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The initial examination of an acute orthopedic injury is influenced by the circumstances and severity of the injury. In the case of an ambulatory examination where the patient approaches and seeks help from a clinician, the examination will follow the guidelines described in Chapter 1. However, in cases of acute injury, the clinician may need to approach the patient, often on the court or field, and rule out a severe or catastrophic injury. The examination of acute conditions focuses on identifying gross pathologies, determining the patient’s ability to move and/or bear weight, and selecting the appropriate method for moving the patient. Once the patient has been moved to the sideline or clinic, when appropriate, a more thorough examination can occur. This examination will determine whether the patient must be immediately referred for advanced medical attention, removed from participation for the day for further evaluation and treatment, or returned to activity.

This chapter focuses on the immediate management of an acute orthopedic injury. Other possible emergent, nonorthopedic conditions, such as anaphylaxis, myocardial infarction, and other medical conditions that might require emergency interventions, are not addressed in this textbook.


The plans for event medical coverage of practices and games must account for worst-case scenarios, such as catastrophic conditions to athletes, spectators, and/or others at the venue. Each venue (e.g., stadium, arena) should have a written emergency action plan (EAP) that identifies the personnel, equipment, lines of communication between healthcare professionals, coaches and other personnel, and standard operating procedures for managing catastrophic events.3 When visiting an away site, communicate with the host institution to determine the appropriate EAP.

The coaching staff and other personnel should receive regular training in first aid and cardiopulmonary resuscitation (CPR), including use of an automated external defibrillator (AED), and be prepared to provide assistance when needed. Clinicians should rehearse such scenarios to become comfortable directing untrained bystanders while managing the examination process.

An on-field communication plan also must be established for managing on-field injuries. Preestablished hand signals and walkie-talkies allow individuals on the field to communicate with sideline personnel. This makes it possible to quickly relay the need for emergency equipment, the team physician, other emergency personnel, and transport personnel on the field.

image Practical Evidence

The clinical skills described in this text, such as muscle function and joint stress tests, can be difficult to perform when the patient is on the ground and you are kneeling. The best way to acclimate yourself to performing an on-field examination is to practice these skills with a person lying on the ground or on the ice wearing sporting equipment. Other athletic venues, such as swimming pools and gymnastics pits, also present challenges to those conducting acute examinations.


Before the on-field examination can begin, play must ...

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