Athletic Training Chap 13

What special test distinguishes collateral ligamentous tears from capsular and meniscal tears?

Apley distraction test

Lateral calcaneus, lateral malleolus, sinus tarsal, etc. belong in which aspect?

Lateral

Lateral tibial plateau, lateral femoral condyle, etc. are what aspect of knee palpation?

Lateral

The fibularis longus tendon, fibularis brevis tendon, etc. are what aspect of soft-tissue palpation?

Lateral

The lateral collateral ligament, illiotibial band, etc. are what aspect?

Lateral

Normal ankle function is dependent on what?

Normal ankle function is dependent on action of the rear foot and subtalar joint

hemorrhage

abnormal discharge of blood

What is the foundation for assessment of musculoskeletal injuries?

Biomechanics

symptom

subjective evidence of an abnormal situation within the body

With the kinetic chain, forces must be ______ and _________

absorbed; distributed

What must be assessed in functional examinations?

Walking, running, turning, and cutting

Complete tear of deep capsular ligament and partial tear of superficial layer of MCL; no gross instability, laxity at 5-15 degrees of flexion; slight swelling; moderate to severe joint tightness with decreased ROM

MCL grade II sprain

Three major principles for the emergency care of emotional reactions to trauma:

1) Accept everyone's right to personal feelings, because everyone comes from a unique background and has had unique emotional experiences. Do not tell the injured person how he or she would feel. Show empathy, not pity 2) Accept the injured person's limitations as real 3) Accept your own limitations as a provider of first aid

What five steps can be taken to prevent ankle sprains?

1) Achilles tendon stretching 2) Strength training 3) Neuromuscular control training 4) Footwear 5) Taping and orthoses

What are the two movement assessments?

1) Active movement 2) Passive movement

The four aspects of soft-tissue palpation of the knee are?

1) Anterior 2) Medial 3) Posterior 4) Lateral

What are the two bony landmark categories that should be palpated?

1) Anterior aspect 2) Posterior aspect

Signs of circulation

coughing, breathing, movement

What should you look for in a visual observation?

gross deformity, swelling, skin discoloration

syndrome

group of typical symptoms or conditions that characterize a deficiency or disease

Generalized pain and stiffness, localized proximal to calcanea insertion; warm and painful with palpation; may limit strength; may progress to morning stiffness

Achilles tendinosis

Sudden snap (kick in leg) with immediate pain which rapidly subsides; point tenderness, swelling, discoloration, and decreased range of motion; obvious indentation and positive Thompson test

Achilles tendon rupture

A ruptured __________ may occur because of _________

Achilles tendon; chronic inflammation

The critical link forms what?

Critical link is in the kinetic chain

What are volumetric measurements?

These can be taken to determine changes in limb volume caused by swelling, which can be attributed to hemorrhage, edema, or inflammation

syndesmotic joint

an articulation in which the bones are united by a ligament

Depending on the grade, variable amount of swelling, pain, and muscle disability; may feel like "being hit in leg with a stick"; edema, point tenderness, and functional loss of strength

Gastrocnemius strain

Anterior talofibular ligament, calcaneofibular ligament, etc. belong in which aspect?

Lateral and dorsal

Local pain and possible shooting nerve pain; numbness and paresthesia in cultaneous distribution of the nerve; added pressure may exacerbate condition; generally resolves quickly

Peroneal nerve contusion

Pain, weakness, or fatigue in medial longitudinal arch; calcaneal eversion, bulging navicular, flattening of medial longitudinal arch, and dorsiflexion with lateral splaying of first metatarsal

Pes planus foot (Flatfoot)

Poor shock absorption resulting in metatarsalgia, foot pain, clawed or hammer toes; associated with forefoot values, shortening of Achilles and plantar fascia; heavy callus development on ball and heel of foot

Pets caves (high arch foot)

prone

Lying flat, especially face downward

Little fiber tearing or stretching, stable values test, little or no joint effusion, relatively normal ROM, and some joint stiffness and point tenderness on lateral aspect.

MCL grade I sprain

Complete tear of supporting ligaments, complete loss of medial stability, minimum to moderate swelling, and immediate pain followed by ache

MCL grade III sprain

Tibialis posterior tendon, flexor hallucis longus tendon, etc. belong in which aspect?

Medial and plantar

Pain or cramping in metatarsal region; point tenderness, weakness, positive Morton's test

Metatarsal arch strain

What provides the main sources of stability to the knee?

Muscles and ligaments provide the main sources of stability in the knee

What is the contractile tissue?

Muscles and their tendons

What must be conditioned to maximize stability?

Muscles around joint must be conditioned (flexibility and strength) to maximize stability

stabilized

No longer exhibiting a life-threatening condition

Fall on bent knee is most common mechanism, can also be caused by rotational force, more at risk at 90 degrees flexion, and sometimes referred to as 'dashboard' injury

PCL sprain

The superior patella border, inferior patella border, etc. are what aspect of palpation?

Patella

Hemorrhaging and joint effusion with generalized swelling; indirect fractures may cause capsular tearing, separation of bone fragments, and possible quadriceps tearing; little bone separation with direct injury

Patellar fracture

Pain and tenderness at inferior pole of patella; 3 phases: pain after activity, pain during and after, pain during and after (possibly prolonged) and may become constant

Patellar tendinitis (Jumper's/Kicker's knee)

Palpable defect, lack of knee extension; considerable swelling and pain (initially)

Patellar tendon rupture

Tenderness of lateral facet of patella and swelling associated with irritation of synovium; dull ache in center of knee; patellar compression will elicit pain and crepitus; apprehension when patella is forced laterally

Patellofemoral stress syndrome

Pain with palpation superior and anterior to Achilles insertion, swelling on both sides of the heel cord

Retrocalcaneal bursitis (pump bump)

Immediate and intense pain but short lived; immediate swelling and discoloration occurring within 1-2 days; stiffness and residual pain will last several weeks

Sprained toes

What is the most critical component of the off-the-field evaluation?

Taking a detailed history from the athlete is the most critical aspect of the off-the-field assessment

shock

condition where tissues in body don't receive enough oxygen and nutrients to allow cells to function

Conversion of Fahrenheit to Celsiuse

degrees C = (degrees F - 32) / 1.8

HOPS

evaluation scheme that includes history, observation, palpation, and special tests

palpation

examine by touch

pathomechanics

mechanical forces that are applied to a living organism and adversely change the body's structure and function

Determining what is crucial in knee injuries?

mechanism of injury

myotomes

muscle or groups of muscles innervated by a specific motor nerve

Generally the meniscus has a ______ blood supply

poor

The main blood supply to the knee comes from the ___________, which stems from the ________. Blood drains via the ________________ into the __________ and then to the _________

popliteal artery; femoral artery; small saphenous vein; popliteal vein; femoral vein

What muscles are used for internal rotation?

popliteal, semitendinosus, semimembranosus, sartorius, and gracilis muscles

stance phase

portion of the gait cycle from initial contact to toe-off

swing phase

portion of the gait cycle that is a period of non-weight bearing

The foot serves as a _________ at heel strike, adapt to ______________, and at lift-off serves as a _________ to _________

shock absorber; uneven surface; rigid lever; provide propulsive force

Capsular ligaments are _______ during full extension and _____ during flexion?

taut; relaxed

subjective

noted by athlete

objective

noted by examiner

dyspnea

difficult breathing

mechanism

mechanical description of the cause

What are the four muscle compartments and what muscles do they have?

1) Anterior compartment- muscles that dorisflex- tibialis anterior, extensor hallucis longus, and extensor digitorum longus muscles; anterior tibial nerve; and the tibial artery 2) Lateral compartment- fibularis longs and brevis (which evert the ankle), the preens tetras muscle (which assists in dorsiflexion), and the superficial branch of the perennial nerve 3) Superficial posterior compartment- gastrocnemius and soles (which plantar flex the ankle) 4) Deep posterior compartment- tibialis posterior, flexor digitorum longs, and flexor hallucis longus muscles (which invert the ankle), and the posterior tibial artery

What are the four ankle stability special tests?

1) Anterior drawer test 2) Talar tilt test 3) Kleiger's test 4) Medial subtalar glide test

What are the three rotatory instabilities?

1) Anterolateral 2) Anteromedial 3) Posterolateral

Keys to obtaining history for the examiner

1) Be calm and reassuring 2) Ask open-ended questions 3) Listen carefully 4) Maintain eye contact 5) Record exactly what the patient says 6) Try to obtain history as soon as possible after injury

6 Symptoms and signs of shock

1) Blood pressure is low 2) Systolic pressure is usually below 90 mm Hg 3) Pulse is rapid and weak 4) Patient may be drowsy and appear sluggish 5) Respiration is shallow and extremely rapid 6) Skin is pale, cool, and clammy

What are the eight inert tissues?

