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Principles of Assessment

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.

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.

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)

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.

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

Indicates need for referral.

Severity (Severity (SSINS)INS)

Refer the more severe injuries.

Never hesitate to refer if unsure of the severity.

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.

Includes type of injury and type of structures involved.

Nature (SINature (SINNS)S)

History is important.

Confirm suspicions through objective assessment.

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)

Evaluate in the following order:

Sideline AssessmentSideline Assessment

History1.

Observation2.

Palpation3.

Functional tests (if appropriate)8.

Special tests4.ROM5.

Strength6.

Neurovascular tests7.

Evaluate in the following order:

Off-Field AssessmentOff-Field Assessment

History1.

Observation2.

ROM3.

Functional tests9.

Strength4.Neurovascular5.

Special tests6.

Joint mobility7.

Palpation8.

Develop a good picture of the injury:

HistoryHistory

Current and previous injuries

Unusual sounds or sensations

Onset, type, and location of pain

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

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.

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)

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.

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.

Jendrassik’s Jendrassik’s maneuvermaneuver

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.

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

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)

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.

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

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)