Evaluation & Assessment
Injuries
• Primary Injury: an injury which occurs as a
direct result of the stress imposed on the body
during a particular sport or activity
• Secondary Injury: an injury which is caused by
improper care of the original injury
Mechanical Forces
• Compression Force: A force that crushes the
tissue due to the bodies in ability to absorb it
– Ex. – Sprains, strains, avulsions
• Tension Force: A force that pulls or stretches
the tissue
– Ex. – Fractures, contusion, arthritic changes
• Shearing Force: The force moves along the
parallel organization of the tissues.
– Ex. – Blisters, abrasions, vertebral disc injuries
Tissues
• Muscles, in its various forms, performs four
important functions for the body; it produces
movement, maintains posture, stabilizes
joints, and generates heat.
– Skeletal Muscle: Attaches to and covers the bony
skeleton, it is responsible for overall body mobility.
• Tendons: Attach muscle to bone.
• Ligaments: Attach bone to bone.
Bone
• Bone is a specialized type of dense connective
tissue consisting of bone cells that are fixed in a
matrix, which consists of an intercellular material.
The outer surface is composed of compact tissue,
and the inner aspect is composed of a more
porous tissue known as cancellous bone.
• Functions: body support, organ protection,
movement (through joints and levers), calcium
storage, and formation of blood cells.
• Types: flat, irregular, long, and short
Bones
• Structures:
– Diaphysis – main shaft of the bone
– Epiphysis – the ends on long bones
– Periosteum – dense white fibrous membrane that
covers long bones
– Medullary Cavity – the hollow inside of the diaphysis
of long bones that contain the fatty marrow in adults.
– Articular Cartilage – covers the end of the long bones
protecting the epiphysis during movement and helps
cushion jars and blows to the joint.
Open Wounds
• Abrasion: The skin is scrapped against a rough surface,
the epidermis and the dermis are scrapped away and
• Incision: A wound in which the skin has been cut
sharply.
• Laceration: A wound in which the skin has been
irregularly torn.
• Avulsion: Skin that is torn by the same mechanism as a
laceration to the extent that tissue is completely ripped
from its source.
• Puncture: A wound cause by penetration of the skin by
a sharp object.
Closed Wounds
• Contusion: When a blow compresses or crushes
the skin surface and produces bleeding under the
skin.
• Hematoma: Is a blood tumor, formed by the
localization of the extravasted blood into clot,
which becomes encapsulated by connective
tissue membrane
• Blister: Continuous rubbing over surface of the
skin causes a collection of fluid below or within
the epidermal layer.
Fractures
• Fractures can be partial or complete
interruption in a bone’s continuity; it can
occur without external exposure or can extend
through the skin, creating an external wound
(open fracture).
Types of Fractures
• Depressed: They are cause by falling and striking
the head (flat bone) on a hard immovable surface
or by being hit with a hard object.
• Greenstick: Are incomplete breaks in bones that
have not completely ossified, such as the bones
of adolescents.
• Impacted: Can result from a fall from a height,
which causes a long bone to receive, directly on
its long axis, a force of such magnitude that the
osseous tissue is compressed.
Types of Fractures
• Longitudinal: Are those in which the bone splits
along it length.
• Spiral: Have an S-shaped separation, for example
the foot is firmly planted when the body is
suddenly rotated in an opposing direction.
• Oblique: Similar to the spiral, occurs when one
end of the bone receives sudden torsion or
twisting while the other end is fixed or stabilized.
Types of Fractures
• Serrated: The two bony fragments have a saw
tooth, sharp-edged fracture line, are usually
created by a direct blow.
• Transverse: Occurs in a straight line, more or
less at right angles to the bone shaft.
• Comminuted: Consists of three or more
fractures at the fracture site.
• Contrecoup: Occur on the side opposite to the
point at which trauma was initiated.
Types of Fractures
• Blowout: Occur to the wall of the eye orbit as
the result of a blow to the eye.
• Avulsion: Is a separation of a bone fragment
from its cortex at an attachment of a ligament
or tendon.
• Stress: Rhythmic muscle action performed
over a period of time at a sub-threshold level
causes the stress-bearing capacity of the bone
to be exceeded.