1) Bones 2) Ligaments 3) Joint capsules 4) Fascia 5) Nerves 6) Bursae 7) Nerve roots 8) Dura mater

What are the two areas of palpation?

1) Bony palpation 2) Soft-tissue palpation

What does a neurological examination measure?

1) Cerebral function 2) Cranial nerve function 3) Cerebellar function 4) Sensory testing 5) Reflex testing 6) Projected or referred pain 7) Motor testing

What are the two categories of stabilizing ligaments of the knee?

1) Cruciate ligaments- two ligamentous bands that cross one another within the joint capsule of the knee; consists of the anterior cruciate ligament (ACL) and the posterior cruciate ligament 2) Capsular and collateral ligaments- direct movement in a correct path and are divided into medial and lateral complexes; consists of the medial collateral ligament (MCL), deep medial capsular ligaments, and the lateral collateral ligament (LCL)

Two steps for establishing breathing

1) Determine whether victim is breathing, maintain the open airway; place your ear over the victim's mouth; observe the chest; and look, listen, and feel for breath sounds for 5-10 seconds. If victim is prone, look for the back to rise and fall with breathing 2) If victim is not breathing, using hand on victim's forehead, pinch the nose shut, keeping the heel of the hand in place to hold the head back (if no neck injury)

What are the four categories of movements of the foot?

1) Dorisflexion and Plantar flexion- occurs at ankle 2) Inversion, adduction, and supination 3) Eversion, abduction, and pronation 4) Movement of the phalanges- flexion, extension, abduction, and adduction

What are the five anterior cruciate ligament (ACL) tests?

1) Drawer test at 90 degrees of flexion 2) Lachman drawer test 3) Pivot-shift test 4) Jerk test 5) Flexion-rotation drawer test

What are ten other diagnostic tests?

1) Electrocardiography (ECG)- assesses impulse formation, conduction, depolarization and repolarization of atria and ventricles 2) Electroencephalography (EEG)- changes or abnormal brain wave patterns 3) Electromyography (EMG)- evaluate muscular conditions 4) Nerve conduction velocity- determine conduction velocity of nerves and can provide key information relative to neurological conditions 5) Pulse oximetry 6) Synovial fluid analysis- detect presence of infection in joint 7) Blood testing- assess red blood cell count, hemoglobin levels, hematocrit levels, white blood cell count, platelet deficiency, and serum cholesterol 8) Glucometer 9) Urinalysis- assess specific gravity, pH, presence of ketones, hemoglobin, protein, nitrates, red and white blood cells, bacteria, electrolytes, hormones and drug levels 10) Peak flow meter

What do abnormal endpoints (endpoints) include?

1) Empty feel- movement is definitely beyond the anatomical limit, and pain occurs before the end of the range (a complete ligament rupture) 2) Spasm- involuntary muscle contraction that prevents motion because of pain; also called guarding (back spasms) 3) Loose- occurs in extreme hyper mobility (previously sprained ankle) 4) Springy block- a rebound at the endpoint (meniscus tear)

Eight steps to establishing circulation:

1) Feel for a pulse at carotid artery; this is done by placing two fingers on Adam's apple and sliding them toward oneself into groove on the side of the neck 2) If an AED is available, use it as soon as possible; deliver one shock followed immediately by chest compressions 3) If no AED is available and there is no evident signs of circulation, begin chest compressions immediately after giving two rescue breaths 4) Maintain an open airway; position oneself close to side of victim's chest 5) Position heel of hand closed to victim's head on middle of sternum. Place other hand on top so that heels of both hands are parallel and fingers are directed straight away from oneself. Fingers can be extended or interlaced, but must be kept off chest wall 6) Keep elbows in a locked position, with arms straight and shoulders positioned over the hands, bending at the hips to enable the thrust to be straight down 7) For normal-sized adult, apply enough force to depress sternum at least 2 inches (child at most 2 inches). After compression, completely release sternum to allow heart to refill. Time of release should equal time of compression. 8) After 2 minutes or five cycles of 30 compressions and two breaths, recheck pulse at carotid artery for five seconds, while maintaining head tilt. If no pulse, continue 30:2 cycles, beginning with chest compressions.

What are the four articulations of the knee?

1) Femur and the tibia 2) Femur and the patella 3) Femur and the fibula 4) Tibia and the fibula

Two methods of opening the airway

1) Head-tilt/chin-lift method 2) Modified jaw thrust technique

Six factors of a musculoskeletal assessment

1) History 2) Visual observation 3) Palpation 4) Assessment decisions 5) Immediate treatment 6) Emergency splinting

Steps when victim is unconscious:

1) Immediately note the body position and determine level of consciousness/responsiveness 2) Circulation, airway, and breathing should be established 3) Injury to neck and cervical spine should always be considered a possibility in unconscious patients. 4) Never remove helmet until neck and spine injuries have been unequivocally ruled out; however, if CPR is needed then the helmet should be removed immediately 5) An airway, breathing, and circulation (ABC) should be established immediately if the patient is not breathing 6) If patient is supine and breathing, monitor closely until consciousness is regained 7) If patient is prone and not breathing, he/she should be logrolled carefully to supine position and CPR should be done immediately 8) If patient is prone and breathing, monitor closely until consciousness regained; then patient should be logrolled onto spine board because CPR could be necessary at any time 9) Life support for unconscious patient should be maintained and monitored until emergency medical personnel arrive 10) Once patient is stabilized, athletic trainer should begin secondary survey

On-the-field assessment follows what order for conscious patients?

1) Injury 2) Primary Survey 3) Level of consciousness determined 4) Secondary Survey 5) Vital signs, history, musculoskeletal evaluation 6) Treatment decision [may have to follow steps 6 and 7 of unconscious procedure if it is necessary] 7) Transportation from field or court

On-the-field assessment follows what order for unconscious patients?

1) Injury 2) Primary Survey 3) Level of consciousness determined 4) Stabilize cervical spine 5) Responsiveness, airway, breathing, circulation, shock, profuse bleeding [patient may be conscious at this time; if so, then follow procedure of conscious patient] 6) Call 911 and access rescue squad 7) Care for patient until rescue squad arrives

What are the six articulations (joints) of the foot?

1) Interphalangeal joint- designed only for flexion and extension 2) Metatarsophalangeal joint- permits flexion, extension, abduction, and adduction 3) Intermetatarsal joint- permits only slight gliding movements 4) Tarsometatarsal joint (Lisfranc's joint)- allows for some gliding and thus for a restricted amount of flexion, extension, abduction, and adduction 5) Subtler joint- allows inversion (sole of foot turns medially), eversion (sole of foot turns laterally), pronation, and supination 6) Midtarsal joint (Chopart's joint)- affects distal portion of foot

What questions should be answered during observation?

1) Is there an obvious deformity? 2) How does the patient move? 3) Is there a limp? 4) Are movements abnormally slow, jerky, and asynchronous? 5) Is the patient unable to move a body part? 6) Is the patient holding his or her body stiffly to protect against the pain? 7) Does the patient's facial expression indicate pain or lack of sleep? 8) Are there any obvious body asymmetries? 9) Does soft tissue appear swollen or wasted as a result of atrophy? 10) Are there unnatural protrusions or lumps, such as occur with a dislocation or fracture? 11) Is there a postural malalignment? 12) Are there abnormal sounds, such as crepitus, when the athlete moves? 13) Does a body area appear inflamed? 14) Is there swelling, heat, or redness?

Soft-tissue palpation involves what four categories?

1) Lateral aspect 2) Medial aspect 3) Anterior aspect 4) Posterior aspect

What are the two different menisci of the knee?

1) Lateral meniscus- O-shaped 2) Medial meniscus0 C-shaped

9 Vital signs to recognize during secondary survey

1) Level of consciousness 2) Pulse 3) Respiration 4) Blood pressure 5) Temperature 6) Skin color 7) Pupils 8) Movement 9) Abnormal nerve response

What are the four special tests of the lower leg?

1) Lower leg alignment tests 2) Percussion and compression tests 3) Thompson test 4) Homan's sign

Two steps for managing shock

1) Maintain body temperature as close to normal as possible 2) Elevate feet and legs 8-12 inches.

What are the three meniscal tests?

1) McMurray's meniscal test 2) Apley compression test 3) Thessaly test

What are the seven key bits of information that must be obtained during the history evaluation?

1) Mechanism of injury or trauma that caused the problem 2) Chief complaints and present problems 3) If pain is present, its location, character, duration, variation, aggravation, distribution or radiation, intensity, and course 4) If pain is increased or decreased by specific activities or stresses 5) The existing environmental conditions when the injury occurred 6) The type of equipment being worn at the time of the injury 7) If the problem has occurred before and, if so, when and how it was treated and if the treatment was successful

What are the four straight instabilities?

1) Medial 2) Lateral 3) Anterior 4) Posterior

The two categories of soft tissue palpation are?

1) Medial and plantar aspect 2) Lateral and dorsal aspect

The bony landmarks for palpation are separated into what four categories?

