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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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