Injury Evaluation
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Transcript of Injury Evaluation
INJURY EVALUATIONAthletic Training
Mr. Fluck
The Step by Step Injury Evaluation Process
Injury History Inspection and Observation Pain and Palpation Range of Motion Manual Muscle Testing Special Test Functional Testing Physical Referral / Diagnostic Tests
Injury History Who? What? When? How? Asking questions to find out what injury
occurred. A good thorough Injury History will often tell you
what the injury is without physically touching the individual
With an acute injury, it is important to get an accurate Injury History right away…Why?
What are some questions you should ask during injury history? Questions that would help you figure out what is wrong
Injury History Questions What happened or How did it happen?
Injury mechanism When did it happen? Did this injury ever happen before? Are you taking any medications? Any relevant surgeries? Is this your dominant side? What sport do you play or even what position do you
play? Do you have any pain anywhere else on your body? Do you have any allergies? Did you hear or feel a anything (“pop”)
Inspection and Observation
Signs and symptoms Signs
Swelling Echymosis Deformity Carrying Angle Bleeding Discoloration
Symptoms Dizziness Headache Nausea Memory loss
Retrograde Post-traumatic
***Bilateral Comparison – to know what is normal for that person you compare the injured part of the body to the uninjured part
Pain and Palpation Palpate specific anatomical structures
distal / proximal to the injury Pain on bone = contusion, fracture or maybe dislocation
/ subluxation Pain on ligament = contusion or sprain Pain on muscle or tendon = contusion, strain, tendonitis
or perhaps bursitis Pain
Type of pain: burning, stinging, tingling, etc… Grade your pain on a scale of 1 to 10
Remember pain is relative to each individual Does the pain change with: movement, weight
bearing, exertion, etc…
Range of Motion (ROM) Active AROM Passive PROM Goniometer – quantify the ROM (put an
exact measurement or number to it) Bilateral Comparison Joint Clearing – check the joint
immediately distal and immediately proximal to the “injured” joint
Manual Muscle Testing Manual assessment of strength You apply steady resistance throughout
the ROM to assess muscular strength. Scale
5/5 full ROM against a full resistance 4/5 full ROM against a partial resistance 3/5 full ROM against gravity 2/5 full ROM with gravity eliminated 1/5 no ROM but signs of muscle contraction 0/5 no ROM and no signs of contraction
***Bilateral Comparison
Special Tests
Very specific test that assess certain injuries
Example: Thompson Test – assess Achilles tendon rupture http://www.youtube.com/watch?v=AmDi08rlR
3I http://www.youtube.com/watch?v=HN4guig3u
-o http://www.youtube.com/watch?v=gkHgY-Y45V
Y http://www.youtube.com/watch?v=uzzV5BRWlI
c&feature=related
Special tests for fracture Tap test http://www.youtube.com/watch?v=0kPjh1nTf-U&feature=BFa&list=PLA8677004E806402F&lf=results_video
Longitudinal compression test
Functional Test Progression of activities that get more
challenging Lower body –
Walk straight ahead, jog straight ahead, jumping or hopping, sprint straight ahead, running figure eights (big and small), cutting, side shuffles, cross-over running, sport specific activities
Sport Specific activities are specific to the sport and even to the position within that sport Basketball – lay-up drills, rebounding drills,
“suicides”, defensive shuffles, pivoting Football Lineman – 5 yard bursts, footwork
drills, monkey rolls, blocking drills
Physician Referral By law, only a physician can diagnose an
injury Physician can give “standing orders”
Only a physician can refer for diagnostic testing X-ray MRI CT scan Blood Work Bone Scan
Injury example Lateral Ankle Sprain
http://www.youtube.com/watch?v=RP42cEbqUD0
http://www.youtube.com/watch?v=_KBYLBuAymc
Injury History Injury mechanism: excessive inversion or
excessive plantarflexion with inversion History of ankle sprains would make the
person more likely to sprain the ankle again
Type of sport, footwear, playing surface could predispose someone to sprain their ankle
They will sometimes hear or feel a “pop” Person usually says “they landed on
something or landed in a hole or an uneven surface”
Inspection and Observation
Swelling and possibly echymosis in either over or just below the lateral malleolus Possible even distal to the ankle joint
Possible deformity (indicating fracture) Point tender to the touch: specifically
over the three ligaments on the medial side of the ankle
Carrying angle for ankle injuries: Limping on your heel or unable to bear weight at all
**Bilateral Comparison will tell me what is normal for that person
Pain and Palpation Pain will depend on the severity of the
injury and the person tolerance for pain The pain will increase will weight-bearing
Especially going up and down stairs and changing directions
Range of Motion Limited AROM and PROM in all motions.
Especially Plantarflexion, Dorsiflexion and Inversion
Goniometric measurements Joint clearing- check the toes and foot as
well as the knee A simple squat would clear all joints
Manual Muscle Testing Acutely – 0/5 -1/5 Within a few hours to a few days – 2/5 –
4/5
Functional Test Take the patient through the functional
test noting at what level they are immediately following the injury
Throughout the rehabilitation process and at the end of the rehab process you will retake them through the progression to make sure that they are improving and can ultimately return to activity
Special Tests Fracture tests –tap, see-saw, longitudinal
compression
Physician Referral Diagnostic tests needed:
X-ray – to rule out fracture Possible MRI to assess ligamentous damage