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Surface anatomy
landmarks provide indications of normal or injured structures Things we can see easily symmetry
Musculoskeletal Anatomy
Structural and functional anatomy Little muscles Take more testing
Understanding the sport
Inherent knowledge of injuries associated with sport and better injury assessment More you know faster you can do assessment
Understanding the sport
Awareness of proper biomechanical and kinesiological principles Talk to coaches and players to learn more about sport
Mechanism of injury (MOI):
mechanical description of cause
Sign
objective, measurable, physical finding
Symptoms
subjective, the athletes perception of the problem
Acute injury
sudden onset Macrotrauma – larger Within 3 days of happen
Chronic injury
insidious onset Microtrauma – overtime Happened 2 weeks ago
Diagnosis
denotes name of specific condition Differential diagnoses – working hypothesis Decides what is wrong with person
Off-the-field Injury Evaluation
Acute or chronic injury
HOPS
History Observation Palpation Special Tests
History
Subjective information Anything athletes tells you
History
Factors affecting efficacy: Ask open ended questions What happen and how they’re feeling? Communication skills hardest Professional demeanor Line between professional and athletes Trust More trust more athletes
History
Subjective information Primary complaint MOI Characteristics of symptoms Disabilities resulting from the injury Related medical history
History
Primary complaint (chief complaint: c/c) What wrong? Where does it hurt? When did it happen?
History
MOI How did the injury occur? Recent training changes?
History
Symptom characteristics: Did you hear anything? Where is the pain? What kind of pain? How long does the pain last? Somatic (organ) vs. visceral (referred) pain Referred pain Risk factors Pg. 95 Table 5.1
History
Disability from injury Sports limitations ADL limitations (activity of daily life) Related medical history Previous injury (bilaterally) Know if they injured anything before Current treatment Taking any meds, ice, how is it working? Medications If referred to physican they know Allergies
Observation
overall appearance, symmetry, general motor function, posture, gait (limp)
Inspection
: actual injury site Looking for basic swelling, redness
Effusion
joint swelling
Ecchymosis
discoloration, bruising ( black and blue), blood got left over and bruise
Palpation
Informed consent Ask for consent Always have even for history Minors always ask them, parental consent
Palpation
Wash your hands / wear gloves Palpate bilaterally Begin on the non-injured side Begin away from the injury Lets athlete get used to your mannerisms
What are you palpating for
Temp Swelling Point tenderness Creptius– rice krispy like under skin, popping under skin Deformity - Muscle spasm – knot, harder area then rest of muscle Cutaneous sensation Neurological complications pulse
Special Tests
Functional Stress Neurovascular
General movements through a combination of planes using multiple muscles
Examples: arms over head, heel raise, move arms in front gross motor movements
Active Range of Motion (AROM)
Quality of movement through different ranges Examples: isolated movements
Passive Range of Motion (PROM)
Athlete remains relaxed, ATC moves joint through ROM Looking for: limitation in movement and presence of pain, end feel
Normal end feels
Soft: tissue approximation Elbow movements, knee bend Firm: muscular, capsular, ligamentous, stretch Hard: bone to bone Extending bone
Abnormal end feels
Empty: movement beyond the anatomical limit with pain, ligament is gone Spasm: involuntary muscle guarding Loose: occurs in extreme hypermobility Pitchers arm goes back farther Springy block: rebound at endpoint Bounce back
Resisted Range of Motion (RROM)
Evaluate strength of contractile tissue Overload throughout ROM to locate “painful arc” Break test: isometric contraction at mid range
Noncontractile tissues
Tendons and ligaments
Laxity (something that person finds) objective vs. Instability (person) subjective
Ligament or tendon not holding thing in place
Special tests
named tests for specific pathologies i.e. Lachman’s test ACL
Neurovascular Tests
Often performed first if a nerve or blood vessel injury is suspected no sense if cant feel
Vascular tests
Pulse: radial, brachial pulse, bottom up Capillary refill – very bottom, last little BV, finger and see how fast it takes blood to go back What sensations are associated with vascular issues? – cramping or pins and needles, cut of blood supply to limb What are common observations you might make for someone with a vascular issue? - white blue pal
Neurological Tests
Test 4 major areas: Cerebral function Cerebellar function Cranial nerves Peripheral nerves
Cerebral function
Assesses: general affect, consciousness, intellectual performance, emotional status, sensory interpretation, and language skills Thinking and front part of brain
Cerebral function
Test procedure: ask questions Answers make sense Lashing out Giggling
Cerebellar Function
Assesses: Control of purposeful coordinated movement Test procedure: touch finger to nose, finger to finger, heel toe walking
Cranial Nerve function
Assesses: motor/sensory function Test procedure: smell, eye tracking, facial, expressions, biting down, balance, swallowing, tongue protrusion and shoulder shrug
Peripheral Nerves
Assesses: sensation, motor function, reflexes Test procedures: Sensory:touch, pain, pressure, temperature, vibration, position sense Motor: tested as AROM, RROM
Peripheral Nerves
Dermatomes (sensory) (one nerve goes to different parts of body vs. Myotomes (muscle) one nerve that goes to one muscle
Reflex testing
Deep tendon reflex Stimulation of stretch reflex Patellar test Superficial reflexes Stimulation of skin at specific sites producing muscle contraction Tickle reflexes Protective reflexive
SOAP Notes
Subjective history information, athletes perception of severity, pain, MOI (method of injury) Objective Exam findings, things we find out Assessment Diagnosis / Differential diagnosis ACL tear but rule out LCL and MCL Plan treatment, referral information, goals
Diagnostic tests
Plain Film Radiographs (X-ray) Arthrography – MRI (white is always fluid or fat) or X-Ray CT Scan – magnetic and huge radiation, really look at bone Bone Scan- bony integrity, look for stress fracture Ultrasound –now on muscles
Diagnostic tests
Echocardiogram - heart EKG – cheapest, 12 stickers, pulse rate EEG Myelogram Arteriogram EMG / NCS Arthroscopy
Emergency Action Plan
A prearranged plan of action that defines the roles and steps to be implemented in case of an emergency Medical response team Includes facility staff and community aid
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