Athletic Training exam 2

primary concern of on field acute injury survey

maintain cardiovascular, respiratory, and CNS function

primary survey

quick

secondary survey

closer look after life threatening injuries have been rules out, assess vital signs

for an unconscious athlete

check responsiveness, airway, breathing, circulation, shock, profuse bleeding
always suspect C Spine injury
does equipment need to be removed to access airway

if athlete remains unconscious

activate EMS and administer first aid if needed (CPR)

components of secondary survey

pulse, respiration, blood pressure, body temp, skin color, pupils. medical history, musculoskeletal assessment

options for transportation off field

spine boarding, ambulance, assisted walking

crutch fitting

Stand with feet close together
Place tip 6inches away from outer margin of shoe and 2 inches in front of the shoe
Underarm is 1 inches below the axilla and elbow angle

cane fitting

Measures superior aspect of the greater trochanter of the femur
Hold it in opposite hand of where injury is

spine boarding

activate EMS
get 4-5 people
one person is in charge of the head
life and slide technique
log roll pull/push

shoulder pad removal

only remove if the helmet is being removed too
cut jersey down middle and sides
cute strings in center
slightly lift athlete at waist to remove pads

facemask removal

use trainers angels or gardening shears and screwdriver
helps with helmet removal and airway access

4 types of injury evaluation

PPE (pre participation exam)
initial on field
off field
progress evaluation

what does HOPS stand for

history, observation, palpation, special tests

HOPS- History

MAPPS
mechanism
acute or chronic
pain level, type, location
previous injury
sounds/sensation

HOPS- observation

Obvious deformity
Gait
Swelling
Bruising
Always check bilaterally

HOPS- Palpation

Always ask before
Point tenderness
Tissue texture
Start away from injury
Compare bilaterally

HOPS- special test

Tests specific pathologies
Rule out ligament sprains
Assess ROM, active, passive, resistive, tell which muscle is affected
Evaluate strength, 0-5 scale
Assess neurological issues, dermatomes and myotomes, reflexes
Circulation
Compare bilaterally
Functional testing, sport specific

what does a SOAP note stand for

Subjective- history
Objective- observation, palpitation
Assessment
Plan

what is the main goal of acute injury management

reduce swelling

RICE

rest, ice, compression, elevation

how long should a patient rest for with an acute injury

active rest for 72 hours

how long should someone with an acute injury ice for

8-20 minute treatments every 1.5 hours

effects of ice

Vasoconstriction
Decrease metabolism, tissue demand for oxygen
Decrease muscle guarding
Slow speed of nerve transmission
Decrease pain

types of ice treatment

Ice bad
Ice cup
Chemical packs
Ice bucket/bath
Cold whirlpool

what is the point of compression

decreases swelling by reducing the amount of space available for swelling to accumulate

types of compression

Ace wrap
Neoprene sleeve
Surgical stocking
Game ready
Muscle contraction

how to elevate

elevate above the heart as much as possible in the first 72 hours to help with lymphatic drainage

why do we want to control swelling

reduce pain
maintain ROM
maintain ability to contract muscles
reduce scar tissue

other strategies to reduce swelling

MEAT- movement, exercise, analgesics, treatment
POLICE- protection, optimal loading, ice

NOCSAE

national operating committee on standards for athletic equipment

examples of acute injuries

One time
Fractures
Dislocations
Sprains
Contusions
Strains

examples of chronic injuries

Repetitive motions
Tendinitis
Tenosynovitis
Bursitis
Osteoarthritis

tension tissue stress

force that pulls or stretches

compression tissue stress

produced by external loads applied towards one another from opposite directions

shearing tissue stress

occurs when equal but not directly opposite loads are applied to opposing surfaces, causing these surfaces to move in parallel direction

torsion tissue stress

twisting in opposite directions from opposite ends of a structure

bending tissue stress

occurs when 2 forces pairs act at opposite ends of a structure or when 3 forces causes bending (greenstick fractures)

muscle strain/tear

Damage from a muscle/tendon being overstretched by tension or forces to contract against too much resistance, separation or tearing

grade 1 muscle strain

some muscle fibers are stretched, tenderness, pain with active ROM, full ROM possible

grade 2 muscle strain

a number of muscle fibers have been torn, active contraction of the muscle is painful, depression/divot can be felt at site of tearing, swelling occurs from capillary bleeding, discoloration, decreased ROM due to pain

grade 3 muscle strain

complete rupture of the muscle/tendon, significant impairment/total loss of motion, pain is initially intense, but diminishes due to nerve fiber separation

muscle cramps

Extremely painful involuntary contractions that occur in calf, abdomen, hamstrings

muscle spasm

Reflex reaction caused by trauma
Clonic= alternating involuntary contractions and relaxation in succession
Tonic= rigid contractions that last a period of time

muscle soreness

Acute onset= occurs during and immediately after exercise
DOMS= occurs 24-48 hours later

