Basic Injury Evaluation: HOPS

1. Basic Injury Evaluation:HOPS Sara Thomas, MEd, ATC Clinical Lead- Dr. Cooper/DME Coordinator Fort Wayne Orthopedics

2. HOPS • H- History • O- Observation • P- Palpation • S- Special Testing

3. 2 Types of Evaluations • On the Field Evaluation • Quick assessment to determine severity of injury. • Makes the decision on ability to move the athlete. • Looking for fractures, neck injury, etc. • Needs to be quick and accurate.

4. 2 Types of Evaluation • Clinical (Off the Field) Evaluation • A more extensive eval. • May be done first, or after an on the field eval. • Should still be performed, even if you have done an eval on the field. • Trying to determine a specific cause for the problem, and a course of action.

5. History • WHAT HAPPENED?!? • Trying to figure out the how, when and why of an injury. • A good history should give you an idea of what may be wrong before you even touch the patient. • But don’t jump to conclusions!!

6. Types of History Questions • NOT SO GOOD- Leading Questions • Questions that could be answered with a yes or no. • Does your ankle hurt? • Does it hurt when you turn your ankle inward? • Does walking make it worse? • GOOD- Open Ended Questions • Questions that require an explanation. • Where does it hurt? • Which movements increase your pain? • What makes it better or worse? • Once you ask an open ended question, you can follow it with a more specific question.

7. So Where Do I Start? • Where are you hurting? • Point with one finger. • How did this happen? • Mechanism of Injury (MOI) • The movement or force that caused the injury. • Twisting the knee with the foot planted. • A blow to the outside of the knee. • Sometimes there is not a specific mechanism. • Knowing the MOI will play a big factor in determining the problem. • When did this start? • Acute vs. Chronic Injury • Acute- Just happened. • Chronic- Has been going on for a while.

8. More Current History • Did you hear or feel a pop or snap? • What type of pain is it? • Burning, stinging, sharp, dull, aching, tingling, stabbing, etc. • Type of pain can tell you a lot! • Does the pain change? • Time of day. • Activity level. • What makes you feel better or worse? • What have you done for it? • Meds? • Ice? • Rest? • Are you able to complete your normal activities? • Does the pain wake you at night?

9. Previous History • Have you ever had this type of pain before? • If so, what was it? • Did you hurt it the same way? • What did you do for it? • Who (if anyone) evaluated your injury? • Did you get completely better? • Have you ever had any surgeries on this body part?

10. General Medical History • Major Health Concerns • Diabetes • Recent Hospitalization • Allergies • Asthma • Cardiac Conditions • Sickle Cell Anemia or Trait • Other Ortho Injuries • Fracture History • Family History • Concussion History**

11. Concussion History • Previous Concussion? • How many? • Dates of concussion. • Duration of symptoms? • How long did you sit out? • How does this concussion compare to the last one? • Complete recovery? • Any lasting symptoms?

12. Observation (aka Inspection) • Looking at the body to see any abnormalities. • Total body observation. • This should start the second you see the athlete. • Is the athlete conscious? • Are they moving? • Are any body parts deformed? • Do you see blood coming from anywhere? • Are they limping? • How are they holding the body part that hurts? • Very important with elbows and shoulders. • Watch their expressions.

13. Keep Looking!! • Specific body part observation. • Is there anything weird about it?? • Bruising? • Redness? (Discoloration) • Open sores or cuts? • Swelling? • Deformity? • Scars from previous injuries? • Always compare to the other side. • If you are paying attention during a game, you may be able to catch a mechanism.

14. What do you see??

15. What do you see??

16. What do you see??

17. Palpation • Using the fingers to touch and feel the body structures to find problems you couldn’t find with observation. • Palpation has a pattern: • Start away from the injured area and work towards the injury. • Start with bones and ligaments first. • Then move to muscle, tendon and other soft tissue. • Then check anything else (pulses, etc.) • Knowing your anatomy is key! • Don’t forget to wear gloves, if needed!!

18. Palpation Definitions • Symmetry • Muscles • Bones • Local Heat • Redness and hot feeling skin around the injured area. • Point Tenderness • Exact spot where it hurts. • “Pointing” to the spot. • Crepitus • Creaking, cracking, crunching, etc. • You might be able hear it, too.

19. Activity Time!! • Wrist Flexors/Extensors • Crepitus, anyone?? • AC Joint • Anatomical Snuff Box

20. We Are ALMOST There!!

21. Special Tests • Fracture Testing • Range of Motion • Ligament Testing • Special Testing • Neurological Testing • Strength Testing • Functional Testing • Sport Specific Testing

22. Wait A Minute– Is it Broken?? • Fracture Testing • Tap Test • Squeeze Test • Very Important Step!! • All other testing stops if you suspect a fracture. • Risk of displacement. • Can damage other structures. • Can lead to surgery.

23. Range of Motion • Two Types • Active Range (AROM) • How much the athlete can move the body part on his own. • Passive Range (PROM) • How much you can you move the body part for the athlete.

24. Ligament/Other Special Testing • Specific by body part. • Testing to see if a ligament is torn. • Can tell you the severity of injury, depending on the end point. • End Points • Solid End Point • Joint movement has a stopping point. • Soft End Point • Joint movement seems to go farther than it should. • Soft endpoints are a signal that something is wrong. • Testing for Cartilage Tears • Testing for specific conditions. • Compare to the other side!

25. Strength Testing • Tells you the severity of injury to the muscle. • Graded on a scale from 0 to 5. • Looking for TWO things. • Pain • Weakness • Break Testing • RROM Testing

26. Neurological Testing • Sensation Testing • Does the sensation feel the same on both sides? • Do with eyes open and eyes closed. • Tap testing • Ulnar Nerve example • Reflexes

27. Functional Testing • Testing to see how well the athlete can use the injured body part. • Walking • Running • Cutting • Overhead Movements • Throwing

28. Sport Specific Testing • Testing to determine ability to play. • Pitching • Sport Specific Movements • Football Stance • Shooting • Cone Drills • Volleyball Attack

29. The End Result • Assessment vs. Diagnosis • Athletic Trainers make assessments based on their evaluations. • A diagnosis can only be made by a physician.

30. Thank You!!