Injury Report
HOPS
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History
Observation
Palpations
Special Tests
History
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Basic Information
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Name of athlete
Date of birth & gender
Sport, position, year & season
Activity & group
Location, weather, & type of surface
History
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Injury History
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Date & time of injury
Onset
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Body part & side
Mechanism & how did it occur
Was there an existing injury and if yes, what & when
Pain
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Acute, chronic, or re-injury
Location, type, any sounds
General condition of the athlete
History
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Present history
What is the problem?
How did it occur?
When did it occur?
Did you fall?
How did you land?
Which direction did your joint move?
Did you feel or hear something when it
occurred?
If so, what?
History
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Present history
Injury Location:
Toes, Lower Leg, Hip, Lumbar, Shoulder,
Forearm, Cervical, Foot, Knee, Pelvis,
Thorax, Upper Arm, Wrist, Head, Ankle,
Thigh, Abdomen, Thoracic, Elbow,
Fingers, Face, Medical
History
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Present history
With one finger, point to the exact
location of the injury:
Proximal, Distal, Superior, Inferior,
Medial, Lateral, Anterior, Posterior, RUQ,
RLQ, LUQ, LLQ, Midline
History
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Present history
Pain Type:
Nerve
– Sharp, bright, burning
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Muscle
– Dull, aching, referred to another area
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Bone
– Localized and piercing
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Vascular
– Poorly localized, aching, referred from
another area
History
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Present history
Pain Location:
Deep
– more difficult to match the pain with the site
of trauma, may cause treatment to be
performed at the wrong site
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Superficial
– better elicited pain corresponding with the
site of pain stimulation
History
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Present history
Does the pain change at different times?
Chronic inflammation
– indicated by pain that usually subsides
during activity
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Edema
– pain that increases in a joint throughout the
day
History
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Present history
Does the athlete feel a sensation other
than pain?
Pressure on nerve roots can produce
pain or a sensation of “pins and needles”
(paresthesia)
History
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Present history
If the injury is related to a joint:
Is there stability?
Does it feel if it will give way?
Does it lock and unlock?
Positive responses may indicate the joint
has a loose body catching or inhibiting
the normal musculature support in the
area
History
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Present history
How long has the athlete had the injury?
Acute
– immediate
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Chronic
– over an extended period of time
Observations
Observations
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Usually taken during the history
What do you see?
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Swelling
Redness
Ecchymosis
Scars, blisters, calluses
Limp or abnormal movement
Asymmetry, protrusions, malalignments,
deformities
– Guarding, facial expressions, etc
Observation
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How does the
athlete move?
Limp
Facial expression
Asynchronous
Movement
No movement
Guarding
Slow movement
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Swelling
Redness
Deformity
Inflammation
Ecchymosis
Asymmetries
Abnormal Sound
Atrophy
Elbow Observations
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Cubitus Recurvatus
– Hyperextension
Toe Observations
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Morton’s Toe
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Bunions (Hallux Valgus) or Bunionettes (Tailor’s Bunions)
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In all bunions, both the flexor and extensor tendons are
malaligned, creating more angular stress on the joint.
Corns
Hammer Toes or Clawed Toes
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Abnormally short 1st metatarsal makes the second toe appear
longer and putting more weight bearing on the 2nd metatarsal
Malalignment of the metatarsophalangeal joint and PIP joints
Toe Overlap
Ingrown Nail
Subungual Hematoma
Foot Observations
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Pes Planus
– Flat feet
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Pes Cavus
– High arch
Knee Observations
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Genu Varum
– Bowed Legs
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Genu Valgum
– Knock Knees
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Genu Recurvatum
– Hyperextension
Lumbar Observations
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Scoliosis
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Kyphosis
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Head protrudes forward caused by kyphosis
Flatback posture
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Increased lumbar curvature
Forward head posture
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Increased thoracic curvature
Lordosis
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Lateral curvature of the spine
Flat posture caused by a decreased lumbar curvature
Swayback posture
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Anterior shifting of the entire pelvis resulting in hip extension
Postural Malalignments
A.
B.
C.
D.
E.
F.
Kyphosis
Forward head
Flatback
Swayback
Lordosis
Scoliosis
Palpations
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Bony & muscular
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Point tenderness (pain)
Differences compared to the able side
Temperature (hot or cold)
Crepitus
Pulse
Dermatomes
Spasms or cramps
Special Tests
Active range of motion (AROM)
Passive range of motion (PROM)
Resistive range of motion (RROM)
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Muscle grade (done with active range of motion)
Ligament tests
Special tests
Functional tests
Sports specific tests
Neurological tests
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Aka active resistive range of motion (ARROM)
Reflexes and glascow coma scale
Vital signs
Suspected Injury
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Write all suspected injuries
Severity
Immediate care
Service & initial treatment
Status & restrictions
Instructions to the athlete
Athlete & evaluator must sign the
document
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The unconscious athlete must always be
considered to have a life-threatening
injury, which requires an immediate
primary survey.
