Athletic Training Knee and Thigh Injury Assessment

What type of force typically causes injury to the medial collateral ligament, medial meniscus, and anterior cruciate ligament of the knee? A. A valgus force with the tibia in external rotation B. A varus force with the knee in full extension C. A valgus force with the femur in external rotation D. A valgus force with the knee in recurvatum E. None of the above

A - When the tibia is stabilized in an externally rotated position and a strong valugs force is applied, the medial collateral ligament, medial meniscus and anterior cruciate ligament are vulnerable to injury.

When working on a bleeding athlete, what should the athletic trainer always do? A. Avoid touching the bloody areas B. Wash hands before treatment C. Wear gloves D. Wear eye protection E. Elevate the body part

As per universal precautions, the athletic trainer should always wear gloves when treating a bleeding athlete

Which of the following muscles is not involved in internal rotation of the hip? A. Adductor magnus B. Gluteus maximus C. Gracilis D. Tensor fascia latae E. Gluteus minimus

B - The gluteus maximus externally rotates the hip.

True leg-length discrepancy is measured between which two points? A. The posterior inferior iliac spine to the medial malleolus B. The umbilicus to the midpatella C. The umbilicus to the lateral malleolus D. The anterior superior iliac spine to the medial malleolus E. The anterior superior iliac spine to Gerdy's tubercle

D - True leg length discrepancy is measure between the anterior superior iliac spine to the medial malleolus of the ankle.

When taking a history during a physical examination of an athlete, all of the following information is pertinent except: A. The mechanism of the injury B. If a "pop" or "snap" was heard or felt C. If the athlete is on medication D. Whether or not the athlete has medical insurance E. History of previous injury

D - Whether or not the athlete has medical insurance should not be an immediate concern of the athletic trainer during the history-taking portion of the initial evaluation. Only those pieces of information that assist the athletic trainer in developing a course of action or treatment plan for the athlete should be considered pertinent.

An athlete has a suspected fracture involving the knee. Which of the following areas should be splinted? A. The ankle and the lower leg areas B. The knee and thigh C. The ankle, knee and thigh D. The lower limb joints and one side of the trunk E. The hip and ankle

D - With a suspected fracture of the knee joint or of the surrounding area, the splint should stabilize all the lower limb joints and one side of the trunk.

All of the following parameters should be assessed when checking the neurovascular status of an injured limb except: A. Sensation B. The pulse distal to the injury C. Motor function D. Joint range of motion E. Atrophic changes

D -Measuring the amount of motion available at a joint will provide the athletic trainer with no significant information regarding the neurovascular status of the injured limb.

What is the average range of motion of knee flexion? A. 0-180 degrees B. 0-120 degrees C. 0-100 degrees D. 0-155 degrees E. 0-135 degrees

E - The average range of motion of the knee is 0 to 135 degrees.

Which muscle flexes both the foot and the knee? A. Biceps femoris B. Flexor digitorum C. Posterior tibialis D. Anterior tibialis E. Gastrocnemius

E - The gastrocnemius muscle plantar flexes the foot and flexes the knee.

An athlete presents with loss of strength at the L3 and L4 nerve root levels. What muscle should the athletic trainer test to confirm an injury at this level? A. Gluteus minimus B. Flexor hallicus longus C. Gluteus maximus D. Adductor magnus E. Quadriceps

E - The quadriceps musculature is innervated by the femoral nerve, which originates at the L2, L3, and L4 nerve levels.

All of the following are factors in lower extremity overuse syndromes in runners except: A. Poor footwear B. Poor posture C. Change in surface D. Short Strides E. A and B

Short Strides

What is the best position for the athlete to be in to muscle test the piriformis? A. Sitting B. Prone C. Supine D. Side lying E. Standing

. A - To test the strength of the piriformis, the athlete should be sitting. The lower leg is resisted as the athlete attempts to externally rotate the hip.

