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 ¹,²,³,⁴.

General Assessment Principles for Traumatic Injuries:

• A multidisciplinary team assessment should evaluate the person's pre-injury and current physical functioning ³. This includes assessing pain management to enable physical rehabilitation activities ³.
• A comprehensive neuromusculoskeletal assessment is crucial to identify physical impairments such as nerve injury, muscle imbalance, and proprioception problems ³.
• Assess upper and lower limb function, including the impact on movement and the use of walking aids ³.
• Record the range of movement for each affected joint ³.
• Inquire about balance or dizziness issues and other vestibular symptoms, considering assessment for benign paroxysmal positional vertigo (BPPV) and head injury ³.
• If the injury resulted from a fall, ask about previous falls and consider a falls risk assessment ³.
• Assess for new or existing cognitive, hearing, visual, or communication impairments, or emotional difficulties that might affect rehabilitation engagement ³.
• Complete a safeguarding assessment for children, young people, and vulnerable adults, considering any known or suspected non-accidental injury ³.
• Regularly reassess whether referral for specialised rehabilitation is still needed ³.

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 ¹.
• Referral to an emergency department may be necessary based on clinical judgement ¹.
• Referral to physiotherapy should be arranged if needed, to consider measures such as external support (bracing or taping) ¹.
• MRI may be arranged for suspected high-grade ligament injuries, osteochondral defects, or occult fractures, particularly if there are persistent symptoms ¹. MRI is considered the gold standard for imaging ligamentous and intra-articular structures of the knee and ankle ¹. 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 ¹.

Specific Assessment for Shoulder Pain:

• Urgent referral to secondary care for same-day assessment may be required following acute trauma, depending on clinical judgement ².
• A suspected neurological lesion should be discussed with neurology, neurosurgery, or orthopaedics ².
• Diagnosis of intrinsic shoulder disorders is often based on algorithms like the Oxford University Hospitals algorithm ².
• Initial management for shoulder pain without red flags focuses on pain control to facilitate an early return to normal activities ².
• Physiotherapy and home exercises are considered for improvement, though the optimum timing for physiotherapy referral is not always clear ².

Specific Assessment for Head Injuries:

• Involve a clinician with safeguarding training in the initial assessment ⁴.
• Use a standard head injury proforma for documentation throughout the person's time in hospital, ensuring consistency across departments ⁴.
• Discuss the care of anyone with new and surgically significant abnormalities on imaging with a neurosurgeon ⁴.
• 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 ⁴.
• CT imaging of the head is the primary investigation for detecting an acute clinically important traumatic brain injury ⁴.
• 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 ⁴.
• Plain X-rays of the skull should not be used to diagnose important traumatic brain injury before discussion with a neuroscience unit ⁴.