Injury Evaluation Basics
The Process
Be systematic on your assessment, but
do not have a “cookbook” approach.
Be calm (it can’t be an emergency for
you!)
Be confident!
Listen to your patient!
Do NOT overstep your bounds.
– If you don’t know something, do not be
hesitant to ask others for assistance.
HOPS- History
History: Attitude, mental condition,
and perceived physical state.
– Stated by the athlete.
– Primary Complaint
– Mechanism of Injury
– Characteristics of the Symptoms
– Limitations
– Past History
Purpose: Find out the
symptoms.
What are the component
parts?
USE OPEN-ENDED QUESTIONS
Depending on the injury, you
may have to ask specific
questions
LISTEN
Seven Attributes of a Symptom
Location:
Quality:
Quantity or Severity:
Timing:
Setting in which it occurs:
Remitting or exacerbating factors:
Associated Manifestations:
Sample History Questions
When did problem start?
What makes it better? What makes it
worse?
Is it better or worse in the morning
or at night?
Is it better or worse w/ breathing,
urination, eating, excitement, stress,
rest, movements, etc.
History of Illness
Have you had symptoms like this
before?
Have you had x-rays, MRIs, or CT
scans?
Getting better, worse or same?
Have you received any treatments?
Do you have any family history of
chronic disease or health concerns?
When Pain is associated!
Type of Pain
– Acute vs chronic
– Local vs referred
– Constant vs intermittent
– Sharp?
– Radiating?
– Burning?
– Location
– Etc.!
Purpose: Find out the signs.
– Appearance
What does it look like?, skin appearance,
signs of trauma
– Bilateral symmetry
– Bleeding
– Color/Discoloration
– Deformity
– Edema/Swelling
– Expressions denoting pain
RED FLAGS!
Constant pain
Heart palpitations
Fainting
Night pain or sweats
Difficult or painful
swallowing
Vision loss
Unexpected weight
loss
Insomnia
Excruciating pain
Nausea, vomiting
Difficult urination
Blood in urine
Dizziness
Chronic fatigue
Injury Evaluation Process
Symptom: Athletes perception of his or
her injury.
Sign: Objective, measurable physical
finding regarding the individuals condition.
HOPS- History Observation Palpation
Special tests
SOAP- Subjective Objective Assessment
Plan.
HOPS- Observation and
Inspection
Observation: Measurable objective
signs.
– Appearance
– Symmetry
– General Motor Function
– Posture and Gait
– Deformity, swelling, discoloration, scars,
and general skin condition
Begin away from the pain & move
towards the injury
Pain & Point tenderness
Malalignment of joint/bone
Crepitus
Swelling
Tissue temperature & Circulatory
status
HOPS- Palpation







Rule out FX (fracture)
Skin temperature
Swelling
Point tenderness
Crepitus
Deformity
Muscle spasm
HOPS- Palpation
Cutaneous Sensation (nail bed refill)
Pulse
Stress Tests
– Uniplanar tests designed to assess ROM,
muscular strength, or ligament stability
Special Tests
– Multiplanar tests designed to assess
ligament stability and functionality
Neurological Tests
Stress Tests
Active Range of Motion (AROM)
Passive ROM (PROM)
Resistive ROM (RROM)/Manual
Muscle Tests (MMT)
Ligament stability
– Instability & Endpoints
– End feel (Starkey Tables 1-3, 1-4, p. 13)
– Relative ligament laxity (Starkey, Table
1-7, p. 15)
HOPS- Special Tests
Functional Tests
– Active Range of Motion (AROM)
– Passive Range of Motion (PROM)
– Resisted Manual Muscle Testing (RROM)
Stress Tests
– Ligamentous Instability Tests
– Special Tests
HOPS- Special Tests
Neurologic Tests
– Dermatomes
– Myotomes
– Reflexes
– Peripheral Nerve Testing
Sport-Specific Functional Testing
– Proprioception and Motor Coordination
HOPS- Special Tests
Sport-Specific Skill Performance
– Throw the football, baseball, softball,
javelin...
– Kick the soccer ball, football,
opponent…
– Macarena, Cabbage Patch, Mash
Potato
Special Tests
Ligament stability
– Instability & Endpoints
– End feel (Starkey Tables 1-3, 1-4, p. 13)
– Relative ligament laxity (Starkey, Table 1-7, p.