A tennis player comes to the athletic trainer complaining of medial thigh pain. He is limping and has pain with resisted hip adduction and hip flexion. There is diffuse tenderness and ecchymosis along the proximal aspect of the medial thigh. What is the probable cause of pain? A. Hip flexor rupture B. Groin strain C. Medial hamstring strain D. Popliteal strain E. None of the above

. B - Pain with resisted hip adduction and hip flexion with diffuse tenderness and ecchymosis of the medial thigh is indicative of a strain of the groin area.

A basketball player reports to the athletic training room complaining of a "burning" pain along the lateral aspect of his right knee during and after running. No edema or ecchymosis is found during the exam, but he is tender to palpation of the affected area. Which of the following special tests might be positive? A. Lachman's test B. Patella apprehension test C. Ober's test D. Sag sign E. Faber's test

. C - Burning pain with tenderness to palpation over the lateral epicondyle of the femur is associated with iliotibial band syndrome. If the iliotibial band is too tight, it will rub over this area during running, causing localized inflammation. Ober's test is appropriate for a tight iliotibial band.

When evaluating an unconscious athlete, what should the athletic trainer do first? A. Check for sources of bleeding B. Take vital signs C. Check for normal extremity movement D. Take the athlete's pulse rate E. Check that the athlete's airway is open and he or she is breathing normally

. E - During emergency care of the unconscious athlete, the athletic trainer should make sure the athlete's airway is clear and he or she is breathing normally.

A ______ is a device used to measure joint range of motion A. Goniometer B. Dynamometer C. Caliper D. Flexometer E. Sphygmomanometer

A - A goniometer is the instrument most commonly used for measuring joint range of motion in the clinical setting. A goiniometer may come in a variety of shapes and sizes and may be made of metal or plastic.

Who is the only person who can legally diagnose a medical problem? A. The school nurse B. A physician C. The athletic trainer D. An emergency medical technician (EMT) or paramedic E. Physical therapist

A - A physician is the only person who can legally diagnose a medical condition or problem.

At what point should the athletic trainer's initial evaluation of an injury begin? A. At the moment the injury is witnessed B. Once the athlete has been stabilized in the athletic training room C. Once the athletic trainer receives a medical referral from a doctor D. After the athlete is seen by the team doctor E. B and D

A - An athletic trainer's initial evaluation of an injury should begin the moment the injury is witnessed or upon initial contact with the athlete or another individual who might have witnessed the injury.

An athlete reports to the athletic trainer with a deep laceration to his thigh. The cut is approximately 1/8-inch deep, 1-inch long, and bleeding moderately. What would be proper steps for the athletic trainer to take to treat his wound? A. Use a pressure bandage to control the bleeding, keep the wound clean and free of debris, use Steri-Strips for temporary closure, and apply ice and compression to the area. B. Use a pressure bandage to control the bleeding, keep the wound clean, suture the laceration, and cover with a sterile dressing C. Wipe the area clean with soap and water, use and antibiotic ointment to minimize infection, suture the wound, and cover it with a sterile dressing D. Wipe the area clean with soap and water, apply a large adhesive bandage, and apply ice to the area E. None of the above

A - Applying pressure will minimize the bleeding. Keep the area clean with sterile saline or hydrogen peroxide; apply Steri-Strips for temporary closure, and use ice and a compressive dressing to minimize further bleeding. Refer the athlete to the physician for sutures, if necessary.

What type of stretching is not recommended because of the potential for causing muscle soreness and possible injury when done over a period of time? A. Ballistic B. PNF C. Static D. Concentric E. None of the above

A - Ballistic stretching is not recommended.

All of the following movements occur in the sagittal plane except: A. Hip abduction B. Shoulder flexion C. Knee extension D. Hip flexion E. Elbow flexion

A - Hip abduction occur in the frontal plane.

