Chapter 13: Off the FIeld Injury Evaluation

Question 0

What are the anatomical directions?

Answer 0

anterior: in front of
posterior: in back of
superior: above
inferior: below
proximal: closer to
distal: farther away
medial: toward middle
lateral: away from the middle

Question 1

What are the three most common planes?

Answer 1

sagittal: divides body left to right
transverse: divides body top to bottom
coronal (frontal): divides body front to back

Question 2

What is etiology? mechanism? pathology? symptom? sign? prognosis? diagnosis? sequela?

Answer 2

etiology: cause of disease
mechanism: mechanical description of cause
pathology: structural and functional changes that result from injury
symptom: change that indicated injury or disease
sign: indicator of a disease
prognosis: predicted outcome of an injury
diagnosis: name of a specific conditio
sequela: condition resulting from disease or injury

Question 3

What is a syndrome?

Answer 3

def: group of symptoms that indicate a condition or disease

Question 4

What is HOPS? What is SOAP?

Answer 4

HOPS: history, observation, palpation, and special tests
SOAP: subject, objective, assessment, and plan

Question 5

When obtaining a history, how should the athletic trainer communicate with the athlete? What information should be obtained?

Answer 5

be calm and reassuring, open-ended questions, listen carefully, maintain eye contact, record exactly what is said without interpretation, obtain it ASAP

MAPPS: MOI, acute/chronic, pain, previous history, signs/symptoms

Question 6

What are some specific things to look for during observation?

Answer 6

deformity, how patient moves, limp, anything abnormal, inability to move, stiffness, facial expression, body asymmetries, swollen, atrophy, unnatural protrusions, lumps, postural malialignment, crepitus, inflamed, heat, redness

Question 7

Where should palpation begin?

Answer 7

light pressure to harder pressure

away from site to the site

Question 8

Movement assessment should begin with what: active, passive, or resistive ROM?

Answer 8

active to passive to resistive

active: motion that occurs because of muscle contraction
passive: performed completely by examiner

Question 9

What are you looking for with passive ROM?

Answer 9

what the endpoint feels like or the sensation of the patient at the end of the ROM

Question 10

What is the MMT grading scale?

Answer 10

0-5

0: no evidence of muscle contractility (zero, 0%)
1: evidence of slight contractility with no joint motion (trace, 10%)
2: complete ROM with gravity omitted (poor, 25%)
3: complete ROM against gravity with no resistance (fair, 50%)
4: complete ROM against gravity with some resistance (good, 75%)
5: complete ROM against gravity with full resistance (normal, 100%)

Question 11

What are normal ROMs for the shoulder, elbow, forearm, wrist, hip, knee, ankle, and foot?

Answer 11

shoulder: flexion (180), extension (50), add (40), abd (180), IR (90), ER (90)
elbow: flexion (145)
forearm: pronation (80), supination (85)
wrist: flexion (80), extension (70), abd (20), add (45)
hip: flexion (125), extension (10), abd (45), add (40), IR (45), ER (45)
knee: flexion (140)
ankle: plantar flexion (45), dorsiflexion (20)
foot: inversion (40), eversion (20)

Question 12

What 6 things are included in a neurological examination?

Answer 12

cerebral function, cranial nerve function, cerebellar function, sensory testing, reflex testing, projected or referred pain, and motor testing

Question 13

What are the 12 cranial nerves: #, name, function, sensory or motor?

Answer 13

1. olfactory - smell
2. optic - vision
3. oculomotor - eye movement, opening of eyelid, pupil constriction
4. trochlear - lateral and inferior eye movement
5. trigeminal - face sensation, mastication
6. abducens - lateral eye movement
7. facial - facial expression, taste
8. vestibulocochlear - balance and hearing
9. glossopharyngeal - swallowing, gag reflex, sensation of tongue/ear
10. vagus - speech
11. accessory - shoulder shrug - sternocleidomastoid muscle
12. hypoglossal - tongue movenemt

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Question 14

What is the reflex grading scale?

Answer 14

0-4

0: absence - areflexia
1: diminished - hyporeflexia
2: average
3: exaggerated - hyperreflexia
4: markedly hyperactive - often associated with clonus

Question 15

What are the 5 deep tendon reflexes?

Answer 15

biceps (C5), brachioradialis (C6), extensor digitorum (C6), triceps (C7), adductor (L2), patella (L4), achilles (S1) and hamstring (S2)

Question 16

What are some different superficial and/or pathological reflexes?

