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

HOPS H- History O- Observation P- Palpation S- Special Testing

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.

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.

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!!

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.

So Where Do I Start? Where are you hurting? How did this happen? 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.

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?

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?

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**

Concussion History Previous Concussion? Duration of symptoms? 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?

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.

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.

What do you see??

What do you see??

What do you see??

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!!

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.

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

We Are ALMOST There!!

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

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.

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.

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!

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

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

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

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

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

Thank You!!