1. I NJURY M AINTENANCE

2. W HAT TO DO ONCE AN INJURY OCCURS ? Create a medical form including everything you think needs to be included in an injury report.

3. T YPES OF I NJURIES Closed (Unexposed) Wounds Closed soft tissue: Contusion Sprain Strain Bone and Joint Articulation (a union between two bones): Closed Fx- Simple (no disruption of skin surface) Traumatic (acute) Fx- Immediate pain, rapid swelling, bony tenderness, crepitus, with movement of bony fragments and possible deformity if fx is displaced Stress Fx- onset of pain is gradual, pain or deep ache at first noticeable only during activity, may subside with rest, progressing to more constant pain if offending injury continues

4. B ONE AND J OINT A RTICULATION I NJURIES C ONT … Epiphyseal Injury – disruption or separation of the epiphysis or epiphyseal plate (Salter-Harris Fx) Dislocation- complete disassociation of two joint surfaces Subluxation – incomplete disassociation of two joint surfaces (may be difficult to identify) Nerve Injuries Neuralgia- achiness or pain along a nerve secondary to chronic irritation or inflammation Neuroma – thickening of a nerve or “nerve tumor” secondary to chronic irritation or inflammation

5. O PEN (E XPOSED ) W OUNDS Open wounds – injuries that involve a disruption in the continuity of the skin caused by friction or by blunt or sharp trauma Abrasion – “Strawberry” large surface area exposed, caused by friction Blister – separation and accumulation of fluid or blood between superficial skin layers secondary to repetitive friction or shearing movements Incision – a cut through all layers of the skin by a sharp object or instrument (smooth, even wound edges) Laceration – a tearing of the skin by blunt trauma to the skin over a bony prominence, (jagged, uneven wound edges) Puncture – a small disruption in the skin caused by sharp penetrating object Avulsion – a tearing off or complete disassociation of a portion of skin Compound fx/dislocation- disruption of the skin surface secondary to penetration by a displaced fx fragment or joint dislocation (Fx = Fracture)

6. P RINCIPLES OF E XAMINATION Assessment – a procedure through which the clinician determines the severity, irritability, nature and stage of an injury Evaluation – is the systematic process that allows the clinician to make a clinical judgment Primary Survey- ABCs Secondary Survey- rapid examination of the seriousness of the injury before the athlete is moved

7. S TAGES OF A SSESSMENT SOAP Notes Subjective Objective Assessment Plan Subjective = history Severity, irritability, nature of the injury, MOI, only as good as the questions you ask What questions should be asked? Objective = tests Comparable sign= reproducing the problem Bilateral Comparison Observation Palpation Range of Motion (ROM) Strength Special Tests (any body know any tests?) Neurological Status Vascular Status Functional Testing

8. F UNCTIONAL TESTING L OWER B ODY Balance in standing (Stork or tandem stand) Walking forward Walking up and down stairs (practicality?) Jogging Forward Running Forward Sprinting Forward Hopping Forward Jogging, running, sprinting backward Jogging, running, sprinting side to side Hopping alternate feet Hopping involved leg only Skipping forward and backward, side to side Jumping forward, backward Sport Specific Activities

9. F UNCTIONAL T ESTING U PPER E XTREMITY Tossing Throwing Pitching Hitting Batting Catching Receiving Standing on hands Supporting body weight on arms Sport Specific Activities Anything else?

10. Chief Complaint- what’s wrong?, where does it hurt?, what happened? Mechanism of Injury (MOI)- how the injury occurred Compressive force Tensioning force Twisting force Shearing force Nature of illness or injury Events surrounding the injury T AKING A H ISTORY

11. A CUTE H ISTORY Q UESTIONS What happened and how did it happen? What position were you in when the injury happened? (How they landed) Did you hear or feel any unusual sounds or sensations at the time of injury? (snap, pop, or click) Do you feel any unusual sensations now? (numbness, tingling, burning) Where is the pain? Point with one finger Can you describe the pain? Quality of pain (Sharp, dull, achy) Intensity (Pain scale 0-10) Localized or diffuse Referral of pain to other segments Changes in pain from when it started (intensified or lessened) When does it hurt? What is the previous history? What is the previous hx for the opposite side? Are there any other medical conditions to be aware of?

