Chapter 11 Assessment and Evaluation of Sports Injuries

Objectives

Explain the difference between assessment, evaluation, and diagnosis of an injury.

Describe the various factors that influence the type and severity of athletic injuries.

Evaluate an athletic injury using the systematic approach.

Explain the different methods and reasons for documenting injuries

Assessment

Assessment: orderly collection of objective and subjective data on the athlete’s health statusCollect medical historyObjective vs SubjectivePalpationROMSpecial Tests

Diagnosis

Diagnosis: Using information from assessment and physical examination findings to establish the cause and nature of the athlete’s injury or disease

Made only by physician or other licensed health care provider Must remember to work in scope of practice

Influencing Factors

Anthropomorphic Data: size, weight, body structure, gender, strength, and maturity levelCollege vs High School

Mechanism of Force: all forces involved at the time of impactDirection, intensity, duration, position of body

Influencing Factors

Speed: influence type and severity of injuryGreater speed usually equals greater chance

of injuryAthletes should compete against athletes of

similar level

Influencing Factors

Protective Equipment: better equipment has helped keep number of injuries down. Make sure equipment is worn properly

Skill Level: beginners are at a greater risk for injury due to being unfamiliar with basic techniques

Primary Injury Survey

Check for serious, life-threatening injuries Activate EMS if needed CAB’s

Circulation: Check for pulse, coughing, movement Airway: Open airway using head tilt/chin lift or jaw

thrust Breathing: Listen, look and feel for signs of breathing

Head Tilt vs Jaw Thrust

Head tilt, chin-lift is used to open airway of an unconscious person

Jaw thrust opens the airway when a spinal injury is suspected

Secondary Injury Survey

Secondary injury survey is a thorough, methodical evaluation of an athlete’s overall health to reveal additional injuries beyond the initial injury

HOPS History Observation Palpation Special Tests

History

What happened? When did injury occur? Did you hear a sound? Where is the pain? What type of pain? Pain Scale? Neurological function? Prior history?

Observation

What do you see? Compare injured to uninjured side Deformity? Swelling? Bleeding? Bruising or ecchymoses?

Palpation

Palpation is the touching of the injured athlete

Examine uninjured side first Palpate firmly enough to produce pain if

present Watch for facial expressions or wincing Palpate one joint above and below injury

Special Tests

Active range of motion: athlete moves body part through range

Passive ROM: examiner moves body part through range

Strength: isometric and through ROM Stability: ligament laxity tests Special Tests

Activity

Functional activity: level of movement the athlete can comfortably participate inRun, hop, sprint, cut, twist

Sport-specific activity: movements related to a particular sportVolleyball spikeBasketball shot Soccer kick

Return to Play

The athlete must exhibit 100% strength in the injured area.

The athlete must be free from pain. Skill performance tests must be taken to

determine the athlete’s ability to return to play. The athlete must exhibit emotional readiness to

return to the chosen activity.

Soft Tissue Injury

Abrasions: occurs when several layers of skin are torn loose

Laceration: tear in the skin

Stitches if more than ¼ inch deep and ½ inch long

Soft Tissue Injury

Avulsion: injury where skin is torn off

Keep skin flap if possible

Puncture: caused by sharp, pointed objects

High risk of infection

Care of Soft Tissue Injuries

Clean woundMake sure it is free of dirt and debris

Apply antibiotic ointmentHelp prevent infection and keeps dressing

from sticking to wound Apply bandages or non-adherent pad Check for signs of infection

Signs of Infection

Swelling Heat Angry Redness Pus Streaks

Injury to Muscle

Strain: caused by twisting or pulling a muscleOveruse or acuteSigns and symptoms: pain, spasm, weaknessMay feel deficit in severe strainsRICE Rehab to increase flexibility and strength

Injury to Ligaments

Sprain: results from a fall, sudden twist, or blow to the body that forces a joint out of its normal positionS/S: pain, swelling, bruising, loss of ROMSeverity is classified by grades

Grade I: Mild Grade II: Moderate Grade III: Severe

Tendonitis

Tendon: fibrous tissue that connects muscle to bone

Tendonitis: inflammation of the tendonTypically worse after activity and at nightCaused by overuse Treat with rest, ice, NSAIDs, ultrasound,

rehab

Bursitis

Bursa: located throughout the body to decrease friction between two surfaces

Bursitis: inflammation of a bursa Joint pain with

movement and at night

Contusions

Direct blow that does not break the skin Usually includes ecchymosis or bruising Myositis Ossificans

Documentation of Injuries

SOAP noteSubjective, Objective, Assessment, Plan

Daily Injury ReportCommunication between coaches on status of

athletes AT room treatment log

Athletes receiving treatments should be logged in