Examination and Management of Acute Pathologies ATHT 305

Objectives Obtain an on field history Steps to on-field evaluation Decide necessary tests to perform Determine what tests not to perform Determine return to play

First goal Determine if condition requires emergency management – ABC compromise – Life-threatening to head or spine – Profuse bleeding – Fractures – Joint dislocation – Peripheral nerve injury – Other soft tissue trauma

On-field examinations Best with 2 people – 1 to evaluate, 1 to control crowd & calm athlete Ensure play has stopped to protect responder and victim – If at practice, move play to other end EAP Sport-specific rules – Know rules of your sport Does an official have to call you out? How long do you have? Wrestling has a time limit for injuries. Past that time, A disqualified.

On-field Continued Critical findings – May not need more info, just transport Determine extent of injury and how to transport safely – Focus on If/how to splint body part How to remove from playing area Take athlete to sideline, ATR, or hospital?

Problems encountered No treatment table on field – Lying prone, sitting sideways on a bench – Swimming pool Equipment – Ankle and knee braces

Steps to Evaluation Primary Survey Secondary Survey On-field history – Location of pain- just because they are holding one area, don’t assume that’s it – Peripheral symptoms- pain or altered sensation – MOI – Associated sounds – Hx of injury

On-field inspection Position of athlete Prone, supine, awkward, gross deformity – Inspection of injured area Abreviated: look for signs of Fx, joint Dx, or edema

Palpation Palpate bone and muscle – Terminate evaluation and transport if needed Bony structures: – Bony alignment: palpate length of bone – Crepitus – Joint alignment Soft Tissue: – Swelling: immediate swelling = major disruption of tissue, trauma to bursa – Painful areas – Deficit in muscles or tendons: palpable defect “Golden period” is small window after injury where defects can be palpated before edema and muscle spasm set in

On-field Joint and Muscle Function Assessment Find out ability and willingness to move. AROM most important on-field. – Functional testing: can they bear weight? When do we not perform AROM? – Fx – Dx – Muscle or tendon rupture AROM Strength PROM (case by case) WB status – If they can AROM, they can walk off the field (with assistance when needed)

Joint Stability Gain immediate impression of integrity of capsule and ligaments before muscle guarding or swelling masks Single plane tests compared bilaterally Neurological testing – Assess motor function distal to injury if it can be done without movement – Reflexes? Vascular assessment

Immediate management No splinting is needed – Athlete walks off field – Athlete is assisted off field – Athlete is transported directly to hospital Splinting needed: – UE: Athlete walks off field – LE: Athlete is assisted off field – Athlete is transported directly to hospital

Transportation Most UE injuries can walk off field If lying on the field – Start with sitting position to check for lightheaded or dizziness – If no problem, stand them up

Return to Activity Decision based on relative risk of re-injury and athlete’s functional ability Age and level of competition- youth more conservative

Final determination based on assessment of function Strength and ROM – Approx. equal bilaterally & sufficient to protect injured area Pain – Tolerable pain during exertional activities that doesn’t result in noticable change in function or worsen the condition Proprioception – Sufficient to protect Functional Activity Progression – Increase demands

Homework questions List the major differences between clinical evaluation and on-field evaluation