Techniques of Athletic Training Exam I study guide

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Department
Exercise Science and Sport Studies
Course Code
01:377:215
Professor
Sara Campbell

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1 Techniques of Athletic Training Exam I CHAPTER 1: Injury care and the AT I. Performance Domains of an AT 1. prevention against injury/illness- proper equipment use, checking of fields, etc 2. clinical evaluation and diagnosis- determine proper course of action, educating athlete about extent of injury 3. immediate and emergency care- be fully aware of the emergency access plan (EAP) 4. treatment and rehabilitation- implement treatment program developed in diagnosis, including exercises, therapeutic modalities, braces etc 5. organization professional health & wellness- perform daily responsibilities (standards of professional practice) and maintenance of records II. Education: two routes 1. entry level AT education program 2. clinical education experience III. registration and licensure ■ registration- with state government agency ■ licensure- strict form of state regulation ■ certification- indicates that the person has the basic knowledge and skills for the profession and has passed the state certification exam IV. Legal Considerations- any legal action involving AT is typically tried under the tort law ■ standard of care: standard responsibilities another individual with same certification and equal training in that profession should be able to perform , established once you become certified ■ negligence: causing harm to another person because of failure to perform standard level of care ○ negligent torts: a) malfeasance: when an individual commits an act that is not their responsibility to perform b) misfeasance: when an individual commits an act that is their responsibility to perform but performs either the wrong procedure or the correct procedure in an improper manner c) nonfeasance: occurs when an individual fails to perform their legal duties of care d) malpractice: occurs when a person commits a negligent act while providing care (ex held for malfeasance and sued for malpractice) e) gross negligence: occurs when a person has a total disregard for the safety of others ○ requirements to be held negligent a) there was a duty of care b) there was a breach of that duty of care c) there was harm done to the individual d) the resulting harm was a direct result of the breach of AT’s duty ■ limiting risk of litigation- inform individual of risks in participating, informed consent, foresee potential injury ■ foreseeability of harm- AT responsibility to recognize potential for injury and remove 2 danger before injury occurs (ex ensure equipment is working properly, field and weather conditions) ■ informed consent- implies injured party has been informed of the needed treatment, alternative treatment, and the advantages/disadvantages of each course of action ■ assault- putting someone in fear of bodily harm ■ battery- unpermitted or intentional contact with another individual without that individual's consent ■ product liability- standards set by equipment companies to cya ○ implied warranty: expected duty of care of the manufacturer to provide equipment that is safe to use ○ expressed warranty: written guarantee that product is safe to use a) example NOCSAE sticker on football helmets (national operating committee for standard athlete equipment) V. Legal Defenses- used by AT to strengthen their case ■ assumption of risk- individuals are informed of risk in participating ■ good samaritan laws a. acts during an emergency b. acts in good faith to help the victim c. acts without expected compensation d. is not guilty of any malicious misconduct or gross negligence ■ comparative negligence- including all parties which are responsible (physician, AT, PT, etc) VI. work settings ■ sports medicine clinics, secondary schools, high schools, colleges, professional sports, industrial/occupational setting, physician practices EMERGENCY SITUATIONS- I. ABC’s: Airway, Breathing, Circulation ■ be aware of athletes physical condition and pre existing illnesses (ex hemophilliac) ■ importance of emergency access plan and being CPR certified II. Bleeding ■ hemorrhaging- severe external bleeding, typically damage to arteries because under more pressure ■ internal bleeding- less obvious and may develop gradually commonly due to blunt force trauma ■ external bleeding ○ incision- less common, clear cut wound that is not very deep ○ puncture wound- does not result in a lot of bleeding therefore body doesn't flush out area and can be prone to infection ○ avulsion- partial amputation with still some tissue attachment ○ amputation- full separation from body ○ lascorations- deep cut/tear very serious ■ perfusion- term for adequate blood flow throughout body III. shock ■ psychogenic shock- fainting ○ can be caused by hypoglycemia (low blood sugar) ○ can be caused by hypoperfusion (lack of blood flow) ■ neurogenic shock- because of an underlying neurological medical condition 3 ■ cannot reverse the effects of shock can only prevent it from getting worse IV. neurological damage indications ■ decerebrate posturing- locking/ extension of all four extremities (can indicate unconsciousness) ■ decorticate posturing- extension of the lower extremity (hip and knee joints) and flexion of the upper extremity (wrist and elbow joints) V. injury types ■ contusion: bruising resulting in discoloration ○ to soft tissue or bone (low level stress fracture) ○ varies in severity ○ can develop a hematoma (blood clump) which may inhibit the muscles from working properly ■ sprains: injury to a ligament or capsule ■ strains: injury to the musculotendinous unit (junction) where the muscle belly form into a tendon ■ fractures: includes stress fractures, microfractures (joints), open fractures (bone displacement) ○ treatment varies in an adult and child whose bones are not fully developed ■ tendonitis: inflammation of the tendon ○ tenosynovitis- inflammation of the sheath that surrounds a tendon (typically the first step to full blown tendonitis) ○ results in crepitus creaky sticky feeling when move joint ○ common in wrist ■ bursitis: inflammation of the bursa ○ sac between muscles, tendons, and joints ○ ex elbow and pre-patellar ■ nerve injuries: can become compressed from trauma or swelling and put pressure on nerve ○ traction- movement that causes stretch or partial tear of nerve ○ determine which nerve based on sensory or motor fx, symptoms ■ dislocation: when two bones that form a joint separate, usually stay separated and must be manually relocated (common in shoulder) ■ subluxation: temporary dislocation of a joint resulting in sliding movement but joint does not completely separate ■ separation of AC joint or SC joint: trauma results in separation of the joint, sprain of the ligaments or capsule ■ concussion: head trauma, can result in cerebral hematomas ■ cartilage tears: tear of articular cartilage that serve as protection for bone (commonly meniscus of knee) ■ overuse conditions: injuries resulting from chronic overuse common in repetitive sports (running swimming) ○ microtrauma- injury results from repetitive overuse, slow onset of symptoms ○ macrotrauma- injury results from a single force acute injury resulting in sudden onset of symptoms ■ effusion: swelling within a joint (intra articular swelling) ■ atrophy: loss/deterioration of muscle (compare bilaterally) ■ hypertrophy: exaggerated muscular ■ antalgic gait: walking with a limp VI. Terms 4 ■ axial segment: head, spine, trunk, abdomen, chest ■ appendicular skeleton: pelvis, upper and lower extremities ■ axial skeleton: skull and vertebral column ■ abdominal quadrants: R upper and lower L upper and lower ■ mechanism: source of an injury, important because can help determine treatment but is not always known ■ pathology: development of abnormal conditions or diseases, structural or functional changes that occur because of an injury ■ prognosis: outlook ■ indication: when dealing with treatment something that is okay to do ■ contraindication: when dealing with treatment something that is not okay to do (ex ultrasound contraindications) ■ sign: diagnostic objective measurable finding regarding the individuals condition ■ symptom: information provided by the injured individual regarding their perception of the problem VII. Injury Assessment Procedure: HOPS 1. History- establish level of comfort, gain subjective info from athlete a. primary complaint- focuses on the person's perception of the injury ■ current nature, location, onset of condition ■ Q: what is wrong when did it happen? b. mechanism ■ Q: how did it happen? ■ cause of stress, position of limb, direction of force ■ changes in running surface, shoes, equipment, techniques, or conditioning c. characteristics of the symptoms- establish pain level as well as location, onset, severity, freq, duration and limitations caused by it ■ somatic pain- most common, arises from skin, ligaments, muscles, bone, and joints ■ visceral pain- arises from organs and abdominal area ■ referred pain- type of visceral pain that travels along same pathways that somatic pain does and is perceived by body as being somatic in origin ■ presence of unusual sensation (pain, sounds, feelings) d. disability resulting from injury ■ immediate limitations ■ limitations of ADL’s ■ functional ability: what is the athlete able to do vs not able e. related medical history- obtain information regarding other conditions that may affect the current injury ■ past musculoskeletal injuries, congentitive abnormalities, family history, allergies, cardiac, respiratory, neurological problems 2. Observation and Inspection a. observation- visual analysis of overall appearance, symmetry, general motor functioning, posture, and gait ■ does not require immediate contact with athlete ■ examine walking cycle look for antalgic gait ■ symmetry and appearance- ○ look for congenital problems (existing at birth) that may have 5 contributed to injury (ex posture) ■ motor function- look for hesitation or favoring of body part b. inspection- factors seen at the actual injury site, such as swelling, redness, cuts, scars, deformity, general skin conditions ■ requires injured area to be fully exposed ■ effusion- swelling of joint and redness ■ ecchymosis- superficial discoloration of tissues ■ keloids- scars from previous injuries 3. Palpation- always palpate bilaterally and start with the non injured side a. Temperature- increased temp at injury site could