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