AT 359
Chapter 13 - Off-the-Field Injury Evaluation

Injury Evaluation vs. Diagnosis
-athletic trainers evaluate injuries but by law, they cannot diagnose them
-only doctors are allowed to diagnose injuries
-there is a very fine line between injury evaluation and diagnosis

Surface Anatomy
-3 body planes of movement:
        1)sagittal - divides into left /right halves
        2)transverse - divides into top/bottom halves
        3)frontal - divides into front/back halves

-4 abdominal quadrants:
        -Left Upper Quadrant - spleen, stomach, pancreas, large intestine, kidney
        -Left Lower Quadrant - intestines
        -Right Upper Quadrant - liver, gall bladder, kidney
        -Right Lower Quadrant - appendix, intestines

Common musculoskeletal terminology
        -abduction, adduction, eversion, inversion, external/internal rotation, flexion, extension,
         pronation, supination, valgus, varus

        -biomechanics - application of mechanical forces (inside/outside) to living organisms

        -pathomechanics - mechanical forces applied to the body because of structural body deviation
            leading to faulty alignment

        -etiology - cause of an injury or disease; mechanism and etiology are synonymous

        -pathology - structural and functional changes that result from injury

        -symptom - subjective findings; something that can be described such as: pain, tenderness, nausea

        -sign - objective findings; something that can be seen or measured such as deformity, swelling, etc.

        -diagnosis - name of a specific condition

        -prognosis - predicted outcome of injury/illness

        -sequela - conditon resulting form disease/injury; ex: getting pneumonia from the flu; "sequel"

        -syndrome - group of symptoms that indicate a condition or disease

OFF-THE-FIELD EVALUATION PROCESS
-use HOPS or SOAP method for evaluating a medical injury/condition
        1)HISTORY - most important
                    -be calm and reassuring while gathering information
                    -ask simple questions without misleading the patient
                    -listen carefully and maintain eye contact
                    -record what the patient tells you without interrupting if possible
                    -questions to ask:
                            Basic information
                                -Has this happened before?  If so, when?
                                -What is the problem?
                                -How did it happen?
                                -When did it happen?
                                -Did you hear or feel anything (pops, snaps)
                            Pain/Injury Location
                                -Where does it hurt?
                            Pain characteristics
                                -What type of pain?
                                            -nerve pain is sharp/burning
                                            -muscle pain is dull/aching
                                            -bone pain is localized and piercing
                                -Where is the pain?
                                -Does the pain change at different times?
                                -Does the athlete feel sensations other than pain?
                                            -pins and needles, paresthesia
                            Joint Responses
                                -Does the joint feel unstable ?
                                -Does the joint give way?
                                -Do you have popping, clicking, grinding, etc.

        2)OBSERVATION -
                    -looking for things that can clue you in as to what could be the problem
                            -ambulation - any limping, favoring, etc.
                            -any guarding, listing
                            -deformities
                            -swelling
                            -discolorations
                            -postural alignment
                            -facial expressions

        3)PALPATION -
                    -divided into bony and soft-tissue
                    -feeling for deformities, lumps, gaps, temperature, spasm, pain or point tenderness

        4)SPECIAL TESTS -
                    -ROM/Muscle Assessment
                            -Measure AROM, PROM with goniometer
                            -Measure RROM by strength scale (Grades 0-5)

                    -Neurologic Examination
                            -dermatomes - area of skin innervated by single nerve
                                        -look for numbness, tingling, decreased sensation
                            -myotomes - muscle or group of muscles innervated by single nerve
                                        -use muscle brake testing to assess nerve function
                            -deep tendon reflexes - grades 0-4; grade 2 is average or normal

                    -Ligaments
                            -determines joint stability
                            -specific tests for specific ligaments
                            -looking for laxity as compared bilaterally, also looking for pain

                    -Vascular
                            -capillary refill
                            -pulses

-You can also use the SOAP note format, it is just a little different:
        1)Subjective - history
        2)Objective - observation, palpation and special testing
        3)Assessment - impression and nature of injury
        4)Plan - treatment

ADDITIONAL DIAGNOSTIC TESTING UTILIZED BY PHYSICIANS
-X-RAYS
        -used to identify fx's and dislocations or other bone abnormalities (i.e. tumors)
        -can also rule out bone infection
-ARTHROGRAPHY
        -xray of joint after dye has been injected
        -can show soft tissue tearing and loose bodies
-ARTHROSCOPY
        -most accurate, but more invasive
        -surgical procedure
-MYELOGRAPHY
        -dye is injected into spinal canal showing different things such as tumors, nerve root compression, disk disease
-COMPUTED TOMOGRAPHY (CT SCAN)
        -fan-shaped xray taking cross-sectional views
        -can be viewed at many angles
        -shows good detail, used to rule out internal bleeding, bone fx's, etc.
-BONE SCAN
        -radioactive tracer is injected and then 3 hours later a scan is performed
        -shows "hot spots" or areas where there is high tissue metabolism
        -can be used to diagnose stress fx's
-MAGNETIC RESONANCE IMAGING (MRI)
        -electromagnetic field causes hydrogen atoms in different tissues to spin at different rates
        -a computer translates these into images
        -clearer images than CT scan
        -diagnostic test of choice for soft-tissue injuries
-ELECTROMYOGRAPHY (EMG)
        -records muscle contraction and the amount of electrical activity
        -used to evaluate neuromuscular conditions
-NERVE CONDUCTION VELOCITY
        -after a stimulus is applied to a peripheral nerve, the speed with which a muscle action occurs is measured
        -can indicate nerve compression, or neuromuscular disease

-BLOOD TESTING
        -CBC = complete blood count
        -usually done to assess anemia or infection
        -low red blood cell count and hematocrit can signify anemia
        -elevated white blood cell count can signify infection
        -cholesterol level should be below 200mg/dL
-URINALYSIS
        -if not testing within 1 hour, sample should be refrigerated
        -pH level can indicate certain conditions
                -alkaline - urinary tract infections, kidney disease
                -acidic - diabetes, dehydration
        -protein indicates kidney disease
        -glucose indicates diabetes
        -blood can indicate kidney injury
        -generally, the clearer the urine, the less dehydrated you are
                -dark urine is usually a sign of dehydration

Web Sites for further study/learning:
www.ccsd.k12.wy.us/cchs_web/cramerfirstaider/fstaider.htm - Cramer First Aider

www.nata.org - National Athletic Trainers' Association