Off-the-Field EvaluationAthletic Medicine I

Objectives

● Know:o The organs located in each abdominopelvic

quadrant.o Difference between clinical and medical dx. o The order in which evaluations are conducted. o The specifics of HOPS. o What different ROMs are testing for. o How to document injuries.

Evaluation of Sports Medicine Injuries

● Four distinct evaluationso Pre-participationo On-the-fieldo Off-the-fieldo Progress (during rehabilitation)

Diagnoses

● Athletic Trainers offer a clinical diagnosis.o Accurately identifies the pathology of injury,

the limitations and possible disabilities associated with a condition.

● Physicians offer a medical diagnosis.o Use of X-rays, MRIs, CT scans, blood tests,

etc.o Ultimate determination of a patient’s physical

status.

Basic Knowledge Requirements

● Athletic trainers must have a thorough knowledge of human anatomy and its function, as well as the sport and its demands.

Anatomy

● Surface Anatomy● Abdominopelvic Quadrants

o Quadrants● Musculoskeletal Anatomy

o Boneso Landmarkso Muscles

Abdominopelvic Quadrants

● URQo Liver o Gallbladder

● ULQo Spleen o Stomacho Livero Kidney

Abdominopelvic Quadrants

● LLQo Colon

● LRQo Appendix

Activity

● We must understand what demands specific activities place on the body. o Football vs. swimming vs. tennis.

Descriptive Assessment Terms

● Etiology: Cause of disease/injury.● Mechanism: Mechanical description of the

cause.● Pathology: Structural and functional changes

that result from injury.● Sign: Indicator of disease (you can see it).● Symptom: Change that indicates injury (athlete

describes it).● Diagnosis: Name of a specific condition.● Prognosis: Predicted outcome of injury.● Sequela: Condition resulting from disease or

injury.

Off-the-Field Injury Eval Process

● HOPSo Historyo Observationo Palpationo Special Tests

History

● MOST critical aspect of the evaluation.● Information obtained:

o Mechanismo Chief complaintso Pain location, character, duration, variation,

aggravation, distribution, intensity, and course.

o Existing conditions.

History: 10 Questions

● What’s going on?● How did it

happen?● When did it

happen?● What did you

hear?● What did you feel?● Where does it

hurt?

● What does it feel like?

● On a scale of 1-10, how bad is the pain?

● Has this happened before?

● Have you done anything for it?

Observation

● Usually done while taking a history.● Things to look for:

o Obvious deformityo Limp; abnormal movementso Postureo Facial expressiono Edema; redness; bruisingo Asymmetrieso Abnormal sounds

Palpation

● Two types:o Bony

Can reveal abnormal gap in joint, swelling on a bone, joints that are misaligned, or abnormal protuberances associated with a joint or bone.

o Soft tissue Swelling, lumps, gaps, muscle tension,

temperature variations.

Special Tests

● Designed to detect specific pathologies.

● To decide which tests to perform, take into account all information up to this point.

● Types of special tests:o Movement assessmento Manual muscle testingo Neurological assessmento Joint stabilityo Functional performance

Special Tests: Movement Assessment

● Active Range of Motion (AROM)o Athlete moves joint with no assistance.

● Passive Range of Motion (PROM)o Athletic trainer moves joint with no assistance

from the athlete. ● Resisted Range of Motion (RROM)

o Athlete moves joint through range against resistance applied by athletic trainer.

Special Tests: ROM

● Tells us what types of structures may be involved.o Pain with AROM, PROM and RROM: Most likely

bone or ligament. o Pain with AROM and RROM, but not PROM:

Most likely muscle.

Special Tests: Manual Muscle Testing

● Tests muscular strength● Places athlete in different positions to

test different muscles.● Athlete holds body part in specific

position while the athletic trainer provides resistance.

Special Tests: MMT Scale

1: Unable to move affected body part.2: Unable to hold affected body part against gravity.3: Able to hold the position against gravity. 4: Able to hold position against gravity and minimal resistance.5: Able to hold position against gravity and maximal resistance.

Special Tests: Neurological Exam

● Five major areas:o Cerebralo Cranial nerveo Cerebellaro Sensoryo Reflex

● You only need to do the first three if you suspect a head injury.

Special Tests: Sensory Testing

● Dermatome: Area of skin innervated by a single nerve.

● Myotome: Muscle or group of muscles innervated by a specific nerve.

● Need to test:o Superficial sensationo Superficial paino Deep pain

Special Tests: Joint Stability

● Special tests used to test ligaments and cartilage.o i.e. Lachman’s for ACL; McMurray’s for

meniscus. o https://www.youtube.com/watch?v=oFWjwxJJ

mmQ

Injury Documentation

Injury Documentation

● For documenting what we see, there is a specific way we must document.

● Why do we document?o See any changes that are occurring. o Document the treatment that we did.

SOAP Notes

● Used to document injuries.

● Subjective (everything the athlete tells you).

● Objective (everything you see feel and measure)

● Assessment (Diagnosis)● Plan (what are you going to do?)

Subjective

Pt. is complaining of sharp pain in L ankle. Recalls “rolling” it in a soccer game yesterday when she stepped on an opponent’s foot. Pt. states that pain is 5/10 with walking and 2/10 at rest. Pt. was not able to finish the game. Pt. reports feeling a pop in ankle; did not hear it. Reports spraining ankle last soccer season. After current injury, went home and iced and elevated.

Objective

Observation: No obvious deformity. Moderate edema over L lateral malleolus. Discoloration distal to lat. mallelous and near phalanges. Walking with obvious limp.Palpation: TTP over distal L lat. malleolus and sinus tarsi. No bone tenderness. No palpable deformity, crepitus. Mild temperature difference when compared bilat. Mild palpable edema.

Objective

● ROMo AROM:

Plantarflex: Full when compared bilat., mild pain. Dorsiflex: Full when compared bilat. Inversion: Diminished when compared bilat., moderate

pain. Eversion: Full when compared bilat.; mild pain

o PROMo RROMo Manual Muscle Test

Plantarflex: 5/5 Dorsiflex: 5/5

Objective/Assessment/Plan

● Special Tests:o (-) Bump testo (-) Compression testo (+) Anterior drawer for pain; mild laxityo (+) Talar tilt for pain

● Assessment: L Grade 2 ATFL Sprain● Plan: RICE ~48 hours; begin ROM

exercises when pain subsides.

Progress Notes

Done periodically during rehabilitation.