injury prevention

injury evaluation process

a logical, systematic process before giving care (WILL change)

anatomy

structure

physiology

function

biomechanics

the the body moves normally

pathomechanics

how the body moves abnormally (physiology goes wrong)

accurate evaluations require…

a systematic plan

inflammatory effects

body responding in a normal, healthy manner post injury

contralateral

opposite side

ipsilateral

same side, different place

bilateral

left and right (looking at both sides adds a degree of reference

etiology

using the healthy side to show movement to determine how injury happened, then think of anatomy (structure determines function)

purpose of etiology

allows for bilateral comparison

congenital

had since birth

chromobidity

something going on that’s abnormal that adds to a previous injury

most important step in injury evaluation model

history

7-step injury evaluation model (steps)

history

observation/inspection

(physical exam process)

• palpation

• range of motion tests

• ligamentous tests

• special tests

• neurological tests

history step

starts conversation, open-ended questions, ask questions and listen to answers

**establishes mechanisms of injury**

determines structures involved

onset/duration of symptoms

sounds/sensations felt at the time of injury

prior medical history

sign

something objective (can see)

examples of a sign

gait/limping, ecchymosis, swelling, spasm, cramping, redness, bleeding

symptom

something subjective (can’t see, patient must tell you)

symptom examples

shortness of breath, fatigue, nauseous, headache, numbness, tingling, pain, weakness, achy

palpation

examination by touch, contact should be gentle but firm, start distal to injury

ligamentous testing

application of a specific stress to test the integrity of isolated ligaments (laxity and instability)

laxity

clinical signs, professional feeling for looseness/teather of ligament

instability

symptom—subjective

patient feeling “giving out”

conditions warranting terminating eval

cardiovascular or respiratory arrest/distress

head or neck injury

profuse bleeding

fractures/dislocations

peripheral nerve injuries

other soft tissue trauma

mechanical injury

some force is implemented onto body, body will react by swelling, bleeding, etc

(depends on type/amount of force)

physical stress theory

body’s tissue will respond depending on the amount of force and the direction of force

(creates redness, swelling, heat, pain)

tissue loading

compression, tensile load, shearing

compression

collision, something being pinched

tensile load

muscle tear

shearing

dislocation, abrasion

musculoskeletal injuries

strains, tendinitis, heterotrophic ossifications, bursitis

bony injuries

exostosis, agpophysitis, fractures

joint injuries

sprains, subluxations, dislocations, osteochondral defects, osteochondritis dessicans, arthritis

strains

stretching or tearing of a muscle or tendon (eccentric muscle contraction, dynamic overload, predisposing factors?)

1st degree strain

overstretching and mircotearing, no gross fiber disruption

mild pain and tenderness

full arom and prom

pain with resisted contraction

2nd degree strain

further stretching and partial tearing

immediate pain, localized tenderness, and disability

varying degrees of swelling, ecchymosis, decreased rom, and decreases strength

3rd degree strain

complete rupture

audible pop

immediate pain

loss of function and palpable defect

muscle hemorrhage and diffuse swelling

tendinitis

microtrauma, inflammation occurring in overuse conditions

heterotrophic ossifications

formation of bone within a muscle belly’s fascia (treat with ice and compress, let it naturally heal)

bursitis

inflammation of the bursa sacs (localized swelling)

sprain

injury to ligament or capsular structure (graded based on amount of laxity)

dislocation

(luxation), goes out and stays out

severe stretching or complete disruption of ligaments

subluxation

goes out, comes back in

osteochondritis dessicans

dislodged fragments of bones

osteochondral defects

fractures of a bone’s articular cartilage, progressive softening of cartilage

agpophysitis

growing pains, inflammation of growth plate, muscle pulling away from bone

greenstick fracture

comminuted fracture

linear fracture

transferred, nondisplaced fracture

oblique, nondisplaced fracture

spiral fracture

stress fractures

nondescript initial findings

causes: change in workout, equipment, playing surfaces, frequency, duration, intensity

epiphyseal fracture

weak growth plate