12. N ON A CUTE H ISTORY Q UESTIONS What happened and how? (did it come on gradually and when did they appear) What activities aggravate the injury now? What makes it feel better? When you work out, when do the symptoms come on and for how long? Do the symptoms interfere with daily activities, and if so, what activities? Can you describe the pain? Quality of pain (sharp, dull, achy) Intensity (0-10 scale) Localized or diffuse Referral to other segments Changes in pain from when it started (intensified or lessened over time) Does the pain wake you up at night? Is there anytime during the day that the pain is worse or less or is the pain activity related? What treatments if any have you self- administered?

13. C HRONIC H ISTORY What hurts? When did this occur? Was it sudden onset or gradual? Can you describe the pain? When does it hurt? Is the pain constant or intermittent? How long does the pain last? What makes it worse? Have you made any abrupt or significant changes in training? Change in intensity, duration, training surface, type of activity Change in training implements Shoes, rackets, bat grips, etc. What is the previous hx for the body region? Are there any medical conditions to be aware of? Change in diet or weight? Recent illness? Other signs and symptoms? Existing medical conditions? Taking any medications or receiving treatment?

14. S IGNS AND S YMPTOMS Current signs and symptoms Vs. Previous history and contributing factors

15. O BSERVATION Initial/overall impression on the field/clinical setting Observation of body type Ectomorph- low to normal body fat, low muscle mass (underweight) Mesomorph – low to normal body fat, high muscle mass Endomorph – high fat and muscle mass and is overweight Observation of Posture and Gait Observation of Injured Segment What would you be looking for?

16. P ALPATION Need anatomical knowledge Personal skills Keep patient comfortable Technique Rolling and strumming Movement when palpating still structures Stillness when palpating moving structures Movement of a limb as a palpation tool Structures to palpate Skin Use back of hand to palpate for moisture and temperature Fascia Superficial fascia has spongy soft end feel (when moving skin the resistance you feel is superficial fascia) Muscle Bone Joint Structures Neurovascular Tissue Lymph Nodes

17. P ALPABLE B ONY S TRUCTURES Shaft- body of a long bone Head or condyle – rounded end of a long bone that articulates with the joint Epicondyle – the prominent aspect of the bone, proximal to the condyle Groove – a narrow, longitudinal depression in a bone (passage for a tendon) Ridge or crest – raised surface on bone Tubercle – small and rounded projection Tuberosity – A more prominent and large rounded projection Apophysis – A small projection on a bone that serves as the attachment for a tendon Epiphyseal Plate – area of growth between shart and end of bone Notch – indentation in the end of a bone (ligaments, nerves, arteries, tendon)

18. P ALPABLE J OINT S TRUCTURES Synovial Capsule – a well-defined membranous connective tissue that surrounds and encloses the structures of a synovial joint Articular Cartilage – smooth, cartilage that covers the articular surface of a bone Bursa - fluid filled sac that contains synovium to reduce friction between structures Joint Line – a palpable separation between two articulating bones Ligament – a taut, cordlike or bandlike fibrous connective tissue that connects bone to bone

19. R ANGE OF M OTION Range of Motion – the arc of motion through which a segment moves Active ROM Passive ROM Resistive ROM 1-5 Grading Scale Goniometer – measuring tool for ROM

20. P RACTICE ROM With a partner practice moving them through PROM Shoulder flex/ext/abd/add/int/ext rot Knee flex/ext Elbow flex/ext Pronation/Supination Calculate using the Goniometer their ROM in each direction

21. S TRENGTH T ESTS

22. P RACTICE B REAK T ESTS With a partner Perform a break test on their: Quadricep Shoulders Bicep Hip Flexor

23. S PECIAL T ESTS Each injury may or may not have specific special tests that can be used to identify that injury.

24. N EUROVASCULAR T ESTING Myotomes vs. Dermatomes

25. V ASCULAR T ESTING Check Pulse Capillary Refill

26. A SSESSMENT What do you think the injury is? Your diagnosis?

27. P LAN What do you plan to do next? Referral? Treatments/Modalities