Types of Fractures
• Epiphyseal: an injury which occurs at the
growth plate of a bone and may result in
stunted growth in young athletes
Signs and Symptoms of Fracture
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Pain at the injury site
Deformity
Swelling
Bruising
Immobility
A cracking sound or crepitation
Numbness or impaired sensation
Pale or ashen skin due to poor circulation
Dislocations
• Dislocations, which result primarily from
forces causing the joint to go beyond it’s
normal anatomical limits and are divided into
two classes
– Subluxations are partial dislocations in which an
incomplete separation between two articulating
bones occurs.
– Luxations are complete dislocations, presenting a
total disunion of bone apposition between
articulating surfaces.
Range of Motion
• Range of Motion (ROM): Refers to the distance
and direction a joint can move between the
flexed and the extended positions.
• Active (AROM): Joint motion that occurs because
of muscle contraction, performed by the athlete
• Passive (PROM): Movement that is performed
completely by the examiner.
• Resisted ROM: Requires an isometric contraction
at the midpoint in the range, athlete goes against
resistance.
Sprain
• A sprain, one of the most common and disabling
injuries seen in sports, is a traumatic joint twist
that results in stretching or total tearing of the
stabilizing connective tissues.
– Grade 1: Minimal swelling , pain, and loss of function,
no abnormal motion when tested and mild point
tenderness.
– Grade 2: Pain, swelling, moderate loss of function,
and slight to moderate instability.
– Grade 3: Severe pain, tenderness, swelling and
instability, along with loss of function.
Strain
• A strain is a stretch, tear, or rip in the muscle or
adjacent tissue such as the fascia or muscle
tendons.
– Grade 1: Some muscle fibers have been stretched or
actually torn.
– Grade 2: A number of fibers have been torn, and
active contraction of the muscle is extremely painful.
– Grade 3: A complete rupture of a muscle has occurred
in the area of the muscle belly at the point at which
muscle becomes tendon or at the tendinous
attachment of the bone.
Muscle Injuries
• Muscle Cramp: Is a painful involuntary
contraction of a skeletal muscle or muscle group.
• Muscle Spasm: Is a reflex reaction caused by
trauma of the musculoskeletal system.
• Contusion: Is due to a sudden traumatic blow to
the body.
• Tendonitis: Has a gradual onset, diffuse
tenderness because of repeated micro traumas ,
and degenerative changes.
Muscle Soreness
• Acute-Onset Muscle Soreness: Accompanies
fatigue, the muscle pain is transient and
occurs during and immediately after exercise.
• Delayed-Onset Muscle Soreness: Appears
approximately 12 hours after exercise and it
becomes most intense at 24-48 hours, it
gradually subsides so that the muscles
becomes symptom-free after 3 to 4 days.
Joint Injuries
• Bursitis: Inflammation of the bursa at the sites of
bony prominences between muscle and tendon.
– Bursa is the fluid filled sac of synovial membrane
found in places at which friction might occur between
body tissues.
• Osteoarthritis: A degeneration of the articular or
hyaline cartilage, due to wear and tear of the
joints. The cartilage may be worn away to the
point of exposing, eroding, and polishing the
underlying bone.
Nerve Injuries
• Hypoesthesia: Impaired or decreased
sensation.
• Hyperesthesia: Abnormal increased sensitivity
to stimuli of a sense (touch, sound, sight, etc)
• Paresthesia: Abnormal or morbid sensation
such as itching or prickling.
• Referred Pain: Pain that is felt at a point of the
body other than its origin.
Evaluation
• Objective: Is measurable evidence
• Subjective: Is descriptive evidence
• Sign: Something that can be measured or felt,
objective evidence
• Symptom: A description of what the athlete is
feeling, subjective evidence
Evaluation
• Etiology: The cause of a disease or injury
• Pathology: The changes that occur due to
injury
• Mechanism: How the injury occurred.
• Acute: An injury with a sudden onset and
short duration
• Chronic: a recurring injury, with a long onset
and long duration.
HOPS
• Evaluation: An organized process of
determining the type and severity of an injury.
• HOPS: Is a evaluation scheme that includes
history, observation, palpation, and
special/stress test.
HOPS
• History: A series of questions asked to
determine the nature and location of the
injury.
– How did it happen?
– Where does it hurt?
– Have you hurt that body part before?
• Observation: A visual examination of the
injury.
– Look for deformity, discoloration, signs of pain.
HOPS
• Palpation: A hands on approach where the
examiner feels for deformity or other
abnormal findings.
