Medbridge Test Review
Exercise-induced asthma:
Is triggered by cooler and dryer air drawn into the lungs Reason: This is felt to be the pathology behind EIA. With increased volume of air passing over the mucus membranes, the surfaces change and set up bronchospasm.
You are analyzing your athlete's overhead throwing. He reports medial elbow pain in the late arm cocking and early acceleration phases. You suspect an ulnar collateral ligament sprain/insufficiency. Which test has the best sensitivity and specificity?
Moving valgus stress test Reason: Sensitivity 100%, specificity 75%.
A player's shin guards don't fit correctly, and the coach is concerned about further injury. He recommends adjusting the straps since the new shin guards are too long. As the sports physical therapist, you advise the coach that equipment modification is only allowed in the following situations:
Only with the written consent of the manufacturer Reason: Equipment manufacturers do not like for their equipment to be modified due to the risk of litigation.
The patient returns three days later with continued neck pain and is unconcerned that he has numbness and tingling into his right hand, thumb side. At this point you are considering imaging. Which modality would you order?
Plain X-ray Reason: X-rays are always considered first-line imaging modality of choice for cervical spine injuries, according to Canadian C-Spine Rule and ACR guidelines.
You are analyzing your athlete's overhead throwing. He reports elbow pain during the acceleration and deceleration phases. What is the likely diagnosis that may be contributing his elbow pain?
Triceps tendinitis Reason: During these throwing phases, the elbow is extending from a flexed postion. This motion puts higher strain on the area, and there is high EMG activity with both the biceps and triceps muscles.
In preparation for the event, what is the appropriate preactivity hydration?
17-20 oz three hours prior to the event and 7-10 oz every 10-20 minutes during the event
Partial meniscectomies appear to be a much better procedure than complete meniscal removal as we've come to appreciate the role of the meniscus. However, the impact of a partial meniscectomy with removal of some (~20%) inner avascular portion of the medial meniscus creates an increase in articular cartilage contact pressure by:
350% Reason: Correct. There is approximately a ~350% increase in articular cartilage contact pressure, which is very concerning. Interestingly, our recent data indicates that attempting to fix tears is valuable but that it is not always the best answer as attempting very complex repairs is not uniformly successful.
You embark on additional questions about other aspects of her medical history. You come to find out that she has not yet begun to menstruate after recently turning 14. Her mother reports that she herself began menstruating at age 13 and has been regular, effectively ruling out a familial cause. Which of the following is a predisposing factor for the female athlete triad that is of concern in this athlete?
A medical history that she has not yet started her menstrual period Reason: Delayed menarche is a direct predisposing factor. All others are tangential to the triad presentation and injury potential for this athlete.
A 14-year-old pitcher comes into your clinic complaining of vague global shoulder pain and arm fatigue with throwing. Considering the phases of throwing, during what phase of throwing are the most forces imparted to the shoulder?
Deceleration Reason: During the deceleration phase, the compressive force = 1,100 N, the posterior shear force = 400 N, hor abd torque = 100 N⋅m, and BW = 900 N or approximately 200 lbs. These forces are greater than any other phase of throwing. [Escamilla, R., Fleisig, G., Barrentine, S., Andrews, J., & Moorman, C. (2002). Baseball: Kinematic and kinetic comparisons between American and Korean professional baseball pitchers. Sports Biomechanics, 1(2), 213-228.] [Fleisig, G. S., Barrentine, S. W., Escamilla, R. F., & Andrews, J. R. (1996). Biomechanics of overhand throwing with implications for injuries. Sports Medicine, 21(6), 421-437.
You are the sports medical professional assigned to ABC University. Your player is a 20-year-old volleyball player who comes to you complaining of light-headedness, dizziness, blurred vision, leg pain, and cramping in the LEs associated with off-season high-intensity conditioning practice. Which of these complaints would be most likely to indicate the possibility of sudden cardiac death (SCD)?
Dizziness Reason: Correct. This is an indication that not enough oxygenated blood is getting to the brain.
