Completing the Loop: Management of the Adolescent Sports Injury. Adam Thomas, PT, DPT, ATC

Transcription

1 : Management of the Adolescent Sports Injury Adam Thomas, PT, DPT, ATC

2 8s3As

3 On field assessment can be the most efficient when the health care provider has observed the injury occur You know the MOI You see athlete s mental and physical response You see athlete's position Is the athlete moving? Is the athlete holding their arm in the position of injury? Is the shoulder in abduction, close to side, or does it appear deformed? Is the athlete in excessive pain or able to control their response to pain?

4 About the athlete s position how do we translate that? Arm splinted against the torso = either clavicle Fx or AC joint injury Arm hanging limply to the side = brachial plexus injury Arm locked possible GH dislocation ADD and ER anterior or inferior GH dislocation ABD and IR posterior GH dislocation

5 Once you are by the athlete what is the first thing we want to check? ABC s Obvious signs of gross deformity Severe bleeding Putting our hands on the athlete may calm them while you are obtaining a more thorough history

6 After the Hx, the next step is warranted by the specific injury Possibility of getting distal pulse and sensory perception Especially with suspected Fx or dislocations Don t forget about referred pain Kehr s sign Location of pain pain involving upper trapezius and radiating into the shoulder and arm (with accompanying weakness) may indicate brachial plexus injury Palpation now we want to palpate bony and soft tissue structures (compare bilaterally) Check for any deltoid flattening which would indicate an anterior dislocation or subluxation No deformity = we can ask the athlete to move the arm SLOWLY

7 During AROM place your hand on the shoulder joint Feel for any crepitus or abnormal movement Able to move arm + no signs of serious injury + no extreme pain get the athlete to seated position and then eventually a standing position DON T PULL ON THE INVOLVED ARM WHEN ASSISTING THE ATHLETE Have athlete support arm with non-involved arm and then walk to sideline for further evaluation

8 For most UE injuries, athletes will be able to move to the sidelines under their own power (passive transport will not be needed) In case of Fx, dislocation, severe pain, light headed, or nauseous we may want to transport them off the field If there is a Fx or dislocation we need to immobilize the injury before we move them. How are we going to do this?

9 Safety of the athlete is always the primary concern in dealing with the mode of transportation from the field Although efficiency is also a concern, never compromise the athlete s health and welfare

10 Primary Survey Consciousness Airway, Breathing, Circulation Severe bleeding Secondary Survey History MOI, location, and severity of pain Information from bystanders Observation Deformity, swelling, discoloration Athlete s response to injury Unusual positioning of limb Palpation Deltoid contour Bony tenderness Bone and joint deformity or crepitus

11 Secondary Survey (cont) Neurovascular Assessment Sensory (C5-T1) Motor (C5-T1) Distal Pulse (radial) Active ROM Good thing to do here is Apley s scratch tests to incorporate a lot of motions at once If all tests are (-) then remove athlete from field

12 Shoulder Pads We can do most of our palpation underneath the shoulder pads without taking them off Unfasten the straps that passes beneath the axilla and loosen the sternal fasteners Sometimes we can palpate by going through the neck opening too REMEMBER you can t see what s going on, so you must be extra cautious when palpating under shoulder pads

13 Shoulder Pads When do we take them off?? If we suspect an AC sprain, SC sprain, and especially a GH dislocation or clavicle Fx How do we take them off Slip uninvolved arm out of jersey and go over the head and then carefully slip the jersey down the involved arm If shirt is too tight or you are in a rush, just cut the jersey off we re not paying for it so who cares!

14 Some athletes may not present with an injury until a little while after they got hurt S&S may have gotten worse Soreness may have not settled in yet Adrenaline

15 History Ask questions pertaining to the following Chief complaint MOI Unusual sounds or sensations Type and location of pain or symptoms Previous injury Previous injury to opposite extremity for bilateral comparison

16 Observation Check for visible facial expressions of pain Check for swelling, deformity, abnormal contours, or discoloration Does the athlete let the arm hang and swing, or do they hold it or splint it? Observe overall position and posture Check muscle development areas of muscular atrophy Make bilateral comparison of acromions, SC joints, inferior border of the scapula and scapular spine

17 Palpation Palpate for pain, tenderness, and deformity over the following SC joint, clavicle, AC joint, acromion, coracoid process, subacromial bursa, greater tuberosity, lesser tuberosity, bicipital groove Spine, superior and inferior angles of scapula, lower cervical and upper thoracic spinous processes Rotator cuff insertion Sternocleidomastoid muscle, pectoralis muscle Biceps tendon and muscle Trapezius muscle, rhomboids, latissimus dorsi, serratus anterior

18 Special Tests GH stability tests AC stability tests RC Biceps Range of motion AROM for shoulder flexion/ext, abd/add, horiz add/abd, IR/ER Scapular elevation/depression, retraction/protraction PROM for shoulder and scapular motions Bilateral comparison

19 Strength Tests Perform manual resistance against same motions as in AROM Check bilaterally and note any pain or weakness Neurovascular Tests Sensory Motor Distal pulse Functional tests

20 Sling and swathe PRN for comfort Obviously if reduced If out still, splint in place for transport Do not do full exam (ROM)

21 MD/NP/PA allowed to perform however law s are a bit silent in MA for ATCs grey area Can the ATC under MD discretion? Immediate reduction is key want to decrease risk of long term neuro damage if possible Where is the next level of care, how long away? Transport dislocated? It happens, not ideal however if you cannot relocate, you ll have to

22 Emergent: Doubt if reduced or deformity? Neurologic compromise? Beyond that, its situational Age - Be very conservative Access to medical care Repeat offender?

23 High School How quick do they need to get in with MD? How quick CAN they get in with the MD? Need to get in touch with/educate their parents/guardian.

24 College Classes to think about accommodations for assignments? Part time job? Access to MDs is usually quick, plentiful Compliance with sling, meds?

25 Professional More resources of MDs, specialists, facilities Service provided immediately Excess services provided (unnecessary MRIs?)