1) Medial aspect 2) Dorsal aspect 3) Lateral aspect 4) Plantar aspect

What are the four aspects of bony palpation of the knee?

1) Medial aspect 2) Lateral aspect 3) Anterior aspect 4) Patella

What are the four arches of the foot?

1) Metatarsal arch- shaped by the distal heads of the metatarsals 2) Transverse arch- extends across the transverse tarsal bones 3) Medial longitudinal arch- originates along the medial border of the calcaneus and extends forward to the distal head of the first metatarsal 4) Lateral longitudinal arch- on the outer aspect of the foot and follows the same pattern as that of the medial longitudinal arch

What are the five different leg deviations?

1) Patella alta 2) Patella baja 3) Genu valgum 4) Genu varum 5) Genu recurvatum

When fitting a patient with a crutch or cane, how should the fitting process be conducted?

1) Patient should stand with good posture, in flat soled shoes 2) Crutches should be placed 6" from outer margin of shoe and 2" in front

What are the 16 imagine techniques?

1) Plain film radiography (X-ray)- determines fractures 2) Arthrography- shows disruption of soft tissue and loose bodies 3) Arthroscopy- assess joint integrity and damage 4) Myelography- detects tumors, nerve root compression, and disk disease and other diseases of the spinal cord 5) Computed tomography- produces cross sectional view of tissues 6) Positron emission tomography (PET) 7) Bone scan- used to image bony lesions 8) DEXA scan- measures bone mineral density 9) Magnetic resonance imaging (MRI) 10) MRI arthrography- more detailed assessment of joint compared to regular MRI 11) Ultrasonography- view location, measurement, or delineation of organ or tissue 12) Musuloskeletal ultrasound- imaging and evaluation of soft tissue structures 13) Doppler ultrasonography- examines blood flow in arms and legs 14) Echocardiography- produce graphic record of cardiac structures 15) Arteriogram- determines path of fluid flow in vessels 16) Venogram- detecting thrombophlebitis and for tracing of venous pulse

What are the three posterior cruciate ligament (PCL) tests?

1) Posterior drawer test 2) External rotation recurvatum test 3) Posterior sag test (Godfrey's test)

What are the four distinct evaluations?

1) Pre-participation (before season) 2) On-the-field assessment 3) Off-the-field evaluation 4) Progress evaluation

Some of the best ways to prevent foot injuries include:

1) Selection appropriate footwear 2) Correcting biomechanical structure deficiencies through orthotics 3) Paying attention to hygiene

What nine issues should an emergency action plan address?

1) Separate plans for each sport/event 2) Specific procedures established regarding removal of protective equipment 3) Phones are readily accessible 4) All staff familiar with community-based emergency health care delivery plan 5) Keys to gates or padlocks are easily accessible 6) Inform all coaches, athletic directors, school nurses, staff, and maintenance personnel of the emergency plan at an annual meeting 7) Assign someone to accompany injured athlete to the hospital 8) Contact information for all athletes are on hand 9) Plan should include management of emergency situations of coaches, referees, and even spectators

Assessment decisions

1) Seriousness of injury 2) Type of first aid and immobilization required 3) Need for immediate referral 4) Type of transportation from field to sideline, training room, or hospital

What do normal endpoints (end feels) include?

1) Soft-tissue approximation- soft and spongy, a gradual, painless stop (knee flexion) 2) Capsular feel- an abrupt, hard, firm endpoint with only a little give (endpoint of hip rotation) 3) Bone to bone- a distinct and abrupt endpoint when two hard surfaces come in contact with one another (elbow in full extension) 4) Muscular- a springy feel with some associated discomfort (end of shoulder abduction

What are the six sensory tests?

1) Superficial sensation- touch dermatomes with cotton 2) Superficial pain- touch dermatomes with a pin 3) Deep pressure pain- squeeze a muscle 4) Sensitivity of temperature- touch dermatomes with ice cube 5) Sensitivity of vibration- touch dermatomes with tuning fork 6) Position sense- move fingers or toes passively and ask athlete to indicate direction

What are the three articular joints?

1) Superior and inferior tibiofibular joints 2) Talocrural joint 3) Subtalar joint

What are the five parts of normal human anatomy?

1) Surface anatomy 2) Body planes and anatomical directions- sagittal, transverse, and coronal/frontal planes 3) Abdominopelvic quadrants and regions 4) Musculoskeletal system anatomy 5) Standard musculoskeletal terminology for bodily positions and deviations

For a patient with a suspected neck injury, what nine steps should be followed?

1) The examiner should immediately maintain the position of the cervical spine 2) The examiner must determine whether the patient is breathing and has a pulse. The patient is moved onto a spine board 3) If the patient is wearing a a helmet or face mask, the equipment should be removed to allow access to the airway prior to spine boarding. The spine board should be placed come to the patient. All extremities should be placed in axial alignment 4) With the spine board close to the patient, the captain (responsible for holding the neck/spine) gives the command to logroll the patient onto the spine board 5) On the board, the patient's head and neck continue to be stabilized by the captain while the face mask is removed 6) Next, the head and neck are stabilized on the spine board by a chin strap, head strap, and side blocks 7) Finally, the trunk and lower limbs are secured to the spine board by the straps 8) The rescuers place themselves in a position to stand, and then, on the command of the person stabilizing the head, they collectively lift the patient onto the spine board 9) The spine board can then be carried to a transport vehicle or cart for removal from the field

What are the four bones that meet at the knee joint?

1) Tibia 2) Fibula 3) Femur 4) Patella

What are the five bones in the ankle and lower leg?

1) Tibia 2) Fibula 3) Tibial and fibular malleoli 4) Talus 5) Calcaneus

What are the four categories of stabilizing ligaments?

1) Tibiofibular ligaments- joining the tibia and fibia 2) Ankle ligaments- has three lateral ligaments and the medial, or deltoid, ligament 3) Lateral ligaments- anterior talofibular, posterior talofibular, and the calcaneofibular 4) Medial ligaments- deltoid ligament which consists of both superficial and deep fibers; anteriorly are the anterior tibiotalar part and the tibionavicular part; medially is the tibicalcaneal part; posteriorly is the posterior tibiotalar part

Foot hygiene involves:

1) Toenails trimmed correctly 2) Shaving down excessive calluses 3) Keeping foot clean 4) Wearing clean and correctly fitting socks and shoes 5) Keeping feet as dry as possible

What are the eight main bones/bone categories?

1) Toes 2) Metatarsal bones- five bones that lie between and articulate with the tarsals and the phalanges 3) Tarsal bones- seven bones located between the lower leg and the metatarsals 4) Calcaneus- the largest tarsal bone that supports the talus and shapes the heel; conveys body weight to the ground and serves as attachment for both achilles and several structures on the plantar surface of the foot 5) Talus- the most superior tarsal bone that is above the calcaneus over a bony projection called the sustentaculum tali 6) Navicular- positioned anterior to the talus on the medial aspect of the foot 7) Cuboid- positioned on lateral aspect of foot 8) Cuneiforms- located between the navicular and the base of the three metatarsals on the medial aspect of the foot

What are five function tests of the ankle and lower leg?

1) Walk on toes (tests plantar flexion) 2) Walk on heels (tests dorsiflexion) 3) Walk on lateral border of feet (tests inversion) 4) Walk on medial border of feet (tests eversion) 5) Hop on injured ankle

If possible, a knee injury patient should be observed performing what actions?

1) Walking 2) Half-squatting 3) Going up and down stairs

What are the eight anatomical directions?

1) anterior- in front of 2) posterior- in back of 3) superior- above 4) inferior- below 5) distal- farther away 6) proximal- closer to 7) medial- toward the middle 8) lateral- away from the middle

The five major actions of the knee are?

1) flexion 2) extension 3) rotation 4) rolling 5) gliding

What degrees of motion does the normal gait require?

10 degrees of dorisflexion and 20 degrees of plantar flexion with the knee fully extended

What are the degrees of motion for dorisflexion and plantar flexion?

10 degrees of dorisflexion and 50 degrees of plantar flexion

Normal blood temperature

120/80

What is the range of motion in degrees of the knee?

140 degrees

A Q angle greater than _____ could predispose the athlete to patellar femoral pathology.

20

Normal body temperature range

98.2-98.6 degrees F

The ___ angle measures the patellar orientation to the tibial tubercle.

A

What does a clinical diagnosis identify?

A clinical diagnosis identifies pathology and limitations/disabilities associated with pathology

A ballet dancer has been diagnosed as having patellar tendinitis. In 3 weeks, she has two performances and wants to know what she can do to get rid of the problem as soon as possible. What options does the athletic trainer have in treating the dancer?

A conservative approach would be to use the normal techniques to reduce inflammation, such as rest, ice, ultrasound, and anti-inflammatory medications. An alternative and more aggressive technique would be to use a deep transverse friction massage technique to increase the inflammatory response, which will ultimately facilitate healing. If successful, the more aggressive treatment may allow a quicker return to full activity.

