUNDS Open wounds – injuries that involve a disruption in the

continuity of the skin caused by friction or by blunt or sharp trauma Abrasion – “Strawberry” large surface area exposed, caused by

friction Blister – separation and accumulation of fluid or blood between

superficial skin layers secondary to repetitive friction or shearing movements

Incision – a cut through all layers of the skin by a sharp object or instrument (smooth, even wound edges)

Laceration – a tearing of the skin by blunt trauma to the skin over a bony prominence, (jagged, uneven wound edges)

Puncture – a small disruption in the skin caused by sharp penetrating object

Avulsion – a tearing off or complete disassociation of a portion of skin

Compound fx/dislocation- disruption of the skin surface secondary to penetration by a displaced fx fragment or joint dislocation (Fx = Fracture)

PRINCIPLES OF EXAMINATION

Assessment – a procedure through which the clinician determines the severity, irritability, nature and stage of an injury

Evaluation – is the systematic process that allows the clinician to make a clinical judgment

Primary Survey- ABCs Secondary Survey- rapid examination of the

seriousness of the injury before the athlete is moved

STAGES OF ASSESSMENT SOAP Notes

Subjective Objective Assessment Plan

Subjective = history Severity, irritability, nature of the injury, MOI, only as good as

the questions you ask What questions should be asked?

Objective = tests Comparable sign= reproducing the problem Bilateral Comparison Observation Palpation Range of Motion (ROM) Strength Special Tests (any body know any tests?) Neurological Status Vascular Status Functional Testing

FUNCTIONAL TESTING LOWER BODY Balance in standing (Stork or tandem stand) Walking forward Walking up and down stairs (practicality?) Jogging Forward Running Forward Sprinting Forward Hopping Forward Jogging, running, sprinting backward Jogging, running, sprinting side to side Hopping alternate feet Hopping involved leg only Skipping forward and backward, side to side Jumping forward, backward Sport Specific Activities

FUNCTIONAL TESTING UPPER EXTREMITY

Tossing Throwing Pitching Hitting Batting Catching Receiving Standing on hands Supporting body weight on arms Sport Specific Activities Anything else?

Chief Complaint- what’s wrong?, where does it hurt?, what happened?

Mechanism of Injury (MOI)- how the injury occurred Compressive force Tensioning force Twisting force Shearing force

Nature of illness or injury Events surrounding the injury

TAKING A HISTORY

ACUTE HISTORY QUESTIONS What happened and how

did it happen? What position were you

in when the injury happened? (How they landed)

Did you hear or feel any unusual sounds or sensations at the time of injury? (snap, pop, or click)

Do you feel any unusual sensations now? (numbness, tingling, burning)

Where is the pain? Point with one finger

Can you describe the pain? Quality of pain (Sharp, dull,

achy) Intensity (Pain scale 0-10) Localized or diffuse Referral of pain to other

segments Changes in pain from when

it started (intensified or lessened)

When does it hurt? What is the previous

history? What is the previous hx for

the opposite side? Are there any other

medical conditions to be aware of?

NONACUTE HISTORY QUESTIONS

What happened and how? (did it come on gradually and when did they appear)

What activities aggravate the injury now?

What makes it feel better?

When you work out, when do the symptoms come on and for how long?

Do the symptoms interfere with daily activities, and if so, what activities?

Can you describe the pain? Quality of pain (sharp, dull,

achy) Intensity (0-10 scale) Localized or diffuse Referral to other segments Changes in pain from when it

started (intensified or lessened over time)

Does the pain wake you up at night?

Is there anytime during the day that the pain is worse or less or is the pain activity related?

What treatments if any have you self-administered?

CHRONIC HISTORY What hurts? When did this occur? Was it sudden onset or

gradual? Can you describe the pain? When does it hurt? Is the pain constant or

intermittent? How long does the pain last? What makes it worse? Have you made any abrupt

or significant changes in training? Change in intensity, duration,

training surface, type of activity

Change in training implements

Shoes, rackets, bat grips, etc.

What is the previous hx for the body region?

Are there any medical conditions to be aware of? Change in diet or weight? Recent illness? Other signs and symptoms? Existing medical conditions? Taking any medications or

receiving treatment?

SIGNS AND SYMPTOMS

Current signs and symptoms Vs.

Previous history and contributing factors

OBSERVATION Initial/overall

impression on the field/clinical setting

Observation of body type Ectomorph- low to

normal body fat, low muscle mass (underweight)

Mesomorph – low to normal body fat, high muscle mass

Endomorph – high fat and muscle mass and is overweight

Observation of Posture and Gait

Observation of Injured Segment

What would you be looking for?

PALPATION

Need anatomical knowledge

Personal skills Keep patient

comfortable

Technique Rolling and strumming Movement when

palpating still structures Stillness when palpating

moving structures Movement of a limb as

a palpation tool

Structures to palpate Skin

Use back of hand to palpate for moisture and temperature

Fascia Superficial fascia has spongy soft

end feel (when moving skin the resistance you feel is superficial fascia)

Muscle Bone Joint Structures Neurovascular Tissue Lymph Nodes

PALPABLE BONY STRUCTURES Shaft- body of a long bone Head or condyle – rounded

end of a long bone that articulates with the joint

Epicondyle – the prominent aspect of the bone, proximal to the condyle

Groove – a narrow, longitudinal depression in a bone (passage for a tendon)

Ridge or crest – raised surface on bone

Tubercle – small and rounded projection

Tuberosity – A more prominent and large rounded projection

Apophysis – A small projection on a bone that serves as the attachment for a tendon

Epiphyseal Plate – area of growth between shart and end of bone

Notch – indentation in the end of a bone (ligaments, nerves, arteries, tendon)

PALPABLE JOINT STRUCTURES Synovial Capsule – a

well-defined membranous connective tissue that surrounds and encloses the structures of a synovial joint

Articular Cartilage – smooth, cartilage that covers the articular surface of a bone

Bursa - fluid filled sac that contains synovium to reduce friction between structures

Joint Line – a palpable separation between two articulating bones

Ligament – a taut, cordlike or bandlike fibrous connective tissue that connects bone to bone

RANGE OF MOTION

Range of Motion – the arc of motion through which a segment moves Active ROM Passive ROM Resistive ROM

1-5 Grading Scale

Goniometer – measuring tool for ROM

PRACTICE ROM

With a partner practice moving them through PROM Shoulder

flex/ext/abd/add/int/ext rot

Knee flex/ext Elbow flex/ext Pronation/Supination

Calculate using the Goniometer their ROM in each direction

STRENGTH TESTS

PRACTICE BREAK TESTS

With a partnerPerform a

break test on their:QuadricepShouldersBicepHip Flexor

SPECIAL TESTS

Each injury may or may not have specific special tests that can be used to identify that injury.

NEUROVASCULAR TESTING

Myotomes vs. Dermatomes

VASCULAR TESTING

Check Pulse Capillary Refill

ASSESSMENT

What do you think the injury is?

Your diagnosis?

PLAN

What do you plan to do next?

Referral? Treatments/Modalities