Off Field Evaluation of Athletic Injuries

Evaluation of Sports Injuries  Evaluation is an essential skill  Four distinct evaluations Pre-participation (prior to start of season) On-the-field assessment Off-the-field evaluation (performed in the clinic/training room…etc) Progress evaluation

Basic Knowledge Requirements  Anatomy Surface anatomy  Body planes  Anatomical directions  Abdominopelvic quadrants Musculoskeletal  Insertions  Origins  Alignment of muscle fibers

Basic Knowledge Requirements  Biomechanics Knowing the forces that act upon each body part during movement  Understanding Sport How sport is performed Potential for trauma Rules of sport

Injury Evaluation Process H - History O – Observation F - Function P - Palpation S – Special Tests

History  Using questioning to obtain the most amount of information as possible.  This is perhaps the most important part of the evaluation.  After the history is completed the evaluator should have a good idea what the injury possibly is before even touching the athlete

History  Present Mechanism  What happened  How did it happen  When did it happen  What specific mvmt caused the injury?  Did you fall? How did you land?  Which direction did the body part move? Changes in symptoms  Symptoms  or  since injury  Taking any meds?  Treating it on your own at all  Past Has this ever happened Before  When  How did that happen  Did you see a Dr.?  What was the Diagnosis?  How long were you out?  Did you do any physical therapy or have surgery?  Did the treatment resolve your symptoms?

History Can you describe the pain?  Sharp,  Burning,  Shooting (Nerve)  Specific,  General,  Piercing (Bone)  achy,  outside of injury = Vascular  Dull, achy = Muscle  Sounds or Sensations Did you feel any unusual sensations when it occurred? Did you hear any unusual sounds when it occurred?  Pain Where does it hurt?  Point with ONE finger Rate the pain  Scale of 1-10 What makes it hurt?  Specific movements?  positioning When does it hurt?  All the time  In the a.m.  In the p.m  After practice?  Only when off of it? Any numbness or tingling anywhere?

Questions  What are the 5 “categories” of questions in a history  What is the purpose of taking a history?  What are some consequences if a thorough history isn’t taken?

Observation/Inspection  Movement How does he move?  Stiff/ Guarded  Normal How did he walk in?  Normally  Limping  On crutches What mannerisms did he use during the hx?  Asymmetries/ Deformity Do both sides look the same? Facial expressions Pain Tired Frustration Nervous Obvious deformity Swelling / Lumps Markings Redness/ Discoloration Sounds Do you hear any popping or clicking w/ movement?

Observation/ Inspection  Range of Motion/ Functional Testing Have the athlete go through basic movements to see what causes pain Have the athlete attempt to reproduce the pain.

Observation/ Inspection Types of ROM  Active - Patient’s ability to move the body part  Passive – the clinician moves the body part without any assistance from the athlete.  Resistive – clinician gives pressure against the movement  Break test – athlete holds a position while the clinician tries to “break” them out of it.

Palpation Touching/ feeling the area  Used to confirm or deny assessments.  Start away from the injury and move toward the site of pain  Palpate Bilaterally (both sides)  Palpate with purpose  Start w/ light pressure then move to deeper palpation

Palpation  Notice Point Tenderness  Specific site of pain Trigger Points  When palpated they refer pain to other parts of the body Crepitus  Grinding, crunching, or crackling sensation with the rubbing of tissues Tissue Density Increased Spasm Scarring Myositis ossifcans Decreased Swelling Hemorrhage Symmetry Are both sides equal Temperature

Special Tests  Fractures – 1 st for any Acute injury Bump  Bump/tap the end of a bone AWAY from the site of pain Lever (can only be used on long bones or parallel bones where the pain is at the ends)  Squeeze the middle of the bones to elicit pain at the ends Compression  Apply pressure at both ends of the bone AWAY from site of pain

Special Tests Strains – Range of Motion Easiest ST bcs you don’t have to really do anything ;). Active (use muscle) Pain No Pain Passive Resistive (no muscle use) (stress muscle)

Special Tests  Goniometry Normal Range of motion for each joint  End Feels Normal? End FeelStructureExample SoftSoft tissueKnee flex. Firm Musc. Stretch Capsule stretch Hip flexion Finger ext at MCP. HardBone contactElbow ext.

Special Tests  End Feels (cont.) Abnormal? End FeelStructureExample Soft - Sooner or later than usual - Joint that is normally firm or hard Swelling Synovitis Firm - Sooner or later than usual - Joint that is normally soft or hard Incr. Muscle tone Shortened Ligament Hard - Occurs sooner or later than usual - Jt that is normally soft or firm - Bony block Chondromalacia, Osteoarthritis, Loose bodies, Fx, Myositis ossificans Empty No end feel ROM not reached Acute inflammation Bursitis, Fx, Lig. tear

Special Tests  Ligament/ Capsule Tests Testing the integrity of the joint by determining the amount of “give” present when force is applied. Grade Ligament End-Feel Damage 1 Firm (normal) Slight stretch; Little to no laxity present/felt; Pain present 2SoftPartial tearing; incr. glide of jt 3EmptyComplete tear; motion excessive; only end- feel present due to other structures

Special Tests  Specific Special Tests Procedures applied to a joint to determine the presence of pathology Need to be done correctly or will create false positive or negative Bilateral comparison must be performed.

Special Tests  Neurological Testing Dermatomes Myotomes Reflexes Other Screenings (impingement) GradeResponse 0No reflex 1 Hyporeflexoria: Reflex elicited with reinforcement (pre- contracting the muscle) 2Normal response 3Hyperrefloxoria: Greater than normal response

Myotomes  C2 – Cervical Flexion  C3 – Cervical lateral flexion/extension  C4 – shoulder shrug  C5 – Shoulder Abduction  C6 – Elbow flexion and Wrist extension  C7 – Elbow extension and wrist flexion  C8 – Ulnar deviation and Thumb Extension  T1 – Finger Ab & Adduction L2 – hip flexion L3 – Knee extension L4 – ankle dorsiflexion L5 – Hallux Extension S1 &S2 – plantar flexion/ knee flexion/ hip extension S4 – bladder and rectal control

Activity/ Functional Testing  Although we have tested strength, it is useless unless the athlete can go through the activities necessary for sport function. Grade into general movements Grade into more advanced specific movements