INJURY EVALUATIONAthletic Training

Mr. Fluck

The Step by Step Injury Evaluation Process

Injury History Inspection and Observation Pain and Palpation Range of Motion Manual Muscle Testing Special Test Functional Testing Physical Referral / Diagnostic Tests

Injury History Who? What? When? How? Asking questions to find out what injury

occurred. A good thorough Injury History will often tell you

what the injury is without physically touching the individual

With an acute injury, it is important to get an accurate Injury History right away…Why?

What are some questions you should ask during injury history? Questions that would help you figure out what is wrong

Injury History Questions What happened or How did it happen?

Injury mechanism When did it happen? Did this injury ever happen before? Are you taking any medications? Any relevant surgeries? Is this your dominant side? What sport do you play or even what position do you

play? Do you have any pain anywhere else on your body? Do you have any allergies? Did you hear or feel a anything (“pop”)

Inspection and Observation

Signs and symptoms Signs

Swelling Echymosis Deformity Carrying Angle Bleeding Discoloration

Symptoms Dizziness Headache Nausea Memory loss

Retrograde Post-traumatic

***Bilateral Comparison – to know what is normal for that person you compare the injured part of the body to the uninjured part

Pain and Palpation Palpate specific anatomical structures

distal / proximal to the injury Pain on bone = contusion, fracture or maybe dislocation

/ subluxation Pain on ligament = contusion or sprain Pain on muscle or tendon = contusion, strain, tendonitis

or perhaps bursitis Pain

Type of pain: burning, stinging, tingling, etc… Grade your pain on a scale of 1 to 10

Remember pain is relative to each individual Does the pain change with: movement, weight

bearing, exertion, etc…

Range of Motion (ROM) Active AROM Passive PROM Goniometer – quantify the ROM (put an

exact measurement or number to it) Bilateral Comparison Joint Clearing – check the joint

immediately distal and immediately proximal to the “injured” joint

Manual Muscle Testing Manual assessment of strength You apply steady resistance throughout

the ROM to assess muscular strength. Scale

5/5 full ROM against a full resistance 4/5 full ROM against a partial resistance 3/5 full ROM against gravity 2/5 full ROM with gravity eliminated 1/5 no ROM but signs of muscle contraction 0/5 no ROM and no signs of contraction

***Bilateral Comparison

Special Tests

Very specific test that assess certain injuries

Example: Thompson Test – assess Achilles tendon rupture http://www.youtube.com/watch?v=AmDi08rlR

3I http://www.youtube.com/watch?v=HN4guig3u

-o http://www.youtube.com/watch?v=gkHgY-Y45V

Y http://www.youtube.com/watch?v=uzzV5BRWlI

c&feature=related

Special tests for fracture Tap test http://www.youtube.com/watch?v=0kPjh1nTf-U&feature=BFa&list=PLA8677004E806402F&lf=results_video

Longitudinal compression test

Functional Test Progression of activities that get more

challenging Lower body –

Walk straight ahead, jog straight ahead, jumping or hopping, sprint straight ahead, running figure eights (big and small), cutting, side shuffles, cross-over running, sport specific activities

Sport Specific activities are specific to the sport and even to the position within that sport Basketball – lay-up drills, rebounding drills,

“suicides”, defensive shuffles, pivoting Football Lineman – 5 yard bursts, footwork

drills, monkey rolls, blocking drills

Physician Referral By law, only a physician can diagnose an

injury Physician can give “standing orders”

Only a physician can refer for diagnostic testing X-ray MRI CT scan Blood Work Bone Scan

Injury example Lateral Ankle Sprain

http://www.youtube.com/watch?v=RP42cEbqUD0

http://www.youtube.com/watch?v=_KBYLBuAymc

Injury History Injury mechanism: excessive inversion or

excessive plantarflexion with inversion History of ankle sprains would make the

person more likely to sprain the ankle again

Type of sport, footwear, playing surface could predispose someone to sprain their ankle

They will sometimes hear or feel a “pop” Person usually says “they landed on

something or landed in a hole or an uneven surface”

Inspection and Observation

Swelling and possibly echymosis in either over or just below the lateral malleolus Possible even distal to the ankle joint

Possible deformity (indicating fracture) Point tender to the touch: specifically

over the three ligaments on the medial side of the ankle

Carrying angle for ankle injuries: Limping on your heel or unable to bear weight at all

**Bilateral Comparison will tell me what is normal for that person

Pain and Palpation Pain will depend on the severity of the

injury and the person tolerance for pain The pain will increase will weight-bearing

Especially going up and down stairs and changing directions

Range of Motion Limited AROM and PROM in all motions.

Especially Plantarflexion, Dorsiflexion and Inversion

Goniometric measurements Joint clearing- check the toes and foot as

well as the knee A simple squat would clear all joints

Manual Muscle Testing Acutely – 0/5 -1/5 Within a few hours to a few days – 2/5 –

4/5

Functional Test Take the patient through the functional

test noting at what level they are immediately following the injury

Throughout the rehabilitation process and at the end of the rehab process you will retake them through the progression to make sure that they are improving and can ultimately return to activity

Special Tests Fracture tests –tap, see-saw, longitudinal

compression

Physician Referral Diagnostic tests needed:

X-ray – to rule out fracture Possible MRI to assess ligamentous damage