An athletic trainer working in a sports medicine clinic observes a forefoot valgus deformity in a soccer player during a preseason screening. Why might this deformity be a problem? What can be done to manage this condition?

A forefoot valgus deformity can cause excessive or prolonged supination. This condition may limit the ability of the foot and lower extremity to absorb ground reaction forces, resulting in injury. These injuries include inversion ankle sprains, tibial stress syndrome, perennial tendinitis, illotibial band friction syndrome, and trochanteric bursitis. The athlete can use an orthotic to correct this biomechanical problem or wear proper footwear with extra cushioning and flexibility.

A baseball player complains of pain in his right shoulder. A manual muscle test for shoulder external rotation was a grade 3. What does this evaluation indicate about the tissue? If the result of the manual muscle test was a grade 3, what is a possible conclusion for this evaluation?

A grade 3 manual muscle test suggests there is a gross lesion of contractile tissue in the shoulder, such as the rotator cuff. A weak and painful contraction indicates there may be a complete rupture of the tissue or a potential nervous system disorder.

The knee is also what other kind of joint?

A hinge joint with a rotational component

A basketball player playing in a recreation league game sustains a grade 2 lateral sprain of the left ankle. What metatarsal fracture may be associated with this type of strain?

A lateral sprain can produce an avulsion fracture of the proximal head of the fifth metatarsal bone.

What's the result of a positive anterior drawer test?

A positive anterior drawer sign of ankle stability is when the foot slides forward, sometimes making a clunking sound as it reaches its end point.

What's the result of a positive taller tilt test?

A positive taller tilt occurs when the calcaneofibular ligament is sprained.

During practice, a lacrosse player is involved in a collision on the field. When the athletic trainer reaches the athlete, the athlete's ankle is deformed and obviously fractured. How should the athletic trainer immobilize this injury?

A rapid form vacuum immobilizer will work well for this injury because of its ability to mold the splint to the joint without causing unnecessary movement. Therefore, the ankle can be immobilized in the current position before transporting the patient.

A football player who commonly plays on artificial turf complains of pain in his right toe. What type of injury frequently occurs to the great toe of an athlete who plays on artificial turf?

A sprain of the first metatarsophalangeal joint (turf toe) stems from hyperextension, usually because of the unyielding surface of artificial turf. This injury is a tear of the joint capsule from the metatarsal head.

What is a joint capsule?

A thin articular capsule that encases the ankle joint and attaches to the borders of the bone involved.

A football running back is hit on the lateral surface of his knee by an opponent making a tackle. He has significant pain and some immediate swelling on the medial surface of his knee. The athletic trainer suspects that the athlete has a sprain of the MCL. What are the most appropriate tests that the athletic trainer should do to determine the exact nature and extent of the injury?

A valgus stress test should be used to test the MCL. The examination in full extension tests the MCL, posteromedial capsule, and cruciates. At 30 degrees of flexion, the MCL is isolated. If some instability is present with the knee in full extension, the athletic trainer should closely evaluate the integrity of the cruciate ligaments.

AVUP scale for determining level of consciousness

A: alert; patient is alert and awake; alert V: verbal; patient responds to voice but not fully oriented; confused P: pain; patient does not respond to voice but does to painful stimulus; drowsy U: unresponsive; patient does not respond to painful stimulus; unresponsive

Experience pop with severe pain and disability, positive anterior drawer and Lachman's test, rapid swelling at the joint line, and other positive ACL tests

ACL sprain

Pain may be mild to severe; most severe injury is partial/complete avulsion or rupture

Acute Achilles strain

Pain, swelling, and soft tissue insult; leg will appear hard and swollen (Volkman's contracture)

Acute leg fractures

Pain and swelling, restricted ROM, palpable tenderness over adductor tubercle; results in total loss of function

Acute patella subluxation or dislocation

What kind of diagnosis does an athletic trainer make?

Athletic trainers make a clinical diagnosis

A tibial torsion is indicated by what?

An angle that measures less than 15 degrees is an indicator of a tibial torsion

What must all sports programs have?

An emergency action plan

secondary survey

An evaluation of existing signs and symptoms performed after the presence of life-threatening conditions has been ruled out.

primary survey

An evaluation used to determine the existence of life-threatening, emergent conditions or images.

What do athletic trainers use their evaluation skills for?

Athletic trainers use their evaluation skills to make an accurate clinical diagnosis

Swelling and pain may be extreme with possible deformity

Ankle fractures and dislocations

What's the most common injury of the physically active?

Ankle sprains

The anterior tibialis tendon, extensor hallucis longus tendon, etc. are what aspect of soft-tissue palpation?

Anterior

The fibular head, fibular shaft, lateral malleolus, etc. are what aspect of bony palpation?

Anterior

The patella and tibial tuberosity are in what aspect of palpation?

Anterior

The vastus medialis, vastus lateralis, etc. are what aspect?

Anterior

A (Assessment)

Assessment of the injury is the athletic trainer's professional judgement with regard to impression and nature of injury

A collegiate field hockey player has a history of repeated ankle sprains. She complains of constant pain and aching and says the ankle feels like it catches when she runs. There also appears to be some mild effusion. What might the athletic trainer suspect is wrong, and how should this injury be managed?

Based on these symptoms, it is likely that the patient has either an osteochondral fracture or osteochondritis dissecans. The patient should be referred to a physician for X-rays to confirm this opinion. It is likely that the physician will recommend an arthroscopic procedure to remove these fragments.

May be localized swelling above knee; swelling in popliteal fossa

Bursitis

A football defensive back is making a tackle and drops his head on contact with the ball-carrier. He hits the ground and does not move. When the athletic trainer gets to him, the patient is lying prone, is unconscious, but is breathing. How should the athletic trainer manage this situation?

Because of the mechanism of injury, the athletic trainer should suspect that the patient has a cervical neck injury, and the head should be stabilized throughout. Because the patient is prone and breathing, the trainer should do nothing until the patient regains consciousness. An on-field exam should determine the athlete's neurological status. Then the player should be carefully logrolled onto a spine board because CPR could be necessary at any time. The face mask should be removed in any case CPR is required. The helmet and shoulder pads should be left in place. The patient should then be transported to an emergency facility. In this situation, the worst mistake the athletic trainer can make is not exercising enough caution.

Girth measurements must be taken routinely because?

Because the musculature of the knee atrophies so readily after an injury, girth measurements must be taken routinely.

What is the most stable position of the ankle and why?

Because the talus is wider anteriorly than posteriorly, the most stable position of the ankle is with the foot in dorisflexion.

Increased understanding of the activity results in what?

Better assessment and care for the athlete

An office worker who is participating in a corporate fitness program complains of feeling tired and run down. The athletic trainer suspects that she may be anemic and sends her to the physician for a blood test. After getting the results, the physician calls the athletic trainer and reports that her hematocrit was 36 percent and that her hemoglobin was 11g/100mL. Are these values normal? What should the athletic trainer conclude?

Both the hematocrit and the hemoglobin levels are low, and it is likely that the office worker does have anemia. However, depending on other signs and symptoms, the physician may need to order additional diagnostic tests to determine what may be causing this problem.

Tenderness, swelling, and enlargement of joint initially; as inflammation continues, angulation increases causing painful ambulation; tendinitis in great toe flexors may develop

Bunion (Hallux valgus deformity)

Weight bearing (particularly at heel strike) causes pain, pain continues following exercise; may require bone scan for diagnosis

Calcaneal stress fracture

With an unconscious victim, what should be done by the athletic director immediately?

Call 911

Pain with walking, running, stairs, and squatting; possible recurrent swelling, grating sensation with flexion and extension; pain at inferior border during palpation

Chondromalacia patella

What different compartment syndromes are there and what type of athlete is more prone to each one?

Chronic exertional compartment syndrome occurs most commonly in runners, whereas acute compartment syndrome occurs in soccer players.

A personal fitness trainer is three days postop after reconstruction of her knee using a patellar tendon graft. It is essential that she begin active range of motion and strengthening exercises as soon as possible. What type of strengthening exercises should the athletic trainer recommend?

Closed kinetic chain strengthening exercises, such as mini-squats, lateral or forward step-ups onto a box, leg presses on a machine, terminal knee extensions using exercise tubing, and use of stationary bicycles, stair-climbing machines, and stepping machines are all appropriate exercises that can be used safely and effectively almost immediately after surgery. Limited range of motion secondary to pain and swelling may restrict the athlete's ability to perform these strengthening exercises.

Complaints of deep aching pain and tightness due to pressure and swelling, reduced circulation and sensation of foot occurs, intracompartmental measures further define severity

Compartment syndrome

The knee is what kind of joint?

Complex joint that endures great amount of trauma due to extreme amounts of stress that are regularly appliedT

If an athlete is a minor, then what should be obtained before anything is done to the athlete?