THE PRIMARY SURVEY
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The athletic trainer should immediately note the body
position and determine the level of consciousness and
unresponsiveness.
Airway, breathing, and circulation should be
established immediately.
Injury to the neck and spine should always be
considered as a possibility in the unconscious athlete.
If the athlete is wearing a helmet, it should never be
removed until neck and spine have been clearly ruled
out. However, the face mask must be cut away and
removed to allow for CPR.
If the athlete is supine and not breathing, airway,
breathing, and circulation should be established
immediately.
THE PRIMARY SURVEY
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If the athlete is supine and breathing, nothing should
be done until consciousness returns.
If the athlete is prone and not breathing, he or she
should be log-rolled carefully to the supine position
and ABCs should be established immediately.
If the athlete is prone and breathing, nothing should
be done until consciousness returns, then the athlete
should be carefully log rolled onto a spine board
because CPR could be necessary at any time.
Life support for the unconscious athlete should be
monitored and maintained until emergency medical
personnel arrive.
Once the athlete is stabilized, the athletic trainer
should begin a secondary survey.
Controlling Bleeding
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Direct pressure
Elevation
Pressure points
Tourniquets (only for special
circumstances)
Shock:
Signs and Symptoms
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Blood pressure is low
Systolic pressure is usually below 90 mmHg
Pulse is rapid and weak
Rapid Breathing
Athlete may be drowsy and appear sluggish
Altered level of consciousness
Respiration is shallow and extremely rapid
Skin is pale, cool, and clammy
Restlessness or irritability
Nausea and vomiting
A blue tinge to lips and nail beds
Shock:
Treatment
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Make sure that 9-1-1 or the workplace emergency
number has been called
Continue to monitor the victim’s airway, breathing, and
circulation (ABCs)
Control any external bleeding
Keep the victim from getting chilled or overheated
Help the victim rest comfortably. If the victim is not
having trouble breathing or if it is not expected that
the victim has a head, neck, or back injury or broken
bones in the hips or legs, elevate the legs about 12
inches
Comfort and reassure the victim until advanced
medical personnel arrive and take over
Do not give food or drink to the victim
THE SECONDARY SURVEY:
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Vital Signs
Pulse, respiration, blood pressure,
temperature, skin temperature, skin
moisture, skin color, pupils , level of
consciousness, ability to move, reaction
to pain, abnormal nerve response, and
breath sounds
THE SECONDARY SURVEY:
Pulse
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Adults range between 60 and 80 beats per
minute
Children range between 80 and 100 beats per
minute
Infants range between 120 to 160 beats per
minute
Trained athletes may be slower
Heart rate can be taken at the radial or carotid
artery for 30 seconds then multiply by two
THE SECONDARY SURVEY:
Pulse
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Fast & weak
– Shock, heat exhaustion, diabetic coma
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Fast & strong
– Fright, stress, Fever, HTN, heat stroke,
stimulant drugs
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Slow & weak
– Drug overdose, impending death
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Slow & strong
– Stroke, head injury
THE SECONDARY SURVEY:
Respiration
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Adult breathing rate is 12 breaths per
minute
Children breathing rate is 20 to 25
breaths per minute
Infant breathing rate is 24 to 50 breaths
per minute
Watch the chest rise and fall for 30
seconds then multiply by two
THE SECONDARY SURVEY:
Respiration
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Rapid & shallow
– Airway obstruction (partial), heart failure,
chest or abdominal injury or pain
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Rapid & deep
– Diabetic coma, head injury, stress
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Slow & shallow
– Drug overdose, impending death
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Labored
– Airway obstruction
THE SECONDARY SURVEY:
Blood Pressure
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Normal range 90/60 mmHg - 120/80
mmHg
Borderline HTN 139/89 mmHg
Hypertension is 140/90 mmHg or higher
Top number represents the systolic
pressure
Bottom number represents the diastolic
pressure
THE SECONDARY SURVEY:
Blood Pressure
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High or rising
– Fright, stress, head injury, CNS problems,
poisoning
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Low or falling
– Shock, internal bleeding
THE SECONDARY SURVEY:
Temperature
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Oral = 98.6º ± 1º
Axillary = 97.6º
Rectal = 99.6º
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Very High
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Heat stroke, infection, fever
Elevated
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Core temperature
Heat exhaustion, infection, fever
Low
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Hypothermia
THE SECONDARY SURVEY:
Skin Temperature
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Warm is normal
Hot
– Hyperthermia
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Cold
– Hypothermia
THE SECONDARY SURVEY:
Skin Moisture
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Dry is normal
Damp
– Shock, fright, stress
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Very sweaty
– Heart attack, insulin shock, shock
THE SECONDARY SURVEY:
Skin Color
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Pink on thenar prominence