15)
Function
–
–
–
–
–
–
–
Jumping
Pivoting
Backpedaling
Starts
Change of direction
Throwing & other shoulder activities
Core activities
Neurological Tests
Sensation, Motor function, Reflexes
– Dermatomes
Two-point Discrimination Test
Sharp-Dull Discrimination Test
Hot-Cold Discrimination Test
– Myotomes
Manual Muscle Test (MMT) or Break Test
– Reflexes
Deep Tendon Reflex Grading (Starkey, Table
1-8, p. 19)
On-Field vs. Off-Field
Evaluation
On-field: quick inspection &
evaluation
– What is the seriousness of injury?
– Is first aid & immobilization needed?
– Does the injury need immediate
referral?
– What is the manner of transportation
from the injury site?
Off-field: longer and more in depth
Finish it!
Come to conclusions.
Differential diagnosis
– List the options
For example – What could it be?
– Anterior knee pain
– Lateral ankle pain
Documenting Injuries
Writing SOAP Notes
IF YOU DON’T DOCUMENT IT, IT
DIDN’T HAPPEN
Writing a Medical Record
The ABCs
Accuracy
Brevity
Clarity
Accuracy
Never record false
information
Patient records are legal
documents
Keep information objective
Clarity
Meaning should be
immediately clear
Avoid vague terminology
Your handwriting should be
legible
Brevity
State your information
concisely but enough
information must be
presented
Use sentence fragments
Use abbreviations
Writing a Medical Record
Punctuation
– Avoid hyphens
– Semicolon(;) is used to connect two points
– Colon (:) is used instead of “is”
Correcting Errors
– Never erase or white-out
– Cross out with one line, write the date, and
initial
Signature
– Use your official title
The SOAP Note
Organized according to the source the
information
–
–
–
–
S = Subjective
O = Objective
A = Assessment
P = Plan
Sometimes preceded by a statement of
the problem
– Usually the patient’s chief complaint, the
diagnosis, or a loss of function.
What goes where?
Subjective
– This information is received from the
patient
Objective
– Results of tests measurements
performed and the therapist’s objective
observations
– Break into separate body parts if
necessary
Assessment
– Probable or Differential Diagnosis
SOAP- Subjective
History: Attitude, mental condition,
and perceived physical state.
– Stated by the athlete.
– Primary Complaint
– Mechanism of Injury
– Characteristics of the Symptoms
– Limitations
– Past History
SOAP- Objective:
Observation: Measurable objective
signs.
– Appearance
– Symmetry
– General Motor Function
– Posture and Gait
– Deformity, swelling, discoloration, scars,
and general skin condition
SOAP- Objective
Rule out FX (fracture) Cutaneous Sens.
Skin temperature
Swelling
Point tenderness
Crepitus
Deformity
Muscle spasm
Pulse
SOAP- Objective
Functional Tests
– Active Range of Motion (AROM)
– Passive Range of Motion (PROM)
– Resisted Manual Muscle Testing (RROM)
Stress Tests
– Ligamentous Instability Tests
– Special Tests
SOAP- Objective
Neurologic Tests
– Dermatomes
– Myotomes
– Reflexes
– Peripheral Nerve Testing
Sport-Specific Functional Testing
– Proprioception and Motor Coordination
SOAP- Objective
Sport-Specific Skill Performance
– Throw the football, baseball, softball,
javelin...
– Kick the soccer ball, football, opponent…
– Macarena, Cabbage Patch, Mash Potato
SOAP- Assessment
Analyze and assess the individual’s
status and prognosis
Suspected injury Site
Damaged Structures Involved
Severity of Injury
Progress Notes
SOAP- Plan
1. Immediate treatment given
2. Frequency and duration of
treatments and modalities and
evaluation
3. On-going patient education
4. Criteria for discharge/return to play
Let’s Practice…
Case Study
– A 20-year old tennis player was chasing after a deep hit
ball. While he was maneuvering to the right, he fell
forward and felt a pop in his lateral ankle. He reports
today with swelling along the lateral malleolus
measuring 12 cm in circumference. He is able to partial
weight bear to 75% on the left. He admits that he is
fearful of bearing weight on the leg because he feels it
will give way. His hip and knee strength is grossly 4+/5.
Ankle dorsiflexion and inversion are 3/5, and ankle
eversion is 2+/5. His active ankle range of motion is -5o
dorsiflexion, 40o plantarflexion, and 5o eversion.
Negative tests include Kleiger’s and Talar Tilt (inv and
ever). Positive tests include anterior drawer (mild
opening) and obvious peroneal tendon subluxation with
active inversion. Pedal pulse is normal and dermatomes
are normal. He was planning on participating in Regional
Finals beginning in two days.