Consent should be obtained from parent.

Second, third, and fourth metatarsals, second, theird, and fourth metatarsophalangeal joints, etc. belong in which aspect?

Dorsal

A marathon runner is complaining of nonspecific anterior knee pain. She indicates that not only do her knees hurt during her training sessions but they also bother her when ascending or descending stairs, when she squats and then tries to stand, and when she sits for long periods of time. What anatomical and biomechanics factors that might be contributing to the patient's anterior knee pain should the athletic trainer assess?

During the evaluation, the athletic trainer should look for tightness of the hamstrings or gastrocnemius, tightness of the lateral retinaculum, increased Q angle, tightness of the illotibial band, pronation of the foot, patella alta, vastus medialis oblique (VMO) insufficiency, inhibition resulting from the presence of effusion in the knee, and weak hip adductors to which the VMO is attached

This type of ankle sprain represents 5-10% of all ankle sprains.

Eversion

Pain may be severe, unable to bear weight, pain with abduction and adduction but not direct pressure on bottom of foot

Eversion ankle sprain

Immediate swelling, pain and inability to bear weight; minimal deformity unless comminuted fracture occurs

Fracture of the calcaneus

What are some of the causes of fractures and dislocations of the phalanges?

Fractures and dislocations of the foot phalanges can be caused by kicking an object, stubbing a toe, or being stepped on.

Immediate and intense pain in the toes; obvious deformity with discoloration

Fractures and dislocations of the phalanges

What does a functional performance test evaluate?

Functional examination determines whether the athlete has full strength, joint stability, and coordination, and whether the part is pain free.

A receiver in football has his feet taken out from under him by a tackler and lands flat on his low back with his legs above him. An on-the-field evaluation reveals unilateral decreased muscle strength, decreased sensation, and a decreased patellar tendon reflex in the right lower extremity. Based on the findings of the evaluation, how should the athletic trainer manage this injury?

Generally, injury to the spinal cord would result in bilateral symptoms. Unilateral changes are more indicative of peripheral nerve injury. However, any change in the neurological status of the athlete is cause for great concern. The athletic trainer should remove the patient from the playing field using a stretcher or, preferably, a spine board.

Mild pain and disability, weight bearing is minimally impaired ; point tenderness over ligaments and no laxity

Grade I ligament sprain

Feel or hear pop or snap; moderate pain with difficulty bearing weight; tenderness and edema; positive talar tilt and anterior drawer tests

Grade II ligament sprain

Severe pain, swelling, hemarthrosis, and discoloration; unable to bear weight; positive talar tilt and anterior drawer

Grade III ligament sprain

What should always be exercised when transporting a patient?

Great caution must be taken when transporting the injured athlete.

Pain and swelling in toe which increases during push off in walking, running, and jumping

Great toe hyperextension (Turf toe)

What four broad categories are used in the off-the-field injury evaluation process?

HOPS (history, observation, palpation, and a number of special tests)

The MP, DIP, and PIP can all become fixed; exhibit swelling, pain, callus formation, and, occasionally, infection

Hammer toe, mallet toe, or claw toe

Severe pain in heel and is unable to withstand stress of weight bearing, often warmth and redness over tender area

Heel contusion

A football player is injured while making a tackle. The athletic trainer quickly realized the victim is not breathing and immediately begins CPR. After only a few seconds, the victim begins breathing spontaneously and regains consciousness. What might the athletic trainer choose to do while waiting for the rescue squad to arrive to facilitate the victim's recovery from this life-threatening incident?

If the equipment is available, the athletic trainer should administer supplemental oxygen, using a bag/valve mask and a pressurized oxygen cylinder to facilitate recovery.

A police officer is 6 months post-ACL reconstruction. He has been cleared by the physician to return to duty. However, he still has a concern about his knee being reinsured. He wants to know whether he should be wearing a functional knee brace. What should the athletic trainer recommend to this officer?

If the officer is still concerned about his nee not being ready to return to active duty, then he is not ready, regardless of whether he is wearing a knee brace. The athletic trainer should design a series of functional progression activities that will help the patient gain confidence in his abilities while continuing to work on strengthening and neuromuscular control exercises. If the patient feels strongly about wearing a brace, the athletic trainer should provide every effort to provide him with one, despite the fact that the literature supporting the use of functional knee braces is unclear.

Repetitive/overuse conditions attributed to mal-alignment and structural asymmetries

Iliotibial band friction syndrome (Runner's/Cyclist's knee)

A gymnast complains of pain in the medial aspect of her right tibia. There is pain before, during, and after activity. Assessment rules out a stress fracture, and the injury is diagnosed as medial tibial stress syndrome (MTSS). What could be the cause of this condition?

In gymnastics, athletes often run on hard surfaces either barefoot or wearing shoes with little cushioning. This, combined with overtraining and fatigue, could lead to MTSS. Other reasons are a varus or pronated hyperbole foot.

An athletic trainer is evaluating an assembly line worker who complains of pain in her elbow. During the evaluation, manual muscle testing and active and passive range of motion tests reveal pain when the elbow is moved into extension both actively and passively. However, there is no pain when the elbow is moved into flexion. Does the injury more likely involve the ligament or the musculotendinous unit?

In this case, a ligamentous injury is more likely. A lesion of inert tissue will elicit pain on active and passive movement in the same direction. If a lesion is present in contractile tissue, pain will occur on active motion in one direction and on passive motion in the opposite direction. A sprain of a ligament will result in pain whenever that ligament is stretched either through active contraction or passive stretching.

A professional bull rider is thrown from the bull and, on landing, twists his knee. There is immediate swelling and pain. After evaluation, the athletic trainer is not sure what the injury is and sends the patient directly to the physician for a medical diagnosis. The physician decides that additional diagnostic tests are necessary to determine the exact pathology. What diagnostic tests is the physician likely to order to determine the exact nature and extent of the knee injury?

Initially, it is likely that the standard knee X-rays would be used to determine the presence of a fracture. An MRI is widely used by sports medicine physicians to determine injury to ligamentous, meniscal, and other soft tissues. On occasion, a diagnostic arthroscopy might be done to directly observe the injured structures.

Capillary hemorrhaging and swelling; chronic irritation may lead to scarring and calcification; pain below the patellar ligament; may display weakness

Injury to the infrapatellar fat pad

What is a postural examination?

It is designed to test for malalignments and asymmetries by viewing the body compared with a grid or plumb line

A soccer player has suffered an isolated grade 2 sprain of his ACL. At this point, the physician feels that surgery is not required and decides to try to rehabilitate the athlete and have him return to practice. It is likely that, when the patient returns to full activity, he will experience some feeling of instability when stopping, starting, and cutting. What can the athletic trainer recommend to the patient to help him minimize feelings of instability and to prevent occurrence of additional injury to the ACL.

It is important to understand that, once a ligament has been sprained, the inherent stability provided to the joint by that ligament has been lost and will never be totally regained. Thus, the patient must rely on other structures that surround the joint- the muscles and their tendons- to help provide stability. It is essential for the athlete to work hard at strengthening all the muscle groups that play a role in the function of the knee joint.

A patient comes to an outpatient clinic in a hospital, complaining of her flatfeet and that she has pain in her knees and a big callus under her second metatarsal. What is likely causing this problem, and how can it usually be corrected?

It is likely that this athlete has a forefoot various. To correct a structural forefoot various deformity where the foot excessively pronates, the orthotic should be the rigid type and should have a medial wedge under the head of the first metatarsal. It is also advisable to add a small wedge under the medial calcaneus to make the orthotic more comfortable. The athletic trainer should also recommend that this patient purchase a board-lasted shoe with a medial heel wedge and a firm heel counter.

A relatively inactive middle-age patient complains of pain in the anterior aspect of the knee while walking, running, ascending and descending stairs, and squatting. There is a grating sensation when flexing and extending the knee. What condition should the athletic trainer suspect, and what treatment should he or she recommend?

It is likely that this patient has chondromalacia patella. The athletic trainer should recommend avoiding irritating activities, such as stair climbing and squatting. The athletic trainer should recommend use of a neoprene sleeve and isometric exercises that are pain free to strengthen the quadriceps and hamstring muscles. If conservative measures fail to help, surgery may be the only alternative.

What is the plantar fascia?

It is the thick, white band of fibrous tissue originating from the medial tuberosity of the calcaneus and ending at the proximal heads of the metatarsals

The secondary survey does what?

It takes a closer look at the injury be gathering specific information about the injury from the patient, systematically assesses vital signs and symptoms, and allows for a more detailed evaluation of the injury.

Present as knee sprain, severe pain, loss of movement, and signs of acute inflammation; swelling, discoloration; and possible capsular damage

Joint contusions

What are joint stability tests?

Joint stability tests provide information about the grade of a sprain of a particular ligament and can determine the extent of the functional inability of the joint.