indicate inflammation or infection dec temp could indicate reduction in circulation b. swelling c. point tenderness and crepitus ■ may indicate inflammation when felt over a tendon, bursa, or joint capsule, important to note trigger found on a muscle that trigger pain in another site ■ may indicate fracture when felt over bones d. cutaneous sensation- run fingers along body sides of body part and ask athlete if they feel it, may indicate nerve damage in athlete with numbness and tingling e. peripheral pulses- taken distally to determine damage to a major artery ■ radial pulse point- wrist ■ tibialis posterior and dorsalis pedis pulse point in the lower extremity ■ check adequate blood flow using capillary refill of nail bed 4. Special Tests a. functional tests- determines ability to move a body part through ROM actively, passively, and against resistance ■ normative data- established by evaluating the non-injured side ■ goniometer- measures PROM and AROM at a joint ■ endpoint (end feel)- when athlete moves through a ROM how does it feel to them (ex hard blocking stop maybe a bone displacement versus fluid resistance bc of swelling) ■ Active ROM- performed voluntarily by the individual through muscle contraction ○ unless contraindicated should be performed first bc determines patients willingness to move body party and possible damage of musculotendinous junction, strength, and coordination ○ start at anatomical position ○ important to determine: (a) point during movement at which pain begins (b) presence of pain in a limited ROM (painful arc) (c) type of pain (is is associated with the primary complaint?) ■ Passive ROM- limb is moved through ROM with no assistance from the injured individual ○ position individual in a relaxed state ○ determines injury to contractile tissues from non contractile tissues (* if pain occurs during AROM indicates injury to contractile tissues if pain occurs in PROM indicates injury to non contractile tissues such as bone or nerve) 6 ■ painful arc of motion- limited ROM bc of pain ■ accessory movements- movements within joints that can not be performed voluntarily by the individual (injury can result in excess accessory movement) ○ loose packed position- position in which the joint is under the least amount of stress ○ close packed position- position of maximum compression of joint and tautness of capsule, most stable position of a joint ■ resisted manual muscle testing- pressure is applied to stationary body part (break test) or throughout ROM on a scale of zero to five measures strength against resistance b. special tests ■ neurological testing- at the base of every nerve is a nerve root originating from the spinal cord ○ each nerve root has a somatic component (somatic NS) and visceral component (autonomic NS) ○ myotome- group of muscles primarily innervated by a single nerve root, weakened response in conscious static muscle contraction may indicate injury to spinal cord nerve root (a) paresis- partial paralysis of a muscle can be indicated with a weakened muscle contraction by the nerve root being tested ○ dermatomes- area of the skin supplied by a single nerve root, examine by touching patient and determine their sensation (a) hypoesthesia- decreased tactile sensation (b) hyperesthesia- increased tactile sensation (c) anesthesia- loss of sensation (d) paresthesia- abnormal sensation (numbness, tingling, burning sensation) ○ reflexes: can test the integrity and intensity of nerves ■ activity specific functional testing ○ proprioception (a) muscle spindle- within muscle belly detects stretching of muscles and prevents overstretching (b) golgi tendon- in tendon, detects changes in tension of muscle ○ stress tests- test the integrity of non contractile tissues/ structures surrounding a joint (ligaments, capsule, intra articular structures) (a) laxity- amount of give within a joints supportive tissues (b) instability- a joints inability to function under the stresses encountered during functional activities ■ diagnostic testing ○ magnetic resonance imaging- shows soft tissues, muscles, tendons, ligaments, capsules ○ computed tomography- produces 3D cross sectional image of body part important in assessing head and neck area ○ bone scan- used to assess disease, infection of bone inject dye and will show inflammation of bone (will not show fracture only 7 inflammation causing a fracture) ○ diagnostic ultrasound- deep heat shows soft tissue, swelling, tendonitis of extremities CHAPTER 6: Tissue Healing and Wound Care Factors Influencing Injury- 1. force size, type, and direction 2. material properties of tissues involved 3. surface area over which force is applied I. Force Size, Type, and Direction ■ small forces: tissue response is elastic with little deformation (microtraumatic) ■ large force: tissue response is less elastic with more permanent deformation (macrotrauma) ■ Direction of forces ○ axial loading- force acts on the long axis of a structure ○ compressive force- force that produces a squeezing or crushing, force is at same points on opposite side, often results in contusion ○ tensile force- pulling force that stretches a structure (ex hyperextension or overstriding) ○ shearing force- combination of compression and tensile forces acting in opposite directions causing a