What are the recommended assessment protocols for common sports injuries in primary care?

For common sports injuries in primary care, assessment protocols involve a comprehensive approach to identify the nature and severity of the injury, determine the need for further investigation, and guide appropriate management or referral NICE CKS,NICE CKS,NICE NG211,NICE NG232.

General Assessment Principles for Traumatic Injuries:

• A multidisciplinary team assessment should evaluate the person's pre-injury and current physical functioning NICE NG211. This includes assessing pain management to enable physical rehabilitation activities NICE NG211.
• A comprehensive neuromusculoskeletal assessment is crucial to identify physical impairments such as nerve injury, muscle imbalance, and proprioception problems NICE NG211.
• Assess upper and lower limb function, including the impact on movement and the use of walking aids NICE NG211.
• Record the range of movement for each affected joint NICE NG211.
• Inquire about balance or dizziness issues and other vestibular symptoms, considering assessment for benign paroxysmal positional vertigo (BPPV) and head injury NICE NG211.
• If the injury resulted from a fall, ask about previous falls and consider a falls risk assessment NICE NG211.
• Assess for new or existing cognitive, hearing, visual, or communication impairments, or emotional difficulties that might affect rehabilitation engagement NICE NG211.
• Complete a safeguarding assessment for children, young people, and vulnerable adults, considering any known or suspected non-accidental injury NICE NG211.
• Regularly reassess whether referral for specialised rehabilitation is still needed NICE NG211.

Specific Assessment for Sprains and Strains:

• Consider referral to orthopaedics if recovery is slower than expected, there are worsening or new symptoms, or symptoms are disproportionate to the injury mechanism or degree of trauma NICE CKS.
• Referral to an emergency department may be necessary based on clinical judgement NICE CKS.
• Referral to physiotherapy should be arranged if needed, to consider measures such as external support (bracing or taping) NICE CKS.
• MRI may be arranged for suspected high-grade ligament injuries, osteochondral defects, or occult fractures, particularly if there are persistent symptoms NICE CKS. MRI is considered the gold standard for imaging ligamentous and intra-articular structures of the knee and ankle NICE CKS. However, its routine use for acute ankle sprains is limited by incidence of false-positive findings, availability, and cost, so it is typically reserved for persistent symptoms in severe sprains and chronic ankle instability NICE CKS.

Specific Assessment for Shoulder Pain:

• Urgent referral to secondary care for same-day assessment may be required following acute trauma, depending on clinical judgement NICE CKS.
• A suspected neurological lesion should be discussed with neurology, neurosurgery, or orthopaedics NICE CKS.
• Diagnosis of intrinsic shoulder disorders is often based on algorithms like the Oxford University Hospitals algorithm NICE CKS.
• Initial management for shoulder pain without red flags focuses on pain control to facilitate an early return to normal activities NICE CKS.
• Physiotherapy and home exercises are considered for improvement, though the optimum timing for physiotherapy referral is not always clear NICE CKS.

Specific Assessment for Head Injuries:

• Involve a clinician with safeguarding training in the initial assessment NICE NG232.
• Use a standard head injury proforma for documentation throughout the person's time in hospital, ensuring consistency across departments NICE NG232.
• Discuss the care of anyone with new and surgically significant abnormalities on imaging with a neurosurgeon NICE NG232.
• Regardless of imaging, discuss the care plan with a neurosurgeon if the person has: persisting coma (GCS score of 8 or less) after initial resuscitation, unexplained confusion persisting for more than 4 hours, deterioration in GCS score after admission, progressive focal neurological signs, a seizure without full recovery, a definite or suspected penetrating injury, or a cerebrospinal fluid leak NICE NG232.
• CT imaging of the head is the primary investigation for detecting an acute clinically important traumatic brain injury NICE NG232.
• MRI scanning is not the primary investigation for clinically important traumatic brain injury due to safety, logistic, and resource reasons, but can provide additional prognostic information NICE NG232.
• Plain X-rays of the skull should not be used to diagnose important traumatic brain injury before discussion with a neuroscience unit NICE NG232.