Basic Injury Evaluation:HOPS
Sara Thomas, MEd, ATCClinical Lead- Dr. Cooper/DME Coordinator
Fort Wayne Orthopedics
HOPS• H- History• O- Observation• P- Palpation• S- Special Testing
2 Types of Evaluations• On the Field
Evaluationo 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)
Evaluationo 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
• GOOD- Open Ended Questionso 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.
• NOT SO GOOD- Leading Questionso 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?
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• 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?
• 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?
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 Concernso Diabeteso Recent Hospitalizationo Allergieso Asthmao Cardiac Conditionso 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• Point Tenderness
o Exact spot where it hurts.
o “Pointing” to the spot.
• Crepituso Creaking, cracking,
crunching, etc.o You might be able hear
it, too.
• Symmetryo Muscleso Bones
• Local Heato Redness and hot feeling
skin around the injured area.
Activity Time!!• Wrist
Flexors/Extensors• Crepitus, anyone??• AC Joint• Anatomical Snuff Box
We Are ALMOST There!!
Special Tests• 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 Testingo Tap Testo 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
• Testing for Cartilage Tears
• Testing for specific conditions.
• Compare to the other side!
• 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 Pointso 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.
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 Paino 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 testingo Ulnar Nerve example
• Reflexes
Functional Testing• Testing to see how
well the athlete can use the injured body part.o Walkingo Runningo Cuttingo Overhead Movementso Throwing
Sport Specific Testing• Testing to determine
ability to play.• Pitching• Sport Specific
Movementso Football Stanceo Shooting o Cone Drillso Volleyball Attack
The End Result• Assessment vs.
Diagnosiso Athletic Trainers make
assessments based on their evaluations.
o A diagnosis can only be made by a physician.
Thank You!!