Basic Injury Evaluation: HOPS

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Basic Injury Evaluation:
HOPS
Sara Thomas, MEd, ATC
Clinical Lead- Dr. Cooper/DME Coordinator
Fort Wayne Orthopedics
HOPS
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H- History
O- Observation
P- Palpation
S- Special Testing
2 Types of Evaluations
• On the Field Evaluation
o Quick assessment to
determine severity of
injury.
o Makes the decision on
ability to move the
athlete.
o Looking for fractures,
neck injury, etc.
o Needs to be quick and
accurate.
2 Types of Evaluation
• Clinical (Off the Field)
Evaluation
o A more extensive eval.
o May be done first, or
after an on the field eval.
o Should still be performed,
even if you have done
an eval on the field.
o Trying to determine a
specific cause for the
problem, and a course
of action.
History
• WHAT HAPPENED?!?
• Trying to figure out the
how, when and why of
an injury.
• A good history should
give you an idea of
what may be wrong
before you even touch
the patient.
• But don’t jump to
conclusions!!
Types of History
Questions
• NOT SO GOODLeading Questions
o Questions that could be
answered with a yes or no.
• Does your ankle hurt?
• Does it hurt when you turn
your ankle inward?
• Does walking make it
worse?
• GOOD- Open Ended
Questions
o Questions that require an
explanation.
• Where does it hurt?
• Which movements
increase your pain?
• What makes it better or
worse?
o Once you ask an open ended
question, you can follow it with
a more specific question.
So Where Do I Start?
• Where are you hurting?
o Point with one finger.
• How did this happen?
o Mechanism of Injury (MOI)
• The movement or force that caused the injury.
o Twisting the knee with the foot planted.
o A blow to the outside of the knee.
• Sometimes there is not a specific mechanism.
o Knowing the MOI will play a big factor in determining the problem.
• When did this start?
o Acute vs. Chronic Injury
• Acute- Just happened.
• Chronic- Has been going on for a while.
More Current History
• Did you hear or feel a
pop or snap?
• What type of pain is it?
o Burning, stinging, sharp, dull,
aching, tingling, stabbing, etc.
o Type of pain can tell you a lot!
• Does the pain change?
o Time of day.
o Activity level.
• What makes you feel
better or worse?
• What have you done
for it?
o Meds?
o Ice?
o Rest?
• Are you able to
complete your normal
activities?
• Does the pain wake
you at night?
Previous History
• Have you ever had this
type of pain before?
o If so, what was it?
o Did you hurt it the same
way?
o What did you do for it?
o Who (if anyone)
evaluated your injury?
o Did you get completely
better?
o Have you ever had any
surgeries on this body
part?
General Medical History
• Major Health Concerns
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Diabetes
Recent Hospitalization
Allergies
Asthma
Cardiac Conditions
Sickle Cell Anemia or Trait
Other Ortho Injuries
Fracture History
Family History
Concussion History**
Concussion History
• Previous Concussion?
o How many?
o Dates of concussion.
• Duration of symptoms?
o How long did you sit out?
• How does this
concussion compare to
the last one?
• Complete recovery?
o Any lasting symptoms?
Observation (aka
Inspection)
• Looking at the body to
see any abnormalities.
• Total body observation.
o This should start the second you
see the athlete.
• Is the athlete conscious?
• Are they moving?
• Are any body parts
deformed?
• Do you see blood coming
from anywhere?
• Are they limping?
• How are they holding the
body part that hurts?
o Very important with
elbows and shoulders.
o Watch their expressions.
Keep Looking!!
• Specific body part
observation.
o Is there anything weird about it??
• Bruising?
• Redness? (Discoloration)
• Open sores or cuts?
• Swelling?
• Deformity?
• Scars from previous injuries?
• Always compare to the
other side.
• If you are paying
attention during a game,
you may be able to
catch a mechanism.
What do you see??
What do you see??
What do you see??
Palpation
• Using the fingers to touch and feel the body
structures to find problems you couldn’t find with
observation.
o Palpation has a pattern:
• Start away from the injured area and work towards the
injury.
• Start with bones and ligaments first.
• Then move to muscle, tendon and other soft tissue.
• Then check anything else (pulses, etc.)
• Knowing your anatomy is key!
• Don’t forget to wear gloves, if needed!!
Palpation Definitions
• Symmetry
o Muscles
o Bones
• Local Heat
o Redness and hot feeling
skin around the injured
area.
• Point Tenderness
o Exact spot where it hurts.
o “Pointing” to the spot.
• Crepitus
o Creaking, cracking,
crunching, etc.
o You might be able hear
it, too.
Activity Time!!
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Wrist Flexors/Extensors
Crepitus, anyone??
AC Joint
Anatomical Snuff Box
We Are
ALMOST
There!!
Special Tests
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Fracture Testing
Range of Motion
Ligament Testing
Special Testing
Neurological Testing
Strength Testing
Functional Testing
Sport Specific Testing
Wait A Minute– Is it
Broken??
• Fracture Testing
o Tap Test
o Squeeze Test
• Very Important Step!!
o All other testing stops if
you suspect a fracture.
o Risk of displacement.
• Can damage other
structures.
• Can lead to surgery.
Range of Motion
• Two Types
o Active Range (AROM)
• How much the
athlete can move the
body part on his own.
o Passive Range (PROM)
• How much you can
you move the body
part for the athlete.
Ligament/Other Special
Testing
• Specific by body part.
• Testing to see if a
ligament is torn.
o Can tell you the severity of
injury, depending on the end
point.
• End Points
o Solid End Point
• Joint movement has a
stopping point.
o Soft End Point
• Joint movement seems to
go farther than it should.
• Soft endpoints are a signal
that something is wrong.
• Testing for Cartilage
Tears
• Testing for specific
conditions.
• Compare to the other
side!
Strength Testing
• Tells you the severity of
injury to the muscle.
o Graded on a scale from 0 to 5.
• Looking for TWO things.
o Pain
o Weakness
• Break Testing
• RROM Testing
Neurological Testing
• Sensation Testing
o Does the sensation feel the
same on both sides?
o Do with eyes open and eyes
closed.
• Tap testing
o Ulnar Nerve example
• Reflexes
Functional Testing
• Testing to see how well
the athlete can use the
injured body part.
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Walking
Running
Cutting
Overhead Movements
Throwing
Sport Specific Testing
• Testing to determine
ability to play.
• Pitching
• Sport Specific
Movements
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Football Stance
Shooting
Cone Drills
Volleyball Attack
The End Result
• Assessment vs.
Diagnosis
o Athletic Trainers make
assessments based on their
evaluations.
o A diagnosis can only be made
by a physician.
Thank You!!

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