Week 4 Flashcards
How do we know if an emergency condition is ruled out?
- Alert
- ABCs
- No concerning head/spine MOI
- C-spine and head assessment clear
*next is non-urgent conditions assessment
Non-urgent conditions
- sprains
- strains
- simple fractures
- contusions
- abrasions/minor lacerations
On-field assessment HOPS
H- history
O- observations
P- palpation
S- special test
History taking- SAMPLE
- signs and symptoms
- allergies
- medications
- past medical history
- last oral intake
- events leading up to injury
History taking- PQRST
(all about pain)
- provoke
- quality
- region/radiate
- severity (1-10)
- time
PQRST- Provoke
- what makes it worse?
PQRST- Quality
- sharp, dull, achy, bruning
PQRST- Radiate
- does it shoot anywhere?
PQRST- Severity
- out of 10
PQRST- Time
- when did pain start? intermittent?
Questions to ask about symptoms (SAMPLE)
- what happened?
- where does it hurt?
- did you hear or feel anything?
- did it give out?
- PQRST for pain
Questions to ask about allergies (SAMPLE)
- do you have any?
- if so, do you have an epi-pen, where is it?
Questions to ask about medications (SAMPLE)
- are you on any?
- what are they?
- what are they for?
- were they prescribed? is it safe to take them?
- 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 are before?
Questions to ask about last oral intake (SAMPLE)
- low blood sugar?
- dehydrated?
- what did they have and when?
*imp to know if surgery is required
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
Observations (HOPS)
- what do you see?
- what’s around the athlete?
- what position are they in?
- expose injury site
What to check for in observation of injury site
- bruising/discolouration
- swelling
- deformity
- bleeding
- rashes/hives
Palpations (HOPS)
- have athlete show location (can they use one finger? do they motion to an area with hand?
- check distal circulation
- is the location warm vs other side?
- do you feel a divot or deformity vs other side?
- check above and below injury
Index of suspicion
Once you have gone through HOP, consider what structure you suspect is injured:
- muscle
- ligament
- bone
Special tests - muscle/tendon
- have tissue contract
- resisted testing 1-5
Special tests- ligament
- test to open the joint it stabilizes
Special tests- bone
- fracture testing
Kendall’s resisted muscle testing
- rate the quality of strength out of 5 and mark with a * if it elicits pain
Kendall’s resisted muscle testing- grade 0
- no visible or palpable contraction
Kendall’s resisted muscle testing- grade 1
- visible or palpable contraction without motion
Kendall’s resisted muscle testing- grade 2
- full range of motion, gravity eliminated
Kendall’s resisted muscle testing- grade 3
- full range of motion against gravity
Kendall’s resisted muscle testing- grade 4
- full range of motion against gravity, moderate resistance
Kendall’s resisted muscle testing- grade 5
- full range of motion against gravity, maximal resistance
Ligament testing
- testing for level of instability
- what motion should that ligament limit?
Fracture Test 1: Tap testing
- gentle tap at location on bone away from suspected fracture site
- vibration from tapping will elicit pain if there is a fracture
Should we do a tap test for a fracture if we see a deformity?
- not necessary
Fracture test 2: Compression test
- compress two ends of bone together
- elicits pain if there is a fracture
Compression test direct technique
- either end of long bone
Compression test indirect technique
- compress bones around the smaller bone with suspected fracture (ie. carpals, tarsals)
What is an alternative compression test method?
- press on bones more proximally (ie. radius and ulna)
Fracture test 3: Tuning fork
- bang the end of the tuning fork off shoe/hard surface
- place base of tuning fork on bone with suspected fracture, away from fracture site
- resulting vibration may cause pain
Are tuning forks accurate?
- high proportion of false positives
- value in ruling out a fracture, but not ruling in
Sideline assessment
- more detailed than on-field HOPS assessment
What is included in sideline assessment?
- rule out joint above and below
- full physiological ROM for the joint
- 3 special tests to rule out/confirm
- more extensive palpation
Physiological ROM
- adduction, abduction, flexion, extension etc.
- know which movements joints perform to do sideline assessment
What are the intra-articular movements required for the physiological ROM to take place? (accessory movement)
- roll
- spin
- glide
Are accessory movement tested in sideline assessments?
- no but would be essential to check in clinical analysis
Fundamental arthrokinematics- roll
- multiple points along one rotating articulate surface contact multiple points on another articular surface
Roll example
- humeral head rolling on glenoid fossa
Fundamental arthrokinematics- glide
- a single point on one articular surface contacts multiple points on another articular surface
Glide example
- knee flexion
- femur on tibia
Fundamental arthrokinematics- spin
- a single point on one articular surface rotates on a single point on another articular surface
Spin example
- rotation of the radius on the humerus during forearm pronation and supination
What ROM would you do for a sideline assessment?
- active ROM
- overpressure the end of range if full and pain-free
What must occur for return to play?
- ROM must be full and resisted testing must be 80%
Questions to ask during a side line assessment for special tests
- what other structures could be involved?
- what other structures need to be ruled out? (ie. ligament, muscle/tendon, bone/joint, nerve)
Questions to ask and what to do during a sideline assessment for palpations
- what other structures may be involved?
- starts above and below injured structure and work towards it
- layers of anatomy
- determine the extent of injured structure
Impression- what to include in documentation
- severity (ie. degree)
- structure
- injury
- assessment done
- treatment provided
- plan
What to include in plan
- RTP decision
- Immediate care
- Educate
- Communicate
- Transport
- Referral
Sideline management for a sprain
- ice and elevation
- wrap to support, approximate tissues, provide compression
- crutches for weight-being extremities
Sideline management for strain
- ice and elevation
- wrap for compression
- pressure pad over tissue to approximate ends and provide compression
- crutches
Sideline management for contusions
- ice
- donut pad
- wrap padding with herringbone technique
- no massage
Sideline management for fractures
- splint (SAM or speed splint)
- need to splint joint above and below
- monitor for shock
- refer for imaging
- ice based on condition and monitor
Sideline management for abrasions
- clean wound
- telfa/non-stick pad and cover roll
Sideline management for minor lacerations
- clean wound
- telfa/non-stick pad and cover roll
- steri-strips
Principles of wrapping
- purpose?
- ask yourself which structures am I supporting?
- any abrasions/blisters that need to be covered?
- sensitivities?
- have athlete in comfortable position
- cap refill distal to wrapped area
What are the different wrapping techniques?
- Spiral wrap
- Herring bone/figure 8
Spiral wrap
- overlap by half
- equal distribution of pressure
Herring bone/figure 8
- used over area needing more compression
- wrap up the leg, around and back down for X-effect