Which test, if positive, is indicative of a torn posterior cruciate ligament? A. Sag sign B. Anterior drawer sign C. McMurray's sign D. Ober's sign E. Lachman's sign

A - Sag sign is positive for a torn posterior cruciate ligament when the tibial plateau sags posteriorly as the athlete is lying and the knee is flexed to 45 degrees, causing a sulcus just inferior to the inferior border of the patella of the affected leg.

What is a quick method of testing the motor ability of the S1 nerve root? A. Have the athlete walk on his or her toes B. Have the athlete manually resist ankle inversion C. Have the athlete manually resist great toe extension D. Assess the athlete's ability to squat E. Resisted ankle inversion

A - The SI nerve root innervates the posterior tibialis, plantaris, peroneus longus, and peroneus brevis muscles, which act to plantar flex the ankle and foot.

When choosing a prophylactic knee brace, the brace should meet all of the following criteria except: A. It should always be custom-molded to avoid a poorly fitting brace B. It should not interfere with normal knee function C. It should not increase injuries to the lower extremity D. It should be cost-effective and durable E. B and D

A - The brace should be adaptable to a variety of anatomic shapes and sizes. Not all prophylactic braces need to be custom-molded to achieve this goal.

How is the strength of the pes anserinus musculature manually muscle tested A. Resistance to knee flexion and internal rotation of the lower leg B. Resistance to knee extension and hip adduction C. Resistance to knee flexion and external rotation of the lower leg D. Resistance to knee extension and internal rotation of the lower leg E. Resistance to knee flexion and ankle inversion

A - The pes anserinus (sartorius, gracilis, semitendinosis) flexes the knee and will weakly internally rotate the tibia.

The _____ pulse and _____ pulse should be palpated after an acute traumatic injury to the knee area to make sure the peripheral circulation to the involved limb is adequate. A. Posterior tibial, dorsalis pedis B. Anterior tibial, plantar C. Saphenous, dorsalis pedis D. Femoral, posterior tibial E. Femoral, popliteal

A - The posterior tibial and dorsalis pedis pulses should always be palpated after an acute knee injury to ensure the peripheral circulation of the involved limb is intact.

What position is the "recommended" position for manually muscle testing the glutues medius muscle? A. Side lying, with the affected limb on top B. Supine C. Prone D. Sitting E. Standing

A - To test the gluteus medius in an antigravity position against resistance, the athlete must be side lying with the affected limb on top.

According to the ASCM, when performing flexibility exercises, how long should a stretch be held for optimal results? A. 5 to 10 seconds; after 10 seconds minimal/no results are achieved B. 10 to 30 seconds; only as long as they feel comfortable C. 40 to 60 seconds; no less than 45 seconds D. 60 to 90; until the athlete feels some mild discomfort E. A minimum of one and a half to two minutes

B - The American College of Sports Medicine (ACSM) recommends that when performing flexibility exercises, a stretch should only be held 10 to 30 seconds -- only as long as it is comfortable -- to obtain optimal results.

What is the proper method to manually muscle test the biceps femoris muscle? A. Sitting, resisting knee extension B. Lying prone, resisting knee flexion with the tibia in external rotation C. Sitting, resisting hip flexion D. Lying prone, resisting knee flexion with the tibia in internal rotation E. Sitting, resisting elbow flexion

B - The biceps femoris is tested with the athlete lying in the prone position. Knee flexion is then resisted with the tibia in full external rotation.

Which of the following stages of disease prevention focuses on early detection and appropriate referral? A. Primary stage B. Secondary stage C. Initial stage D. Tertiary stage E. None of the above

B - The secondary stage of disease prevention focuses on early detection of an illness or disease and preventing or reversing progression of the disease.

Tenderness and pain with induration and swelling of the pretibial musculature following overexertion is indicative of which syndrome? A. Chondromalacia B. Pes anserinus bursitis C. Periostitis D. Nerve compression syndrome E. Tarsal tunnel syndrome

C - Periostitis, myositis, tendinitis, or a combination of conditions may cause tenderness and pain with induration and swelling of the pretibial musculature of the athlete's lower leg. They may be classified as anterior or posteromedial "shin splints", depending on which group of structures are involved.