Myofascial Trigger Points

Hypersensitive nodule found within a taut band of skeletal muscle or fascia
Referred pain seen at a different site

myosititis ossificans

Calcium deposits grow in an area following repeated blows to the same area
Can build spurs
Very painful and they lose ROM

Tendinitis

Inflammation of a tendon
S/S= pain with movement, swelling, warmth, crepitus (crunching sound)

Tendinosis

degeneration of the tendon if the tendon fails to heal/without inflammation

Tenosynovitis

Inflammation of a tendon and its synovial sheath
Usually has more swelling

grade 1 ligament sprain

stretching and separation of the ligament fibers with mild instability of the joint, mild to moderate pain, localized swelling and joint stiffness

grade 2 ligament sprain

tearing and separation of the ligament fibers with moderate instability of the joint, moderate to severe pain and swelling (they can't really walk on it)

grade 3 ligament sprain

total tearing of the ligament , leading to instability of the joint, severe pain following by little pain, large amount of swelling, very stiff joint (ACL tear)

joint dislocation

When at least 1 bone within a joint moves out of place
Must be put back into place /reduced
Often injures surrounding structures- fractures, ligament ruptures
X-ray for first time dislocations to make sure that chips of bone don't come off

joint subluxation

Similar to dislocation, bone comes partially out of its normal spot, but goes back into place
Very likely to sub lux/dislocate again because surrounding ligaments tendons are stretched

Osteoarthritis

Results of wear and tear over time, causing degeneration of articular cartilage
Can expose underlying bone
Affects WB joints

bursitis

Bursa: synovial membrane that contains fluid
Occurs around joints, where friction between bones often occurs
It is an accumulation of fluid as they become irritated and inflames
Can severely restrict movement

closed fracture

broken bone with no open wound

open fracture

one in which the bone is broken and there is an open wound in the skin

greenstick fracture

incomplete breaks in bones, breaks like a green twig, in kids

communicated fracture

3 more more fragments at the fracture site

linear fracture

bone splits along its length

transverse fracture

occurs in a straight line at the R angle

spiral fracture

a fracture in which the bone has been twisted apart

avulsion fracture

fragment of bone chipped away from the main bone

blowout fracture

occurs to the wall of the eye socket

depressed fracture

occurs in flat bones, creates a depression from falling or striking an object

contrecoup

fracture occurs on side opposite of the impact (often in the skull)

stress fractures

Caused by altered stress distribution from muscle fatigue, change in ground reaction forces from surface change, repetitive stress/overtraining
s/s- swelling, local tenderness, pain, pain with activity

common areas for stress fractures

metatarsals, wrist, vertebrae lumbar, tibia, femur neck

three phases of healing

inflammatory, proliferative, maturation

how long is the inflammatory healing phase

3-4 days after injury

how long is the proliferation healing phase

4-6 weeks

how long is the maturational healing phase

can last years

chemical mediators

Begins with the release of chemical mediators (limit the amount of exudate, thus
swelling) to facilitate healing

vascular reaction in healing

Immediate vasoconstriction of the vascular walls lasting for 5-10 minutes, then
vasodilation occurs

function of platelets in healing

Adhere to the vascular wall and create a sticky matrix, more platelet and leukocytes
adhere and produce a plug (obstructs local fluid drainage and localize injury
response)

formation of a blood clot

Blood coagulation: (happens 12 hours after injury until ~48 hours)
Area is walled off, then the leukocytes clean up the foreign debris (PHAGOCYTOSIS)

when a fracture occurs in bone...

bleeding occurs within the bone

1 week after a bone break...

fibroblasts lay down a cartilage network and a fibrocartilage callus develops between the two bones that starts soft then firms

avascular necrosis

an area of bone tissue death caused by insufficient blood flow

how long does it take for small bones to heal

3-4 weeks

how long does it take for long bones to heal

6 weeks