While roughhousing in the locker room, an athlete inadvertently kicks a locker and injures his right great toe. What should the athletic trainer be concerned with in this type of injury mechanism?

Kicking the locker with the great toe could cause a fracture of the proximal or distal phalanx. This injury may develop swelling, discoloration, and point tenderness.

What are often mistaken for meniscal injuries?

Knee place that have become thick and hard are often mistaken for meniscal injuries.

Possible history of knee pain/injury, recurrent episodes of painful pseudolocking, possible snapping and popping, pain with stairs and squatting, and little or no swelling with no ligamentous laxity.

Knee plica

Importance of Korotkoff sounds

Korotkoffs sounds identify systolic and diastolic blood pressure

Pain and tenderness over LCL, swelling and effusion around LCL, joint laxity with varus testing, and may cause irritation of the peroneal nerve

LCL sprain

Cramping with pain and contraction of calf muscle

Leg cramps and spasms

The five life-threatening conditions are...?

Level of consciousness, airway, breathing, circulation, severe bleeding, and shock.

Pain with running and jumping, usually below posterior tibialis tendon, accompanied by pain and swelling; may also be associated with sprained calcaneonvacular ligament and flexor hallucis longs strain

Longitudinal arch strain

A triathlete changes her running patterns by increasing distance and performing more hill work. She complains to the athletic trainer of a gradually worsening pain in her forefoot. Inspection reveals point tenderness in the region of the fourth metatarsal bone. X-ray reveals a stress fracture. How should this condition be managed?

Management of this stress fracture usually consists of 3 or 4 days' partial weight bearing followed by 2 weeks of rest. Return to running should be very gradual. An orthotic that corrects excessive pronation can help take stress off the second metatarsal.

Medial calcaneus, calcaneal dome, medial malleolus, etc. belong in which aspect?

Medial

Medial tibial plateau, medial femoral condyle, etc. are what aspect of knee palpation?

Medial

The flexor digitorum longus tendon, posterior tibias tendon, etc. are what aspect of soft-tissue palpation?

Medial

The medial collateral ligament, medial joint capsule, etc. are what aspect?

Medial

Four grades of pain: 1) Pain after activity 2) Pain before and after activity and not affecting performance 3) Pain before, during and after activity, affecting performance 4) Pain so severe, performance is impossible

Medial tibial stress syndrome (shin splints)

Effusion developing over 48-72 hours, joint line pain and loss of motion, intermittent locking and giving way, and pain with squatting

Meniscal tear

A tennis player complains of pain in the ball of the right foot. Inspection reveals a heavy callus formation under the second metatarsal head. This condition produces a metatarsalgia. What is the probable cause of this condition?

Metatarsalgia can be caused by a restricted gastrocnemiussoleus complex that produces a pes cavus. It can also be caused by a fallen metatarsal arch that abnormally depresses the second or third metatarsal head and causes a heavy callus to develop.

mm Hg

Millimeters of mercury;

Burning paresthesia and severe intermittent pain in forefoot; pain relieved with non-weight bearing; toe hyperextension increases symptoms

Morton's neuroma

Stress fractures with pain during and after activity with possible point tenderness; bone scan positive; callus development under second metatarsal head

Morton's toe

How many people will have foot problems in their life?

Most people will develop foot problems at some time in their life.

O (Objective)

Objective findings result from the athletic trainer's visual inspecting, palpation, and assessment of active, passive, and resistive motion

Swelling, hemorrhaging, and gradual degeneration of the apophysis due to impaired circulation; pain with kneeling, jumping, and running; point tenderness

Osgood-schlatter disease and Larsen-Johansson disease

Hear snap and feeling of giving way, immediate swelling and considerable pain, diffuse pain along joint line

Osteochondral knee fractures

Outward projection of great toe articulation or drop in longitudinal arch

Overlapping toes

Metatarsal heads, medial calcanea tubercle, and sesamoid bones belong in which aspect?

Plantar

Pain in anterior medial heel, along medial longitudinal arch; increased pain in morning, loosens after first few steps; increased pain with forefoot dorisflexion

Plantar fasciitis

Semitendinosus, populates, etc. are what aspect?

Posterior

The achilles tendon, posterior tibiofibular ligament, etc. are what aspect of soft-tissue palpation?

Posterior

The medial malleolus, lateral malleolus, dome of the talus, etc. are what aspect of bony palpation?

Posterior

The _______ prevents excessive internal rotation and the _______ prevents excessive internal rotation

Posterior cruciate ligament; ACL

Primary goal of immediate care

Prevention of swelling and hemorrhaging

Why is proper fitting of a crutch or cane important?

Properly fitting a crutch or cane is essential to avoid placing abnormal stresses on the body and causing further injury.

What are used to prevent and reduce severity of knee injuries?

Prophylactic knee braces

The ___ angle is created when lines are drawn from the middle of the patella to the anterosuperior spine of the ilium and from the tubercle of the tibia through the center of the patella.

Q

Rotational component involves the _________?

Screw home mechanism

A 12-year-old, physically immature patient complains of pain in his right heel where the Achilles tendon attaches. This condition is an apophysitis known as Sever's disease. Why and how does Sever's disease occur?

Sever's disease is a traction injury to the apophysis of the calcanea tubercle, where the Achilles tendon attaches. The circulation becomes disrupted, resulting in a degeneration of the epiphyseal region.

Intense pain, rapidly forming hematoma with jelly like consistency

Shin contusion

Warning for observing pupils

Some athletes normally have irregular and unequal pupils

What are the two categories of classification of instabilities?

Straight instabilities and rotatory instabilities

What should be focused on to prevent ACL injury?

Strength, neuromuscular control, and balance

Pain more intense after exercise than before, point tenderness, difficult to discern bone and soft tissue pain, and bone scan results (stress fracture vs. periostitis)

Stress fracture of tibia/fibula

Accumulation of blood underneath toenail; likely to produce extreme pain and ultimately loss of nail

Subungal hematoma

The ankle is what type of joint?

The ankle is a stable hinge joint.

A field hockey player trips over an opponent's stick, plantar flexing and inverting her ankle, and she falls to the turf with a grade 2 ankle sprain. She has immediate effusion and significant pain. On examination, there appears to be some laxity in the ankle joint. The athletic trainer transports the patient to the training room so that the ankle sprain can be managed properly. What specifically should the athletic trainer do to most effectively control the initial swelling associated with this injury?

The ankle should be wrapped with a wet elastic compression wrap. Ice should be applied to both sides of the joint over the compression wrap and secured. The ankle should be elevated so that the leg is above 45 degrees at a minimum. The compression wrap, ice, and elevation should be maintained initially for at least 30 minutes, but not longer than an hour. The athletic trainer should also determine whether a fracture is suspected and make the appropriate referral.

What arteries and veins provide blood supply to the ankle and lower leg?

The anterior tibial artery and posterior tibial arteries supply blood; the blood drains via the peroneal vein, posterior tibial vein, and anterior tibial vein

A soccer player is taken down and lies on the field, holding her knee. The athletic trainer comes onto the field and quickly examines the knee. There does not appear to be any major instability, so the athlete is moved to the sideline, where the athletic trainer does a more careful evaluation. The athletic trainer is fairly certain that the soccer player has sustained a minor grade 1 medial collateral ligament (MCL) sprain and elects not to refer the patient to the physician. The next day the patient comes into the athletic training clinic with a very swollen knee. The athletic trainer now decides to refer the patient to the physician. On examination, the physician determines that the patient does have an MCL sprain but has also sustained a tear of the medial meniscus. How could the athletic trainer have handled the situation better?

The athletic trainer must realize that the physician should have been consulted earlier in this case. Despite the fact that the athletic trainer correctly identified the MCL sprain, the meniscus tear was completely overlooked. Although the athletic trainer's actions were not inappropriate, it would have been better to refer the injured patient to the physician for medical diagnosis. In most cases, the athletic trainer's clinical diagnosis should reveal the same results as the physician's medical diagnosis.

A volleyball player with a history of repeated ankle sprains complains of a snapping sensation in the right ankle. What procedures should be followed when managing a sublimated peroneal tendon?

The athletic trainer should apply compression with a horseshoe-shaped felt pad around the lateral malleolus. This pad should be reinforced by a rigid splint. RICE, NSAIDs, and analgesics should be given as needed. The patient should follow an exercise program to strengthen, stretch, and enhance balance training.

A patient is being treated in a sports medicine clinic. She is chewing gum while doing her exercises and suddenly begins to choke and is having difficulty breathing. What should the athletic trainer do for her?

The athletic trainer should encourage her to continue to cough to attempt to dislodge the gum. If she cannot breathe at all, the athletic trainer should perform a series of abdominal thrusts to help dislodge the gum, continuing the abdominal thrusts until the obstruction is ejected.

