Lecture 4 Flashcards
What are non-urgent conditions
-sprains
-strains
-simple fractures
-contusions
-abrasions/minor lacerations
What is the acronym for on-field assessments
-HOPS
What does H stand for in HOPS
-history
-“what happened”
What does O stand for in HOPS
-observations
-“what do you see”
What does P stand for in HOPS
-palpation
-“what do you feel, where is the pain”
What does S stand for in HOPS
-special test
Acronyms for history taking
-SAMPLE
-PQRST
SAMPLE
-signs and symptoms
-allergies
-medications
-past medical history
-last oral intake
-events leading up to injury
PQRST
-provoke
-quality
-region/radiate
-severity
-time
When do use PQRST
-for pain
Questions to ask about symptoms (SAMPLE)
-what happened
-where does it hurt
-did you hear or feel anything
-etc
Question to ask about provoke (PQRST)
-what makes it worse
Question to ask about quality (PQRST)
-sharp
-dull
-achy
-burning
Question to ask aout radiate (PQRST)
-does it shoot anywhere
Question to ask about severity (PQRST)
-out of 10
Question to ask about time (PQRST)
-when did the pain start
-intermittent?
Questions to ask about allergies (SAMPLE)
-do you have any allergies
-do you carry epi-pen, where is it
Questions to ask about medications (SAMPLE)
-are you on any medications
-what are they
-what are they for
-were they prescribed
-could they be dampening symptoms
Questions to ask about past medical history (SAMPLE)
-do you have any medical conditions
-have you been feeling sick lately
-do you have any previous injuries
-have you hurt this area before
Questions to ask about last oral intake (SAMPLE)
-low blood sugar
-dehydrated
-what did they last have to eat and drink
Questions to ask about events leading up to injury (SAMPLE)
-what happened
-did they collide with someone
-piece together what happened
-looking for MOI to indicate possibilities of injury
Questions to ask about observations (HOPS)
-what do you see
-what is around the athlete
-what position are they in
-check injury site for bruising, swelling, deformity, bleeding etc
Questions to ask about palpations (HOPS)
-have athlete show location
-check distal circulation (use cap refill)
-is location warm vs other side
-do you feel a divot or deformity vs other side
-check above and below injury to make sure not missing anything
When to make an index of suspicion
-after completing HOP
What should you include in index of suspicion
-what structure do you suspect is injured (muscle, ligament, bone, etc.)
What is a special test
-what test can you do to confirm the suspected injury
Special test for muscle/tendon
-have the tissue contract
Special test for ligament
-test to open the joint it stabilizes
Special test for bone
-fracture testing
Kendall’s resisted muscle testing scale
-0-5
Kendall’s resisted testing 0
-no visible or palpable contraction
Kendall’s resisted testing 1
-visible or palpable contraction without motion
Kendall’s resisted testing 2
-full range of motion, gravity eliminated
Kendall’s resisted testing 3
-full range of motion against gravity
Kendall’s resisted testing 4
-full range of motion against gravity, moderate resistance
Kendall’s resisted testing 5
-full range of motion against gravity, maximal resistance
What are you testing for in ligament testing
-testing for level of instability
-need to know what motion the ligament should limit
What are the different fracture tests
-tap test
-compression test
-tuning fork
Tap testing
-gentle tap at a location on the bone away from suspected fracture site
-vibration may cause pain at suspected fracture site
When to not do a fracture test
-if you see a deformity
Compression test
-compress the 2 ends of the bone together
Direct technique for compression test
-either end of the long bone
Indirect technique for compression test
-compress the bones around the small bone with suspected fracture
When to use indirect technique for compression test
-for carpals or tarsals
Tuning fork test
-band end off of shoe/hard surface
-place the base of the tuning fork on bone with suspected fracture, away from fracture site
-resulting vibration may cause pain at the suspected fracture site
What is the problem with the tuning fork test
-high proportion of false positives
What to do when a fracture test is inconclusive
-err on the side of caution and get x ray
-prevent secondary complications
What to do during a sideline assessment
-rule out the joint above and below
-full physiological ROM for joint
-3 special tests to rule out/confirm
-more extensive palpation
What is included in physiological ROM
-flexion
-extension
abduction
-adduction
-internal rotation
-external rotation
-dorsiflexion
-plantarflexion
-cross flexion
-cross extension
-pronation
-supination
-ulnar deviation
-radial deviation
What are accessory movements also known as
-arthrokinematics
What are the accessory movements
-roll
-glide
-spin
Roll
-multiple points along one rotating articular surface contact multiple points on another articular surface
Glide
-a single point on one articular surface contacts multiple points on another articular surface
Spin
-a single point on one articular surface rotates on a single point on another articular surface
What type of range of motion to do on a sideline assessment
-active range of motion
-can do overpressure at the end of range if full and pain free
What is the difference between HOPS palpations and sideline assessment palpations
-HOPS: localizing injured structure
-sideline: more detailed palpations
What is an impression
-conclusion about the injury
-cannot diagnose
What to document for an impression
-severity
-structure
-injury
-assessment done
-treatment provided
-plan
What to include in plan
-RTP (return to play) decision
-immediate care
-educate
-communicate
-transport
-referral
Who should communicate the RTP decision to the coach
-the therapist
-not the athlete
Sideline management of a sprain
-ice and elevation
-wrap to support, approximate tissues, provide compression
-crutches for weight bearing
Sideline management of a strain
-ice and elevation
-wrap for compression
-pressure pad over strained tissues to approximate ends and provide compression
-crutches for weight bearing
Sideline management of a contusion
-ice
-donut pad with cover pad to protect from 2nd insult
-wrap padding onto area with herringbone technique
-no massage
Sideline management of non urgent fractures
-splint
-need to splint joints above and below
-monitor for shock
-refer for imaging
-ice based on condition and monitor
What are the different types of splints
-SAM splint
-speed splint
Sideline management of abrasions
-clean wound
-use non stick gauze and cover-roll (hypafix)
Sideline management of minor lacerations
-clean the wound
-maybe steri strips
-non stick gauze and cover-roll (hypafix)
Purpose of wrapping
-support and minimize swelling through compression
What to ask yourself before wrapping an athlete
-which structures/joint am I covering
-any abrasions/blisters that need to be covered
-any sensitivities
-have athlete in comfortable position
-cap refill
2 different wrapping techniques
-spiral
-herringbone
Spiral wrapping technique
-overlap by half
-equal distribution of pressure
Herringbone wrapping technique
-angle up and come around and angle down
-x effect
When is herringbone wrapping technique used
-when more compression is needed
