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William E. Prentice

OBJECTIVES

When you finish this chapter you should be able to

  • Discuss the athletic trainer's ability to make an accurate clinical diagnosis.

  • Review the terminology used in injury evaluation.

  • Apply the HOPS off-the-field evaluation scheme.

  • Understand the value of using functional screening tests to identify characteristic movement impairments and minimize the risk for injury.

  • Incorporate the best available evidence in the professional literature into the clinical decision making process.

  • Organize the process for documenting the findings of an off-the-field secondary or progress evaluation.

  • Recognize additional diagnostic techniques available to the athletic trainer through the team physician.

  • Discuss how an ergonomic risk assessment can be performed to reduce workplace-related injuries.

KEY TERMS

  • biomechanics

  • pathomechanics

  • etiology

  • mechanism

  • pathology

  • symptom

  • sign

  • diagnosis

  • differential diagnosis

  • prognosis

  • sequela

  • syndrome

  • HOPS

  • active range of motion (AROM)

  • manual muscle testing

  • passive range of motion (PROM)

  • dermatome

  • myotomes

  • functional movement screen (FMS)

  • landing error scoring system (LESS)

  • Intra-rater reliability

  • inter-rater reliability

  • Fusionetics

  • sensitivity (Sn)

  • specificity (Sp)

  • likelihood ratios

  • clinical prediction rules (CPRs)

  • SOAP note

  • basic metabolic panel

  • urinalysis

  • ergonomic risk assessment (ERA)

INTRODUCTION

Injury evaluation is an essential skill for the athletic trainer.78 In athletic training, four distinct evaluations are routinely conducted: (1) The preparticipation examination, which was discussed in Chapter 2, is done prior to the start of preseason practice; (2) the initial on-the-field injury assessment, which was discussed in great detail in Chapter 12, is done immediately after acute injury to rule out injuries that may be life-threatening, to determine the immediate course of acute care, necessary first aid, how the patient should be transported from the field, and the approach to handling emergency situations; (3) a more detailed off-the-field injury evaluation is performed routinely after the immediate on-the-field evaluation either on the sidelines or in the athletic training clinic, a hospital or an outpatient clinic, an emergency room, or a physician's office after appropriate first aid has been rendered; and (4) a progress evaluation is done periodically throughout the rehabilitative healing process to determine the progress and effectiveness of a specific treatment regimen. This chapter concentrates on the off-the-field evaluation and the progress evaluation.

Athletic trainers use their evaluation skills to make an accurate clinical diagnosis.

The setting in which the athletic trainer is employed determines the type of evaluation that is appropriate. An athletic trainer working in a hospital or an industrial setting is likely doing mostly off-the-field injury evaluations and progress evaluations. Athletic trainers who are employed in an athletic setting can expect to be arranging preparticipation exams, performing both on- and off-the-field evaluations, and writing progress evaluations throughout the course of rehabilitation.

BASIC KNOWLEDGE REQUIREMENTS

The athletic trainer who is examining a patient with an injury must have a general knowledge of ...

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