basic injury evaluation: hops sara thomas, med, atc clinical lead- dr. cooper/dme coordinator fort...

Basic Injury Evaluation:HOPS

Sara Thomas, MEd, ATCClinical 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

Evaluationo Quick assessment to

determine severity of injury.

o Makes the decision on ability to move the athlete.

o Looking for fractures, neck injury, etc.

o Needs to be quick and accurate.

2 Types of Evaluation• Clinical (Off the Field)

Evaluationo A more extensive eval.o May be done first, or

after an on the field eval.

o Should still be performed, even if you have done an eval on the field.

o 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

• GOOD- Open Ended Questionso Questions that require an

explanation.• Where does it hurt?• Which movements

increase your pain?• What makes it better or

worse?

o Once you ask an open ended question, you can follow it with a more specific question.

• NOT SO GOOD- Leading Questionso 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?

So Where Do I Start?• Where are you hurting?

o Point with one finger.

• How did this happen?o Mechanism of Injury (MOI)

• The movement or force that caused the injury.o Twisting the knee with the foot planted.o A blow to the outside of the knee.

• Sometimes there is not a specific mechanism.o Knowing the MOI will play a big factor in determining the problem.

• When did this start?o Acute vs. Chronic Injury

• Acute- Just happened.• Chronic- Has been going on for a while.

More Current History• What have you done

for it?o Meds?o Ice?o Rest?

• Are you able to complete your normal activities?

• Does the pain wake you at night?

• Did you hear or feel a pop or snap?

• What type of pain is it?o Burning, stinging, sharp, dull,

aching, tingling, stabbing, etc.o Type of pain can tell you a lot!

• Does the pain change?o Time of day.o Activity level.

• What makes you feel better or worse?

Previous History• Have you ever had this

type of pain before?o If so, what was it?o Did you hurt it the same

way?o What did you do for it?o Who (if anyone)

evaluated your injury?o Did you get completely

better?o Have you ever had any

surgeries on this body part?

General Medical History

• Major Health Concernso Diabeteso Recent Hospitalizationo Allergieso Asthmao Cardiac Conditionso Sickle Cell Anemia or Trait

• Other Ortho Injuries• Fracture History• Family History • Concussion History**

Concussion History• Previous Concussion?

o How many?o Dates of concussion.

• Duration of symptoms?o How long did you sit out?

• How does this concussion compare to the last one?

• Complete recovery?o Any lasting symptoms?

Observation (aka Inspection)

• Looking at the body to see any abnormalities.

• Total body observation.o 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?o Very important with

elbows and shoulders.o Watch their expressions.

Keep Looking!!• Specific body part

observation.o 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.o 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• Point Tenderness

o Exact spot where it hurts.

o “Pointing” to the spot.

• Crepituso Creaking, cracking,

crunching, etc.o You might be able hear

it, too.

• Symmetryo Muscleso Bones

• Local Heato Redness and hot feeling

skin around the injured area.

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 Testingo Tap Testo Squeeze Test

• Very Important Step!!o All other testing stops if

you suspect a fracture.o Risk of displacement.

• Can damage other structures.

• Can lead to surgery.

Range of Motion• Two Types

o Active Range (AROM)• How much the

athlete can move the body part on his own.

o Passive Range (PROM)• How much you can

you move the body part for the athlete.

Ligament/Other Special Testing

• Testing for Cartilage Tears

• Testing for specific conditions.

• Compare to the other side!

• Specific by body part.• Testing to see if a

ligament is torn.o Can tell you the severity of

injury, depending on the end point.

• End Pointso Solid End Point

• Joint movement has a stopping point.

o Soft End Point• Joint movement seems to

go farther than it should.• Soft endpoints are a signal

that something is wrong.

Strength Testing• Tells you the severity

of injury to the muscle.o Graded on a scale from 0 to 5.

• Looking for TWO things.o Paino Weakness

• Break Testing• RROM Testing

Neurological Testing• Sensation Testing

o Does the sensation feel the same on both sides?

o Do with eyes open and eyes closed.

• Tap testingo Ulnar Nerve example

• Reflexes

Functional Testing• Testing to see how

well the athlete can use the injured body part.o Walkingo Runningo Cuttingo Overhead Movementso Throwing

Sport Specific Testing• Testing to determine

ability to play.• Pitching• Sport Specific

Movementso Football Stanceo Shooting o Cone Drillso Volleyball Attack

The End Result• Assessment vs.

Diagnosiso Athletic Trainers make

assessments based on their evaluations.

o A diagnosis can only be made by a physician.

Thank You!!