Week 4: Non-Urgent Conditions Flashcards
On-Field Assessment
-First step is ruling out emergency condition (Alert, ABCs, No concerning head or spine MOI, C-spine and head assessment clear)
-Make sure all are cleared before non-urgent assessment
-Non-urgent conditions assessment
Non-Urgent Conditions (4)
-Sprains and strains
-Simple fractures
-Contusions
-Abrasions/minor lacerations
On-Field HOPS
-History- MOI, what happened
-Observations- what do you see (heat, bruising, swelling)
-Palpation- what do you feel? Where is the pain? (injury site, start gently and only use as much pressure as necessary)
-Special Test- which test can confirm your index of suspicion
History Taking- SAMPLE
-Signs and symptoms
-Allergies
-Medications
-Past medical history
-Last oral intake
-Events leading up to injury
History Taking- PQRST
-Provoke (what makes it worse)
-Quality (type of pain)
-Region/radiate (does it shoot anywhere)
-Severity (1-10)
-Time (when did pain start)
*usually off-field
How to do Special Test for Different Structures
-Muscle/tendon= have tissue contract (resisted testing 1-5)
-Ligament= test to open joint that it stabilizes
-Bone= fracture testing
Kendall’s Resisted Muscle Testing
-Rate quality of strength out of 5
-0= no visible or palpable contraction
-1= visible or palpable contraction without motion
-2= full range of motion, gravity eliminated
-3= full range of motion against gravity
-4= full range of motion against gravity, moderate resistance
-5= full range of motion against gravity, maximal resistance
3 Fracture Tests
- Tap Test
-Gentle tap at a location on bone AWAY from suspected fracture site
-Vibration may cause pain at suspected fracture site
-If we see deformity, DO NOT test (don’t want to cause more pain if you can tell there’s a fracture by looking) - Compression Test
-Compress 2 ends of bone together
-Direct technique: either end of long bone
-Indirect technique: compress bones around small bone with suspected fracture (e.g. carpals, tarsals)
-Alternate compression method= ‘squeeze’ test - Tuning Fork
-Bang end of tuning fork off shoe/hard surface
-Place base of fork on bone with suspected fracture, away from fracture site
-Resulting vibration may cause pain at suspected site
*overall, pretty high sensitivity for ruling out fracture, but lower specificity for ruling in a fracture (high proportion of false positives)
*Reference standard= MRI, radiograph (x-ray) or bone scan
Sideline Assessment
-More detailed than on-field HOPS
-Includes:
-Ruling out joint above and below
-Full physiological ROM of joint
-3 special tests to rule-out/confirm
-More extensive palpation
3 Accessory Movements
-The intra-articular (within joint) movements required for physiological ROM to take place
1. Roll
2. Spin
3. Glide
*If cannot perform these movements, will not get full ROM
*in-clinic
Active ROM vs. Passive ROM
AROM= overpressure at end of range if full and pain-free, must be full for RTP
PROM= limb limp, guide them through ROM *in clinic not on sideline
*Resisted testing must be 80% for RTP
‘Impression’ of Injury- Documentation
-Include the following in any communication/documentation:
-Severity (e.g. 3rd degree)
-Structure (e.g. ATFL)
-Injury (e.g. sprain)
-Documentation: assessment done, treatment provided, plan (important to look back on or give to other people)
*We don’t diagnose, but we get an ‘impression’ on what we think it is
Plan (6 Components)
- RTP decision
- Immediate care (urgent or not)
- Educate
- Communicate
- Transport
- Referral
Sideline Management: Sprains
-Ice and elevation
-Wrap (possibly with pressure pad) to support, approximate tissues, provide compression
-Crutches for weight-bearing extremities
Sideline Management: Strains
-Ice and elevation
-Wrap for compression, use pressure pad over strained tissues to approximate ends and provide compression
-Crutches for weight-bearing extremities