Prevention of a chronic or debilitating illness or injury through appropriate care and rehabilitation is called what? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. All of the above E. None of the above

C - Tertiary prevention is the prevention of a chronic or debilitating illness or injury through appropriate care and rehabilitation.

What problem might the athletic trainer see if the L4 nerve root was compressed? A. Hip flexor weakness B. Plantar flexion weakness C. Knee extension weakness D. Dorsiflexion weakness E. Drop foot

C - The L4 nerve root innervates the rectus femoris muscle and the vastus medialis, intermedius, and lateralis muscle, all of which extend the knee.

What quick test can be performed to check if nerve root L5 is intact? A. Have the athlete flex his or her hip while standing B. Have the athlete walk on his or her toes C. Have the athlete extend his or her great toe D. Have the athlete extend his or her hip E. Have the athlete flex his or her knee

C - The L5 nerve root innervates the extensor hallucis longus muscle.

Which nerve innervates the hip adductor musculature? A. Femoral, superior gluteal B. Femoral, tibial C. Femoral, obturator D. Femoral, obturator, inferior gluteal E. Tibial, obturator

C - The femoral nerve innervates the pectineus muscle, and the obturator innervates the adductor longus, magnus, brevis, and gracilis.

In what position should the athlete be to manually muscle test the hip flexors, and where should the athletic trainer's force be directed during testing? A. Prone, with the force directed down onto the posterior thigh B. Side lying, with the force directed down onto the side of the thigh C. Sitting, with the force directed down onto the anterior aspect of the thigh D. Sitting, with the force directed down onto the medial aspect of the thigh E. None of the above

C - To test the hip flexor musculature, the athlete should be sitting. The athletic trainer then applies a force down onto the anterior aspect of the thigh as the athlete resists the movement.

A lacrosse player comes limping into the athletic training room with assistance from a coach. He is holding his leg in slight hip and knee flexion. There is a large bulge in the proximal thigh. During the exam, the athletic trainer requests the athlete to extend his knee as he sits on the edge of a taping table. He is able to partially straighten his leg, although there is pain down the anterior thigh area with the attempt to move it. What does the athletic trainer suspect is wrong? A. Biceps femoris rupture B. Femoral nerve injury C. Ruptured rectus femoris muscle D. Obturator nerve injury E. Iliopsoas rupture

C - With a rupture of the rectus femoris muscle, a large bulge is seen in the upper thigh, and there is pain along the entire muscle belly. Extension is limited because of the inability to contract the rest of the quadriceps musculature.

All of the following treatments would be inappropriate for an acute quadriceps contusion except: A. Light massage B. Pulsed ultrasound C. Ice massage followed by gentle stretch D. Ice pack with compression wrap with knee in flexion E. Heat pack and massage

D - It is appropriate during the acute stages of a quadriceps contusion to apply ice to the injured area and put the knee into a slight amount of passive flexion to maintain the flexibility of the quadriceps muscle.

A second-degree medial collateral ligament sprain is characterized by all of the following except: A. Pain along the medial joint line B. No gross knee instability, but mild ligamentous laxity is noted in full knee extension during valgus stress testing C. Difficulty in actively flexing and extending the knee D. Immediate severe pain following the feeling of a "pop" in the knee; the pain quickly subsides and the athlete is left feeling a dull ache in the knee joint E. A and B

D - Most often a "pop" is associated with an anterior cruciate ligament injury and less frequently with a subluxed patella.

Shock after a severe injury can result from _____ or _____. A. Pain, increased blood pressure B. Decreased heart rate, infection C. Hemorrhage, hypothermia D. Hemorrhage, stagnation of blood E. Increased heart rate, pain

D - Shock after a severe injury can result from hemorrhage or stagnation of blood.