Normal capillary refill is less than 2 sec
Capillary refill longer than 2 sec is
circulatory compromise
THE SECONDARY SURVEY:
Skin Color
Red (Flushed) – Excessive Circulation to the skin
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Fever, diabetic coma, heat stroke, hypertension (HTN)
White (Pallor/Pale): circulatory insufficiency
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Stress, shock, hypoglycemia, heat exhaustion, heart attack
Blue (Cyanosis): respiratory insufficiency
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Airway obstruction, respiratory insufficiency, pump failure,
shock, traumatic asphyxia
Yellow (Jaundice) – Liver Function
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liver failure, hepatitis, chronic alcoholism
Gray (Ashen): circulatory insufficiency
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heart attack
Blotchy (Mottled): circulatory insufficiency
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shock, poor perfusion
THE SECONDARY SURVEY:
Pupils
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Should be equal and reactive to light
Constricted
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Mid-point
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Dead (pupils are fixed and dilated)
Dilated
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Bright light, opiates/heroin overdose, some
poisonings
Stress, fright, coma, amphetamine/stimulant
overdose, CNS injury,
early stage of death
One pupil dilated
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Head injury
THE SECONDARY SURVEY:
Level of Consciousness
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Alert and oriented to
Time
What day is it?
Place
Where are you?
Person
What is your coaches name?
Purpose
What are you doing today?
THE SECONDARY SURVEY:
Level of Consciousness
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Glascow Coma Scale
Normal Score is 15
– Eye opening is 4 maximum
– Motor response is 6 maximum
– Verbal response is 5 maximum
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Under 15 is considered altered
Under 7 is considered a coma
THE SECONDARY SURVEY:
Level of Consciousness
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Eye opening
4 – Spontaneous
3 – Verbal
2 – Pain
1 – None
THE SECONDARY SURVEY:
Level of Consciousness
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Motor response
6 – Obeys
5 – Localizes to pain
4 – Withdraws to pain
3 – Flexion (decorticate)
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2 – Extension (decerebrate)
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Flexion of arms
Hyperextension legs
Arms and legs extended
Internally rotated
1 – None
THE SECONDARY SURVEY:
Level of Consciousness
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Verbal response
5 – Oriented
4 – Confused
3 - Inappropriate words
2 – Incomprehensible sounds
1 – No verbal response
THE SECONDARY SURVEY:
Ability to Move
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Normal is a full range of motion (ROM)
Apparent inability
– Guarding due to trauma, fracture, or pain
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True inability
– Paralysis
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One sided – head injury
Below – spinal injury
THE SECONDARY SURVEY:
Ability to Move
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Inability to move a body part can indicate a
serious central nervous system injury
Inability to move one side of the body can
indicate head injury
Tingling or numbness of the upper extremity
can indicate cervical injury
Weakness or inability to move the lower
extremity can indicate injury below the neck
THE SECONDARY SURVEY:
Reaction to Pain
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Normal is recognized ability
Localized
– Injury or fracture
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Generalized
– Massive trauma, poisoning
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Absent
– (When injury is obvious) downer drugs,
alcohol, shock, spinal injury
THE SECONDARY SURVEY:
Abnormal Nerve Response
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Numbness or tingling in a limb with or without
movement can indicate nerve or cold damage
Blocking of a main artery can produce severe
pain, loss of sensation, or lack of a pulse in a
limb
A complete lack of pain or of awareness of
serious, but obvious injury may be caused by
shock, hysteria, drug usage, or a spinal cord
injury
THE SECONDARY SURVEY:
Breath Sounds
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Normal is clear
Stridor
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Upper airway obstruction heard on inspiration
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Wheezes
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Lower airway obstruction heard on expiration
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high-pitched whistling
high-pitched whistling
Rhonchi
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Lower airway obstruction heard on expiration
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coarse, loud, gurgling
THE SECONDARY SURVEY:
Breath Sounds
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Crackles
– Lower airway obstruction heard on
inspiration
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fine crackling
Grunting
– Upper airway obstruction heard on
expiration
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“ugh” sound
Snoring
– Soft palate obstruction
THE SECONDARY SURVEY:
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Immediate treatment of all
musculoskeletal injuries:
R.I.C.E.
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Rest
Ice
Compression
Elevation
Special Tests
SOAP Notes
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S = Subjective
O = Objective
A = Assessment
P = Plan
What the athlete tells you
Trainer’s tests
Suspected condition
Treatment
This can be used as an evaluation or a progress
report.