structure to slide on itself *bones do not handle shearing forces well II. Material Properties ■ more elastic tissues (skin, muscle) will result in less permanent deformation ■ stress versus strain curve ○ as load (stress) increases deformation increases until a yield point ○ yield point (elastic limit)- if any more force is applied past this point mechanical failure will occur resulting in some permanent deformation (rupture, fracture) ○ tissues can only sustain stress for a period of time ○ anisotropic qualities- a tissue is stronger in resisting forces from certain directions or certain types of forces over others Tissue “healing”- healing process occurs immediately once tissue is injured injury is common in athletics because bodies are applying forces on objects and receiving forces Soft Tissue Healing Process I. Phase I: Acute Inflammatory Phase ■ time frame: 0 -6 days ■ initial stages of pain, inflammation, discoloration, and swelling ■ inflammation may be acute or chronic depending on nature of injury ○ acute- involves exudate, a plasma like fluid that exudes out of tissue of its capillaries composed of proteins and leukocytes ○ chronic- longer in duration ■ three processes fx in response to blood loss ○ initial vasoconstriction- minimizes blood loss, allows clotting to begin to take place and dec viscosity of blood ○ secondary vasodilation- helps prevent hypoxia (lack of oxygen) and necrosis (cell 8 death) ○ alternation between vasoconstriction and vasodilation to maintain equilibrium ■ zone of primary injury- group of chemicals that accumulate at the sight of injury ○ results in swelling, effusion, hematoma formation ○ vascular walls become increasingly permeable allowing blood and fluid to escape vessels and enter surrounding tissues ○ pressure inside vessels forces plasma and fluid out ○ phagocytosis- process that absorbs dead cells and infectious agents/bacteria (indicates end of phase I when WBC’s ingest agents and enter blood*) ○ leukocytes- WBC the performs phagocytosis ■ primary chemicals ○ heparin- vasodilator and anticoagulant ○ histamine- vasodilator, increases cell permeability ○ bradykinin- stimulates nerve endings to cause pain/ vasodilation ○ mast cells- help carry chemicals ■ zone of secondary injury- chain of chemical activity ○ involves all surrounding tissues affected by the injury and inflammation and swelling ○ develops until chemical activity slows down ■ phase I ends when process of phagocytosis is completed ■ leukocytes are absorbed back into bloodstream ■ length of phase is determined by extent of injury and number of structures involved II. Phase II: Proliferative phase ■ time frame: approx. 3-4 weeks ■ may overlap with the acute inflammatory phase ■ main processes include: ○ blood vessel regeneration ○ fibrous tissue formation ○ epithelial tissue regeneration 1. angiogenesis- damaged vessels begin reformation, growth enzymes are drawn to areas of hypoxia and help lay down groundwork for new vessels 2. fibroplasia- fibroblast cells come together and produce collagen tissue ○ main tissue in tendons and ligaments ○ building block for soft tissue formation ○ forms a criss cross pattern that provides strength and flexibility 3. re-epithelialization- healthy or undamaged epithelial cells from the periphery of the wound area migrate inward to center of wound to begin regeneration of tissue ○ wound contraction- as underlying collagen/ scar tissue forms and new skin forms, wound size becomes smaller ■ scar tissue- less elastic, weaker, more susceptible to re stretching up to 30%, problematic with muscles III. Phase III: Maturation phase ■ time frame: overlaps with end of phase II up to one year ■ maturation of newly formed tissues into scar tissue ■ fibroblastic activity ceases and tissues mature and develop ■ bones are typically easier/better to heal ■ increase in scar tissue causes decrease in vascularity and elasticity ○ scar tissue is basically avascular- doesn't get good blood flow to tissues 9 ■ may only achieve 25% of original tissue strength at beginning and anywhere between 75- 100% after completion (atrophy may not return to normal size) ■ if adhesions develop in severe muscle injuries only 50% or pre injury strength may be regenerated ○ adhesions affect the ability of gaining full ROM or muscle strength back ○ ex knee injury results in adhesion build up in the retinaculum ■ ligaments and tendons will take longer to heal due to poor reparative cells Bone Injury Healing ■ similar to three phase tissue healing process ■ bones withstand compressive forces better than shearing forces ■ damage to periosteum and surrounding tissues causes hematoma formation in medullary cavity ○ medullary cavity contains blood vessels ○ more severe injuries will result in a lot of bleeding and longer healing process I. Phase I: Proliferative Phase ■ osteoclasts- resorb old/damaged bone ■ osteoblasts- build new bone ■ callus formation begins and continues through the end of the maturation phase ○ occurs in every type of break ranging from stress to complete fracture 1. endochondral bone healing: formation of a callus between ends of fracture ○ weak, immature bone that gradually forms ○ callus appears as cloudy on an x ray and eventually can
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