Information gained during the palpation phase of the athletic trainer's initial assessment might include all of the following except: A. Presence of crepitus B. Sensory function C. Presence of a deformity D. Degree of functional movement E. A and B

D - Tactile information alone will not provide the athletic trainer with enough information to adequately assess the athlete's functional status. It is crucial that a well-planned, comprehensive evaluation is performed to assess all aspects of the athlete's condition prior to treatment.

All of the following injuries might be associated with a "popping" sensation of the knee joint except: A. Anterior cruciate ligament injury B. Torn meniscus C. Subluxed patella D. Iliotibial band friction syndrome E. B and C

D - The iliotibial band moves back and forth over the lateral epicondyle of the femur as the knee is flexed and extended. If the iliotibial band is too tight or it overrides and rubs on the lateral epicondyle during downhill running, the bursa between the iliotibial band and epicondyle becomes inflamed. Pain is elicited as the knee is brought into about 30 degrees of flexion. A popping sensation is not a consistent finding with this syndrome.

The rectus femoris muscle ______ and ______ when in contracts. A. Flexes the hip, externally rotates the hip B. Extends the hip, flexes the knee C. Flexes the knee, plantar flexes the ankle D. Flexes the hip, extends the knee E. Extends the hip, extends the knee

D - The rectus femoris muscle flexes the hip and extends the knee when it contracts.

What evaluative test is used to examine the integrity of the lateral collateral ligament of the knee? A. Pivot shift test B. Valgus stress test C. Lachman's test D. Varus stress test E. None of the above

D - The varus stress test is used to test the integrity of the lateral collateral ligament of the knee. The athlete is asked to lie supine with the knee in full extension. The athletic trainer places his or her hand distally on the lateral ankle and the other hand proximally on the knee medially. With the ankle stabilized, a varus force is applied with the proximal hand. Lateral joint pain and/or increased varus movement with an absent or poor endpoint when compared to the uninvolved side are positive findings for a torn lateral collateral ligament.

All of the following symptoms are considered "red flags", requiring urgent referral to a physician, except: A. Persistent headaches B. Constant pain C. Insomnia D. Malaise, fatigue E. Hunger

E - Constant pain, insomnia, malaise, and fatigue are all considered red flags that should alert the athletic trainer to certain pathologies.

Which of the following is used to detect a possible meniscal tear in the knee? A. Faber's test B. Allen's test C. Jerk test D. Lachman's test E. McMurray's test

E - McMurray's test is used to test the knee for a tear in the medial or lateral meniscus with the athlete lying in supine. The knee is fully flexed , and the tibia is externally rotated with a valgus force and extended, or internally rotated with a varus force and extended. A palpable "click" is indicative of a positive test.

A soccer player sustains a strain to the quadriceps muscle group. You are trying to prevent atrophy during rehabilitation. What method of treatment would you use? A. Ultrasound and transcutaneous electrical nerve stimulation (TENS) B. Interferential current (IFC) C. Stretching D. High volt galvanic stimulation E. Russian stimulation

E - Russian stimulation prevents atrophy by contracting the muscles

The inflammatory process includes all of the following signs and symptoms except: A. Redness B. Pain C. Warmth D. Swelling E. Numbness

E - Signs of inflammation include redness (rubor), pain (dolor), warmth (calor), and swelling (tumor).

A Q-angle of >25 degrees may predispose and athlete to what postural deformity?

Excessive genu valgus

Trendelenburg's test is a method used to evaluate the competence of what structures? A. Hip flexors B. Peroneal muscles C. Hip abductors D. Erector spinae E. Abdominals

Trendelenburg's test is used to test for gluteus medius weakness of the hip. The athlete is asked to stand on one leg for approximately 10 seconds and then switch to the other leg. If the pelvis on the unsupported side drops noticeably lower than the pelvis on the supported side, it is a positive finding (i.e., weakness of the gluteus medius on the supported side.