A fencer comes to a clinic complaining of pain in his shoulder, which he has had for a week. He indicates that he first hurt the shoulder when lifting weights but did not think it was a bad injury. During the past week he has not been able to lift because of pain. He had continued to fence, but his shoulder seems to be getting worse instead of better. What is the standard evaluation scheme that the athletic trainer should use?

The athletic trainer should first take a subjective history from the injured patient and follow that with an objective examination that includes observation, palpation, range of motion testing, manual muscle testing, a neurological examination, special tests, tests for joint stability, and a functional performance evaluation.

A fencer has a grade 2 ankle sprain. After spending an hour in the athletic trainer room applying ice, compression, and elevation, the athletic trainer decides that the patient should be sent home on crutches. The athlete indicates some reluctance to use the crutches because he has never used them before. What instructions should the athletic trainer give the patient, so that he can correctly and safely ambulate on crutches?

The athletic trainer should instruct the patient in the tipped gait, in which the patient swings through the crutches without making any surface contact with the injured limb. The tripod gait is also used on stairs. In negotiating stairs, the rule of thumb is go up with the good leg first, followed by crutches, and to go down with the crutches first, followed by the good leg. If the stairs have a handrail, the patient can hold both crutches with his outside hand.

A jogger, after running downhill for an extended period of time, experiences pain in the anterior medial aspect of the left foot. The condition is diagnosed as anterior tibias tenants. How should this condition be managed?

The athletic trainer should instruct the patient to rest or reduce the stress of running. The patient should apply ice packs followed by stretching before and after activity. The patient should follow a strengthening program along with treatment by oral antiinflammatory medications as needed.

A diver, attempting a 2.5 inward dive on a 3-meter board, hits her head on the end of the board. She lands on her face in the water, is briefly submerged, but floats quickly to the surface. She is conscious but disoriented; she has a bump on her forehead but is not bleeding. A teammate nearby jumps immediately in the water and, using a cross-chest technique, tows her about 10 feet to the side of the pool. The athletic trainer is concerned about both a head and a neck injury. What precautions should be taken when removing the injured athlete from the pool?

The athletic trainer should place the swimmer on a spine board and secure her before extracting her from the pool. Several people may be required to get the swimmer appropriately positioned on the spine board while still in the water. The swimmer should be given a brief neurological exam to determine the extent of the injury. The swimmer should then be transported to an emergency facility in a rescue vehicle.

A triathlete has been complaining of knee pain for several months. She has never had an acute injury to the knee, but her training regimen is intense, involving three hours of training each day. She has been diagnosed by a physician as having chondromalacia patella. She has been referred to the athletic trainer for evaluation and rehabilitation. What can the athletic trainer do to help reduce the patient's symptoms and signs?

The athletic trainer should recommend that the patient reduce the length of her training sessions- in particular, limiting the running phase of training. Pain-free isometric exercises to strengthen the quadriceps and hamstring muscles can be used initially, and the patient can progress to closed kinetic chain strengthening exercises. Oral anti-inflammatory agents may also be helpful. A neoprene knee sleeve may also help modulate pain. Use of an orthotic device to correct pronation and reduce tibial torsion can sometimes help eliminate pain.

A construction worker has a history of numerous lateral ankle sprains. How can this patient reduce the incidence of these ankle sprains?

The athletic trainer should take a multifaceted approach to reducing ankle sprains. The individual should stretch his Achilles tendon to allow at least 10 degrees of dorsiflexion and should perform strength training on the peroneals, plantar flexors, and dorsiflexors. The individual should also perform proprioceptive training on a balance board. he should wear high-top shoes. Ankle taping with an orthosis can also be employed.

A soccer player complains of recurrent pain in the anterolateral region of the leg during practice and competition. The pain is described as an ache and a feeling of pressure. This condition is determined to be an exertional compartment syndrome. How should it be managed?

The conservative approach is to apply RICE and NSAIDs and rest. With weakness in the extension and numbness in the dorsal region, surgery may be warranted.

A patient who slipped on the ice and fell straight down on his knee is being evaluated by an athletic trainer. There is significant knee swelling. The swelling is found to be extra capsular and some redness is present on the knee. What is most likely this patient's injury? What tests can be used to evaluate the swelling?

The injury is most likely perpetually bursitis due to the extracapsular swelling pattern, redness, and the mechanism of injury. A possible fracture should be ruled out as well. Ballotable patella, or a sweep maneuver can be used to evaluate the swelling pattern to determine whether the swelling is intracapsular or extracapsular

What kind of nerve supply is in the ankle and lower leg?

The lower leg is supplied by the common peroneal nerve anteriorly; the common peroneal branches into the superficial peroneal nerve and the deep peroneal nerve; the tibial nerve runs posteriorly and supplies the ankle and the foot

A maintenance worker jumps down off a ladder and lands on a hammer, forcing her ankle into dorsiflexion and external rotation. What type of injury is sustained by this mechanism? What is a characteristic sign of this injury?

The mechanism describes a syndesmotic ankle sprain. The patient experiences severe pain in the anterolateral leg region when the ankle is externally rotated.

A maintenance worker stepped down off a ladder and hurt his knee. He is diagnosed by a physician as having a torn medial meniscus. On evaluation, McMurray's test was positive, and a subsequent MRI revealed a longitudinal bucket-handle tear in the posterior horn of the medial meniscus. What are the typical mechanisms of injury that can result in a tear of a meniscus?

The most common mechanism the weight bearing combined with a rotary force while the knee is extended or flexed. A large number of medial meniscus lesions are the outcome of a sudden, strong internal rotation of the femur with a partially flexed knee while the foot is firmly planted. Another way a longitudinal tear occurs is by forceful extension of the knee from a flexed position while the femur is internally rotated. During extension, the medial meniscus is suddenly pulled back, causing the tear.

What is the movement process of the foot that involves the stance phase and the swing phase?

The normal gait

A football running back receives a hard, low tackle. he hears a loud pop and feels a sharp pain in his right lower leg. Weight bearing is impossible. In this situation, what type of injury is suspected?

The patient has sustained a lower leg fracture. The most common site is in the middle third of the fibula.

A wrestler is thrown to the mat and suffers an open fracture of both the radius and the ulna in the forearm. There is significant bleeding from the wound. The patient begins to complain of light-headedness, his skin is pale and feels cool and clammy, and his pulse becomes rapid and weak. What potential problem may be developing, and how should the athletic trainer manage the situation?

The patient may be going into hypovolemic shock secondary to hemorrhage and trauma, which can be a life-threatening situation. The athletic trainer should first direct someone to dial 911 to access the emergency medical system. Next, the athletic trainer must control the bleeding by using direct pressure, elevation, and pressure points. If bleeding is controlled and the rescue squad has not arrived, the forearm should be immobilized in a rapid vacuum immobilizer. The patient should be supine, and his feet should be elevated in the shock position. His body temperature should be maintained.

A male soccer player cuts for the ball and injures his right ankle. He describes a hyperdorsiflexion mechanism of injury. X-rays were negative for this injury. What is this athlete's injury? What are special considerations with this injury?

The patient most likely has a syndesmotic sprain or sprain of the distal tibiofibular ligaments. This is commonly referred to as a high ankle sprain. This injury may take longer to heal compared with an inversion or eversion ankle sprain.

A tennis player sustains a grade 2 ligament sprain of the lateral ankle while making a sudden stop. Assuming good immediate care was carried out, how should this condition be managed 10 days after injury?

The patient should continue to wear a stirrup brace for one to three more weeks. Taping at 90 degrees will be conducted for two to four weeks. The patient should engage in pain-free plantar flexion and dorsiflexion exercises and proprioceptive exercises on a balance board.

P (Plan)

The plan should include the first-aid treatment rendered to the patient and the athletic trainer's intentions relative to disposition

A police officer who stands on his feet many hours a day complains of severe intermittent pain in the region between the third and fourth toes of the left foot. Inspection reveals that the pain radiates from the base to the tip of the toes. There is numbness of the skin between the toes. What is this condition and how should it be conservatively managed?

The police officer has a Morton's neuroma. Conservatively, it is treated by having the patient wear a broadtoed shoe, a transverse arch support, and a metatarsal bar or teardrop pad.

systolic blood pressure

The pressure caused by the heart's pumping.

diastolic blood pressure

The residual pressure when the heart is between beats.

A novice and poorly conditioned recreational runner with pes caves experiences pain and discomfort in the lower third of the left lower leg after three weeks of running. The pain and discomfort become more intense immediately after running. An X-ray shows the beginning of a stress fracture. How should it be managed?

The runner should avoid stressful locomotor activities for at least 14 days and can engage in bicycling and swimming if pain free. Running can be resumed after a pain-free period of two weeks.

What are accessory motion tests?

The testing of accessory motions- the manner in which one articulating joint surface moves relative to another

Following a grade I ligament sprain of the ankle, a patient is rehabilitating his injury. What would be an appropriate progression for him to use to get from non-weight bearing to sprinting?

