Sports Injury Assessment: Primary, Secondary, and HOPS Evaluation

Primary Survey order

Check the scene; LOC; ABCs; Activate EMS/911

Secondary Survey priority order

Head/neck injuries; Profuse bleeding; Fractures; Dislocations

On-field evaluation

Quick assessment to determine seriousness and ability to continue participation

Clinical evaluation

Complete history and thorough examination with detailed testing

Type of history questions preferred

Open-ended questions

Example of an open-ended question

Tell me what happened

Questions to avoid during history

Yes/No questions

When does inspection begin?

The second you see the athlete

H in HOPS

History

O in HOPS

Observation

P in HOPS

Palpation

S in HOPS

Special Tests

Evaluation order

History; Observation; Palpation; AROM; PROM; RROM; MMT; Neuro tests; Special tests; Functional tests

AROM meaning

Active Range of Motion

PROM meaning

Passive Range of Motion

RROM meaning

Resistive Range of Motion

MMT meaning

Manual Muscle Testing

Order of ROM testing

Active; Passive; Resistive; MMT

What is MMT?

An isometric break test used to assess individual muscle strength

When should MMT be performed?

Only after full active ROM and full passive ROM are present

MMT grade 5/5

Normal strength with full resistance

MMT grade 4/5

Good strength with moderate resistance

MMT grade 3/5

Full ROM against gravity only

MMT grade 2/5

Full ROM with gravity eliminated

MMT grade 1/5

Trace muscle contraction

MMT grade 0/5

No muscle contraction

Palpation rule 1

Compare bilaterally

Palpation rule 2

Use both hands

Palpation rule 3

Start away from the injury

Palpation rule 4

Work toward the injury

Things felt during palpation

Temperature; Swelling; Tenderness; Muscle spasm; Crepitus; Deformity

Sprain

Injury to a ligament or joint capsule

Strain

Injury to a muscle or tendon

Grade I injury

Mild injury with minimal fiber damage and little loss of function

Grade II injury

Partial tear with moderate swelling and some loss of function

Grade III injury

Complete rupture with major loss of function

Tensile force

Pulling force that stretches tissue

Compression force

Pushing force that compresses tissue

Shear force

Sliding force acting parallel to tissue

Torsion force

Twisting force that can cause spiral injuries

Acute injury

Sudden injury with a clear mechanism

Chronic injury

Long-term injury caused by repeated stress

Insidious injury

Gradual onset with no obvious mechanism

Salter-Harris Type I

Fracture straight through the growth plate

Salter-Harris Type II

Growth plate fracture extending into the metaphysis

Salter-Harris Type III

Growth plate fracture extending into the epiphysis

Salter-Harris Type IV

Fracture through metaphysis, growth plate, and epiphysis

Salter-Harris Type V

Crush injury to the growth plate

Fracture locations

Epiphysis; Metaphysis; Diaphysis (shaft)

Fracture severity terms

Open; Closed; Displaced; Nondisplaced; Complete; Incomplete

Fracture types

Transverse; Oblique; Spiral; Greenstick; Comminuted

Diaphysis

Shaft of a long bone

Example fracture description

Diaphysis; Nondisplaced; Spiral

Myositis ossificans

Bone formation within muscle after a contusion or strain

Exostosis

Extra bone growth

Cellulitis

Inflammation or infection of connective tissue causing swelling, redness, and warmth

Osteochondral defect (OCD)

Damage to articular cartilage and underlying bone

Full-thickness OCD

Cartilage defect extending through the full thickness

Partial-thickness OCD

Cartilage defect involving only part of the thickness

True positive

Test is positive and the injury is actually present

False positive

Test is positive but the injury is not actually present

True negative

Test is negative and the injury is actually absent

False negative

Test is negative even though the injury is actually present

What makes a fracture test positive?

The athlete reports pain (ouch) at the tested area

Macrotrauma

Single large traumatic event

Microtrauma

Repeated small stresses over time

Atrophy

Decrease in muscle size

Hypertrophy

Increase in muscle size

Contusion

Bruise caused by a direct blow

Crepitus

Grinding or crackling sensation felt during palpation

Deformity

Abnormal shape or alignment of a body part

Swelling

Accumulation of fluid in tissues

Discoloration

Change in skin color due to injury or bleeding

What should you know from inspection?

The major visual signs of injury and abnormal movement or posture

What should you know from palpation?

The rules of palpation and the types of findings you can feel

What fracture information must be identified on an image?

Location; Severity; Type

What Salter-Harris fracture did the instructor emphasize?

Type III

Difference between sprain and strain

Sprain = ligament/capsule; Strain = muscle/tendon

Most important exam topics

Primary Survey; Secondary Survey; HOPS; ROM order; MMT grades; Palpation rules; Sprain vs Strain; Injury grades; Fracture identification; Salter-Harris fractures; Acute vs Chronic vs Insidious; False positive vs False negative

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