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Injury Evaluation Process: Chapter 1. Foundations of Evaluation . Know normal anatomy & biomechanics Systematic standardized approach triage re-eval Compare uninjured to injured. Evaluation Styles --p.2. Systematic HIPS, HOPS, HOPE p.2 : 7 steps Settings: clinical on-field

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Foundations of evaluation
Foundations of Evaluation

  • Know normal anatomy & biomechanics

  • Systematic standardized approach

    • triage

    • re-eval

  • Compare uninjured to injured


Evaluation styles p 2
Evaluation Styles--p.2

  • Systematic

  • HIPS, HOPS, HOPE

  • p.2 : 7 steps

  • Settings:

    • clinical

    • on-field

  • Table 1-1, p. 3

  • Box 1-1, p.4


Evaluation settings p 3 19
Evaluation Settings--p.3, 19

  • Clinical Evaluation—p.3

  • Determine fully severity and scope of injury

  • Controlled environment

  • Usually involves evaluation tools

  • Greater time involvement

  • On-Field Evaluation—p.19

  • Determine severity & mobility status

  • Extended triage

  • Evaluate participation status

  • Shortened process

  • May be ambulatory or non-ambulatory


History hx p 20
History (Hx)--p.20

  • Most important aspect of evaluation

  • Use open-ended questions

  • Learn of PMH

    • questions & documentation

    • past injuries & treatment/surgeries

  • Symptoms/complaints

  • Location of pain (may not = site of injury)

  • Localized vs. diffuse pain

  • On-field: bystanders/witnesses available


Observation inspection p 7 21
Observation/Inspection--p. 7/21

  • Look for signs of injury & injury severity

  • Primary & secondary surveys

  • On-field eval: moving? Conscious? ABC’s? secondary survey?

  • Look for:

    • Gross deformity

    • Signs of trauma

    • Functional status/Gait

    • posture/presentation

    • Attitude


Palpation p 8 21
Palpation--p.8/21

  • Observation using the hands

  • Detecting tissue damage using touch

  • Note:

    • point tenderness

    • crepitus

    • symmetry

    • temperature changes

    • sensation/numbness

  • On-field evaluation:

    • helps to focus the eval when time is limited

    • assesses the mobility of the athlete


Functional testing p 10 21

Assessment of motion & ability to perform necessary actions

Note any apprehension/hesitation

Determine weightbearing status

Functional Testing--p. 10/21

  • Ranges of Motion (ROM)

  • Strength grades (MMT)


Range of motion testing p 10
Range of Motion Testing—p. 10

  • ROM:

    • AROM--tested first

    • PROM--

    • RROM--break test/strength test

  • Goniometry

    • Box 1-4, p.11


Girth measurement p 9
Girth Measurement—p.9

  • Identify differences in size caused by:

    • Atrophy

    • Hypertrophy

    • Edema

  • Always measure bilaterally

  • Only part of the puzzle

  • Girth Measurement

    • Box1-3, p. 9

  • Volumetric Measurement

    • Fig. 1-3, p.10


Strength testing p 14
Strength Testing—p. 14

  • Table 1-5, p. 14

  • MMT/RROM

  • Subjective testing

  • Stabilize joint while stressing muscle

  • Interpersonal variability

  • 0-5 scale

  • NML=5/5

  • Compare bilaterally


Ligamentous capsular testing p 14 22
Ligamentous/Capsular Testing--p. 14/22

  • Severity grading

  • On-field evaluation: perform quickly but efficiently before symptoms are masked by swelling/pain

  • Uninvolved assessed first(?).

  • Endfeel assessment: Tables 1-3 & 1-4, p. 13

  • Assessment of integrity in non-contractile tissues

  • Assess bilaterally

  • Proper positioning crucial to valid results (+/-)

  • Congenital laxity

    • Fig. 1-8, 15

    • Know Your Athletes!

    • Laxity vs. Instability(?)


Neurological testing p 15 22
Neurological Testing--p.15/22

  • Upper/lower quarter screening

  • Assessment of sensation/motor function/DTR’s

  • Especially important with spinal cord injuries

  • Bilateral assessment

  • Box 1-5, 1-6


Removing an athlete from the field p 22
Removing an athlete from the field--p. 22

  • Decision based on objective data, not the situation

  • Immobilization may be necessary--Fig. 1-14, p. 23

  • Methods of removal--p. 24


Injury vs illness
Injury vs. Illness

  • History

  • Observation

  • Palpation

  • Functional Testing

  • Special Testing

  • Neurological Testing


Conclusions
Conclusions:

  • Know your Anatomy!

  • Anatomy->function->pathology->treatment

  • Thorough yet practical & efficient

  • Reassess often

  • Bilateral comparisons

  • Obtain a good history!

  • Table 1-9, p.25: When to Refer Immediately


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