– Palpate bones, muscles, ligaments, and tendons
• Stress Test: A series of tests to specific
structures to determine the type and severity
of the injury.
– PROM, AROM, Functional Activities, Sport Specific
History
• To establish the history, use the MAPPS
pneumonic:
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M = mechanism of injury
A = acute or chronic
P = previous history of injury
P = pain (type & location)
S = sounds heard or felt at the time of injury or since
Observation
• Compare the uninvolved side with the involved
side look for:
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Swelling
Deformity / dislocation
Discoloration
Bleeding
Break(s) in the skin
Scars from previous surgeries
Muscle atrophy (decreased size)
Loss of movement
Is the athlete limping?
Did the athlete need assistance to get up?
Is the athlete protecting the injured extremity?
Palpation
• Areas to be palpated:
– Bones, Muscles, Ligaments, Tendons
– Palpate for:
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Bony deformities
Muscle spasms
Pulse (where applicable)
Breaks in the skin (injury to underlying structures)
Changes in temperature
Changes in sensation
Pain
Stress Test
• Check for the following:
• Active ROM, Passive ROM, Resisted ROM
• Additional tests as indicated by the location &
type of injury:
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Anterior drawer test - ACL
Posterior drawer test - PCL
Modified Lachman’s – ACL
Godfrey’s test - PCL
Appley compression & distraction – meniscus
McMurray’s test – meniscus
Ober’s test – IT band
SOAP Note
• Subjective: Anything the athlete, coach, or
teammate has to say about the injury
• Objective: Anything that is observed or
measured during the evaluation.
• Assessment: The evaluators opinion about the
injury
• Plan: The short-term and long-term goals for
the athlete, rehab plan/treatment.
SOAP Note Tips
• Once the initial form has been completed,
continue to add progress notes to track the
athlete’s progress
• Length and details will vary with the type of
injury
• Be thorough and concise
Why use SOAP Notes?
1. It’s easy to record the findings of an injury
evaluation.
2. It’s an organized way to share information
with other health professionals.
3. It’s a good way to record an individual’s
progress over time.
4. It may be used as evidence to protect you in
the case of a lawsuit.
Vital Signs
• Vital signs are a measure of the body’s
functions that are necessary for life, such as
breathing, heart rate and body temperature
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Heart Rate
Respiration Rate
Blood Pressure
Body Temperature
Heart Rate
• A way to measure the function of the heart and
circulatory system
– Normal Range for adults is 60 to 80 bpm.
– It is measured at the pulse points, where the
artery is close to the skin.
• Carotid artery (either side of the throat)
• Radial artery (thumb side of the wrist)
Respiration Rate
• Respiration, or breathing, is a way to measure
the body’s ability to take in oxygen and get rid
of carbon dioxide
• One breath consists of an inspiration and an
expiration
• All of the cells of the body need oxygen to
function
• Loss of breathing leads to cell death
Respiration Rate
• How is breathing measured?
– After measuring the radial pulse, keep the
athlete’s arm across the chest and count one
inspiration and one expiration as one breath.
– Don’t tell the patient you are monitoring their
breathing.
– Count the number of breaths during a 60-second
period.
• Normal breathing rates:
– 12-20 breaths/minute
Blood Pressure
• Blood Pressure is:
– A measure of the pressure put on the walls of the
arteries by the blood
– Recorded with 2 numbers (i.e., 120/80)
• Top number is systolic (blood pressure when the heart
contracts)
• Bottom number is diastolic (blood pressure when the heart
is at rest)
– Normal ranges:
• Systolic – 110 mm Hg
• Diastolic – 65 to 80 mm Hg
Body Temperature
• What is core temperature?
– A measure the body’s internal temperature
• How is it regulated?
– The hypothalamus regulates body temperature by
measuring the temperature of the blood.
– When the temperature of the blood decreases, the
hypothalamus causes blood vessels to constrict to
conserve heat, and the muscles create heat by
shivering.
– When too much heat is produced by the body, the
blood vessels dilate and the sweat glands are
stimulated to release heat.
Body Temperature
• What is the normal body temperature?
– 98.6 degrees Fahrenheit
• How is it measured?
– Temperature can be measured at a number of
different sites, including the mouth under the
tongue (oral), ear (tympanic), armpit, or rectally.
– Most accurate reading is from the ear or rectum.