2 principles of assessment. rule out life-threatening and serious injuries. on-field assessment:...
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2
Principles of Assessment
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Rule out life-threatening and serious injuries.
On-Field Assessment: On-Field Assessment: GoalsGoals
Determine the nature and severity of the injury.Ascertain the most appropriate method of transporting the athlete off the field.
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Survey the scene (observe surrounding environment) and conduct primary assessment for life-threatening conditions.
On-Field: Primary SurveyOn-Field: Primary Survey
Establish level of consciousness.
Check for ABCs.
Assume spinal injury if you did not witness.
Check for and control severe bleeding.
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History (quickly determine mechanism, location, and severity of injury)
On-Field: Secondary On-Field: Secondary SurveySurvey
Observation (determine level of consciousness; if athlete unconscious, suspect head or neck injury)
Musculoskeletal screen
Shock assessment (wet, white, weak)
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Initial screen should give information sufficient for determining extent and severity of injury.
Musculoskeletal ScreenMusculoskeletal Screen
Observe for swelling, discoloration, deformities.
If you suspect spinal injury, stabilize spine and perform bilateral neurological assessment.
Palpate for fractures and dislocations.
Assess range of motion.
Test for neurovascular compromise.
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Subjective (used to form hypothesis about nature and extent of injury)
Nonemergency Nonemergency AssessmentAssessment
History
Observation
Comparable sign: reproduction of the athlete’s symptoms
Objective (special tests to establish severity and nature of injury)
Bilateral comparison
Athlete’s impression
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Indicates need for referral.
Severity (Severity (SSINS)INS)
Refer the more severe injuries.
Never hesitate to refer if unsure of the severity.
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Relates to the stage and extent of injury, the structures injured, and athlete’s pain tolerance.
Irritability (SIrritability (SIINS)NS)
History can give initial impression.
The less irritable the injury, the more complete the evaluation.
Important to know prior to objective assessment.
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Includes type of injury and type of structures involved.
Nature (SINature (SINNS)S)
History is important.
Confirm suspicions through objective assessment.
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Injuries fall into three stages:
Stage (SINStage (SINSS))
Acute (first 7-10 days following onset)
Chronic (at least 6-8 weeks in duration)
Subacute (4-6 weeks following onset)
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Evaluate in the following order:
Sideline AssessmentSideline Assessment
History1.
Observation2.
Palpation3.
Functional tests (if appropriate)8.
Special tests4.ROM5.
Strength6.
Neurovascular tests7.
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Evaluate in the following order:
Off-Field AssessmentOff-Field Assessment
History1.
Observation2.
ROM3.
Functional tests9.
Strength4.Neurovascular5.
Special tests6.
Joint mobility7.
Palpation8.
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Develop a good picture of the injury:
HistoryHistory
Current and previous injuries
Unusual sounds or sensations
Onset, type, and location of pain
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Begins during subjective assessment.
ObservationObservation
Clues from facial expressions and eyes
Visual inspection of injured area (note swelling, deformity, discoloration; compare bilaterally)
General posture
Holding or protecting injured area
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The process of delineating possible causes and eliminating as many factors as possible. Include in off-field assessment if injury is not obvious.
Differential DiagnosisDifferential Diagnosis
Rule out adjacent joints.
Eliminate referral segments.
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Test uninvolved side first to obtain athlete’s normal motion.
ROMROM
Active (assesses integrity of the active or contractile tissue; performed before passive)
Passive (assesses inert structures around the joint; identifies problems that present with capsular pattern of movement)
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Assesses level of pain, resistive capabilities, neuromuscular integrity in the tissue.
StrengthStrength
Isometric or “break” tests performed with joint in neutral midrange position; build to maximum resistance in 3-5 s
1.
Manual muscle tests to define which specific muscle is causing the weakness
2.
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Neurological exam performed if nerve injury is suspected and symptoms include radiating numbness, tingling, or pain. Assessment includes sensory, motor, and reflex testing.
Neurovascular TestsNeurovascular Tests
Circulatory tests assess integrity of vascular system. Assessment includes palpation of distal pulse and observation of skin color.
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Jendrassik’s Jendrassik’s maneuvermaneuver
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Used to eliminate or confirm a suspected condition, as well as to define the integrity of the structure. Tests allow athletic trainer to
Special TestsSpecial Tests
grade abnormal responses or injury severity and
reproduce athlete’s symptoms.
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Physiological motion: active motion of joint in the planes of motion
Joint MobilityJoint Mobility
Accessory motion: subtle passive motion between the joint’s inert structures
Necessary for full physiological motion
Assess if physiological motion is limited
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Distraction or traction (longitudinal force to separate the proximal and distal parts; assesses general capsular mobility)
Joint Mobility TechniquesJoint Mobility Techniques
Glide maneuvers (anterior-posterior, medial lateral; assesses mobility of capsule, joint structures)
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Reveals information regarding
PalpationPalpation
tension, thickness, texture of soft tissue;
general contours of bony and soft tissue.
swelling, temperature, moisture, pulses, muscle fasciculations; and
Use a systemtic approach (superficial to deep); athlete should be relaxed.
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Assess athlete’s ability to safely return to participation, as well as athlete’s confidence and physical readiness.
Functional TestsFunctional Tests
Specific tasks and controlled skills
Sport and position specific
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Subjective (chief complaint, mechanism of injury, reported signs and symptoms)
Documentation: Documentation: SOAP NotesSOAP Notes
Objective (observations and results from objective assessment)
Plan (immediate treatment and referral plans)
Assessment (impression of the injury)