The typical progression begins when the patient becomes partially weight bearing. Full weight bearing should be started when ambulation is performed without a limp. Walking may begin as soon as ambulation is pain free. The patient then progresses to running on a smooth, flat surface- ideally, a track. Initially, the patient should jog the straights and walk the curves and then progress to jogging the entire track. The cutting sequence should begin with circles of diminishing diameter, figure eighths, and crossover or side steps. Jumping and hopping exercises should be started on both legs simultaneously and gradually reduced to only the injured side.

What is the one collateral ligament stress test?

Valgus and varus

What are anthropometric measurements?

These include osteometry (measurement of the dimensions of the skeletal system), skin-fold measurements to determine body composition, and height and weight measurements.

What are motor tests?

These tests are done by evaluation strength in muscles that are innervated by a specific nerve root level to test neurological functioning of that nerve root.

What should be done at least once a year regarding athletic trainers and EMT staff?

They should have practice sessions to be held at least once a year.

S (Subjective)

This component includes the subjective statements provided by the injured patient

A professional male soccer player is complaining about pain in the toes. Upon inspection, the athletic trainer observes that the second and third toes are heavily callused on the dorsal surface and on palpation realizes that the toes are stuck in a flexed, or clawlike, position. What is this condition, and what steps can be taken to correct this problem?

This condition could be either hammertoes, mallet toes, or claw toes. It is likely that this condition developed from years of wearing shoes that were too tight or small. The athletic trainer could try padding the toes and recommend that the player wear a pair of shoes that has a larger toe box for the rest of the season. It is likely that, to permanently correct this problem, the soccer player will have to have surgery after the season.

A dancer complains to the athletic trainer of swelling, tenderness, and arching in the head of the first metatarsophalangeal joint of her left foot. On inspection, the athletic trainer observes that the great toe is deviated laterally. What is this condition commonly called, and why does it occur?

This condition is a bunion, or hallux values deformity. It is associated with wearing dance shoes that are too pointed, narrow, or short. It may begin with an inflamed bursa over the metatarsophalangeal joint. It can be associated with a depressed transverse arch or a pronated foot.

What's most critical in an emergency situation?

Time

A distance runner is experiencing pain in the left arch. There is palpable tenderness in the left foot's aponeurosis, primarily in the epicondyle region of the calcaneus. What condition does this scenario describe, and how should it be managed?

This condition is characteristic of a plantar fascial strain. It should be managed symptomatically. A doughnut placed over the epicondyle region, a heel lift, and a shoe with a stiff shank may relieve some pain. The patient should stretch the plantar muscles and gastrocnemius and perform arch exercises. Application of LowDye taping for pronation can also relieve pain.

A 35-year-old racquetball player, while moving backward, experiences a sudden snap and pain in the left Achilles tendon. What type of injury does this mechanism describe, and how should it be examined?

This injury is a possible partial or complete rupture of the Achilles tendon. The athletic trainer should look for pain that eventually subsides, an inability to perform a toe raise, point tenderness, swelling, discoloration, an obvious indentation at the tendon site, and a positive Thompson test.

A lacrosse player carrying the ball attempts to avoid a defender by planting his right foot firmly on the ground and cutting hard to his left. His knee immediately gives way, and he hears a loud pop. He has intense pain immediately, but after a few minutes he feels as if he can get up and walk. What ligament has most likely been injured? What stability tests should the athletic trainer do to determine the extent of the injury to this ligament?

This mechanism is typical for a sprain of the anterior cruciate ligament (ACL), although other ligamentous, capsular, and meniscal structures may be injured as well. Appropriate stability tests for the ACL include the anterior drawer test done in neutral, internal, and external rotation; the Lachman test; the pivot-shift test; the jerk test; and the flexion-rotation drawer test.

A gymnast is 4 months post-anterior cruciate ligament (ACL) reconstruction. She was last seen in the clinic three months ago prior to leaving for summer vacation. She has returned for the beginning of classes and visits the athletic trainer to see what kind of activities she should be doing in her rehabilitation program. To generate a progress note, what type of information does the athletic trainer need to know?

To ensure that the progress evaluation will be complete, the athletic trainer needs to go through history, observation, palpation, and specific testing. The patient should be asked pertinent questions, such as "What types of exercises have you done for the past three months?" and "What type of pain, if any, are you still experiencing?" Observation of the symmetry to the other knee and palpation of the injured structures should be done. Range of motions, muscle strength, joint stability, and neuromuscular control should also be assessed.

What basic knowledge requirements are required of athletic trainers for evaluation?

To examine sports injuries, the athletic trainer must have a thorough knowledge of human anatomy and its function and of the hazards inherent in a particular activity

What are the best methods to handle external bleeding?

Use direct pressure, elevation, or pressure points.

A tennis player injures her knee during a match. As she hits a forehand stroke, her knee is in full extension and she feels pain in it as she rotates on the follow-through. She feels some diffuse pain around her knee joint and is concerned that she has sprained a ligament. In a position of full extension, which of the supporting ligaments are taut? Which ligaments are most likely to be injured in this position?

When the patient is weight bearing with the knee in full extension, the femur is internally rotated relative to the tibia and is "locked" in this position. The collateral, the cruciates, and the capsular ligaments are tightest in full extension and tend to become more relaxed when moving into flexion. It is possible to injure any of the ligaments in full extension. The posterior cruciate has the least chance of being injured when the knee is fully extended.

When should you always splint?

Whenever a fracture is suspected, always splint before moving.

neuroma

a bulging that emanates from a nerve

exostosis

benign bony outgrowth, usually capped by cartilage, that protrudes from the surface of a bone

What muscles are used for external rotation of the tibia?

biceps femoris

What muscles are used for knee flexion?

biceps femoris, semitendinosus, semimembranosus, gracilis, sartorius, gastrocnemius, popliteus, and plantaris muscles

obstructed

blocked airway caused by either partial or complete obstruction

hemarthrosis

blood in a joint cavity

apophysis

bony outgrowth to which muscles attach

genu varum

bowleg

biomechanics

branch of study that applies the laws of mechanics to living organisms and biological tissues

Automated external defibrillator (AED)

device that evaluates heart rhythm of a victim of sudden cardiac arrest

Goniometric measurement of joint range

device that measures active or passive joint movement from 0 to 180 degrees; has two arms, one stationary and one movable one

Digital inclinometer

device that measures the slope of elevation or the angle of movement relative to gravity

genu recurvatum

hyperextension at the knee joint

bursa

fluid-filled sac or saclike cavity, especially one countering friction at a joint

diagnosis

identification of a specific condition

What muscles are used as a dynamic lateral stabilizer?

iliotibial band on the lateral side

apophysitis

inflammation of an apophysis

A female patient with no history of knee injury comes to the athletic trainer, complaining of knee pain. She has pain while ascending or descending stairs and when squatting. Her major complaint is recurring episodes of painful pseudolocking of the knee when she sits for a period of time. There is little or no swelling and no ligamentous laxity. A palpable tenderness begins on the medial wall of the knee joint and extends downward into the infrapatellar fat pad. As the knee passes 15 to 20 degrees of flexion, a snap may be felt or heard. Based on the findings of the evaluation, what might be causing these symptoms and signs?

it is likely that the patient inflamed or irritated mediopatellar place. The mediopatellar place may be thick, nonyielding, and fibrotic, which can cause a number of symptoms. The presence of an inflamed mediopatellar plica is sometimes associated with chondromalacia of the medial femoral condyle and patella

active range of motion (AROM)

joint motion that occurs because of muscle contraction

genu valgum

knock-knee

hyperventilation

labored breathing

Initial heel strike while running involves the _________ aspect of the foot with ________ joint in supination

lateral; subtalar

Manual muscle testing

literal manual movement of joints by patient or athletic trainer

supine

lying face upward

passive range of motion

movement that is performed completely by the examiner

sign

objective evidence of an abnormal situation within the body

metatarsalgia

pain in the ball of the foot

point tenderness

pain produced when an injury site is palpated

patella baja

patella more inferior

patella alta

patella more superior

sequela

pathological condition that occurs as a consequence of another condition or event

prognosis

prediction as to the probable result of a disease or an injury

What muscles are used for knee extension?

quadriceps muscle of the thigh, consisting of three vasti- the vastus medialis, vastus lateralis, and vastus intermedius- and by the rectus femoris

tachypnea

rapid breathing

translation

refers to anterior gliding of tibial plateau

RICE

rest, ice, compression, elevation

illotibial band friction syndrome

runner's knee

pathology

science of the structural and functional manifestations of disease

dermatome

segmental skin area innervated by various spinal cord segments

kinetic chain

sequence or chain of events that take place in order for an athlete to throw

bradypnea

slow breathing

Korotkoff sounds

sounds heard through the stethoscope

taut

stretched or pulled tight, not slack

ankle mortise

talocrural joint formed by the tibia, fibula, and talus

apnea

temporary cessation of breathing