Answer 16

superficial: elicited by stimulation of the skin at specific sites. include upper abdominal (T7, T8, T9), lower abdominal (T11, T12), cremasteric (T12, L1), plantar (S1, S2), and gluteal (L4, S3). absence is indicative of some lesion
pathological: presence indiacted lesion in the descending upper motor neuron. babinski’s, chaddock’s, oppenheim’s, and gordon’s

Question 17

Progress evaluations should be based on what?

Answer 17

based on the athletic trainer’s knowledge of exactly what is occurring in the healing process at any given time. the timelines of injury healing provide the framework that dictates the progress of the rehabilitation program

Question 18

What is a CT scan? Bone scan? X-ray? MRI? myelography? DEXA? echocardiography? arteriogram? venogram?

Answer 18

CT scan: aka computed tomography - penetrates the body with a thin, fan-shaped x-ray beam, producing a cross-sectional view of tissues. unlike x-ray, it allows images to be viewed in different angles.
Bone scan: involves intravenous radioactive tracer such as technetium-99. stress fractures can be detected
X-ray: helps identity fractures and dislocations or any bone abnormality that may be present. can also rule out infections or a neoplasm. soft-tissue factors such as joint swelling and ectopic bone development in ligaments and tendons can also be detected.
MRI: aka magnetic resonance imaging - surrounds body with powerful electromagnets, focuses on hydrogen atoms in water molecules, clearer images then CT scan.
myelography: dye in spinal cord
dexa: aka dual-energy x-ray absorptiometry - most widely used method to measure bone mineral density
echocardiography: ultrasound for cardiac
arteriogram: catheter is inserted into blood vessel, examine artery
venogram: radiographic procedure to imagine veins

Question 19

What is an ECG? EEG? EMG?

Answer 19

ECG: aka electrocardiogram - records electrical activity of the heart at various phases in the contraction cycle to determine impulse formation, conduction, and depolarization.
EEG: aka electroencephalography - electrical potentials in the brain
EMG: aka electromyography - graphic recording of a muscle contraction and the amount of electrical activity generated.

Question 20

What does a CBC evaluate?

Answer 20

complete blood count - includes RBC, WBC, platelet, hematocrit, hemoglobin, cholesterol, HDL, LDL, and triglycerides

Question 21

What are normal levels for RBC? What can abnormal levels indicate?

Answer 21

male: 4.5-5.5 million/mm3
female: 4.0-4.9 million/mm3

looks at the number of cells per unit volume to detect anemias, prolonged infections, iron deficiencies, internal bleeding, and certain types of cancers

Question 22

What are normal levels for WBC? What can abnormal levels indicate?

Answer 22

4,500-10,000/mm3

used to determine the presence of bacteria, differentiation of white cell types can identify specific types of infection

Question 23

A deficiency in platelet count can lead to what? What does a low hematocrit indicate?

Answer 23

platelet count: 100,000-450,000/mm3
hematocrit: males (41%-50%), females (36%-44%)

low platelet: lead to dangerous internal bleeding
hematocrit: measures how much of the total blood volume is make up of RBC, low levels indicate certain types of anemia

Question 24

What does a urinalysis evaluate?

Answer 24

if not analyzed within one hour, it should be refrigerated.
evaluate output, color, specific gravity (ability of the kidney to concentrate and dilute fluids), osmolality, pH, uric acid, urea, creatine.

Question 25

Presence of ketones could indicate what? Nitrate?

Answer 25

ketones: diabetes
nitrate: infection

Question 26

What are the normal end feels? (4)

Answer 26

soft-tissue: soft and spongy, a gradual, painless stop
capsular: an abrupt, hard, firm endpoint with only a little give
bone to bone: a distinct and abrupt endpoint when two hard surfaces come in contact with one another
muscular: a springy feel with some associated discomfort

Question 27

What are abnormal endpoints? (4)

Answer 27

empty: movement is definitely beyond the anatomical limit, and pain occurs before the end of ROM
spasm: involuntary muscle contraction that prevents motion because of pain; aka guarding
loose: occurs in extreme hypermobility
springy: a rebound at the endpoint

Question 28

Protein and hemoglobin can indicate what? When else might hemoglobin appear in urine?

Answer 28

hemoglobin/protein: kidney disease

hemoglobin may also appear after intense exercise