The ACL/MCL-injured individual often provides some additional concerns in postoperative management. Frequently this revolves around the role of the MCL. When the ACL/MCL patient has had surgery, after regaining ROM (about 3-4 weeks), early postoperative focus will typically:
Follow the ACL protocol and some additional early additional attention to knee flexion Reason: Correct. You use the ACL protocol but also watch for possible flexion issues with the healing MCL. This often presents in the individual who is less flexible, and in a contact injury more than in a noncontact injury.
A player falls on his right shoulder during a soccer match. He comes to you on the sidelines with his arm hanging loosely at his side. Considering the relative severity of these injuries, what is your primary concern?
Fracture of humerus or clavicle Reason: The primary concern of the sports medicine provider on the sidelines should be to suspect the worst first. The worst in this case would be a fracture of the clavicle or humerus.
Your patient is a 27-year-old male triathlete transitioning from a sprint to Olympic-distance race. As he has ramped up his training to prepare for the increased distances, he has noted a total lack of energy, difficulty sleeping, and difficulty completing his workouts in the building phase of training. When considering the attempt to lose weight and other complaints, you feel the need to consider additional nonmusculoskeletal issues. Which of the following is important for the sports PT to probe or investigate regarding nonmusculoskeletal issues?
If the patient can verbalize all macronutrients that form a correct diet Reason: This is a more general question that helps the PT discern how much assistance and dietary intervention may be needed. An athlete that can verbalize all the macronutrients that form a correct diet and how they get those nutrients may need less help than someone who cannot verbalize the types of macronutrients.
Your patient is a 19-year-old male collegiate soccer player who is 16 weeks post left ACL reconstruction (patellar tendon-bone graft from ipsilateral side). The athlete has full range of motion, full strength on manual muscle testing, and no joint edema, but he continues to have quad and hamstring atrophy. The prescribing physician has given the clear for the patient to begin running and performing more dynamic activity. You want to begin a plyometric program with this athlete. What type of plyometric might you start with?
Rapid response Reason: This has small amplitude, which is relatively safe for most people to begin with.
You are assigned to cover a local spring soccer game. The temperature is in the mid 80s, and the humidity is 60%. In preparation for the event, what fluids should you plan to have on the sidelines?
Reason: Athletes tend to drink what is most favorable to them individually.
Nail bed injuries can occur in all sports from direct blows to the end of the finger. If a significant volume of blood collects under the nail, the best response would be:
Recommend X-rays to determine if there is a fracture Reason: Correct. With blood collection under the nail, presence of a fracture would dictate that the fracture be treated as an open fracture.
You see an athlete make helmet-to-helmet contact while trying to make a play against an opponent during a lacrosse game where you are providing emergency coverage. While performing a sideline assessment for concussion, you ask the athlete the details leading up to the event of injury. Likewise, you ask her if she remembers arriving to the game and what she did after arriving at the field today. By asking these questions, you are assessing for what type of impairment?
Retrograde amnesia Reason: Correct. Retrograde amnesia is loss of memory leading up to the injury.
Joshua is a college lineman who is s/p distal humerus fracture. At what stage of fracture healing is light strengthening initiated and use of dynamic wrist splint implemented?
Soft callus Reason: At 3-4 weeks, the fracture site is stable enough to use dynamic or static splint and to initiate light strengthening.
Testicular torsion is a potential surgical emergency. Which of the following signs or symptoms are consistent with testicular torsion?
Swelling in the testicle without known trauma Reason: Swelling in the testicle without known trauma is a hallmark of testicular torsion.
A composite score of at least four out of the five diagnostic criteria being positive has a specificity of 96% in regard to diagnosing mensical pathology. Which of the following is not a part of the criteria?
Trace effusion or larger Reason: Effusion grading is not part of the diagnostic criteria. [Logerstedt, D. S., Snyder-Mackler, L., Ritter, R. C., Axe, M. J., & Godges, J. (2010). Knee pain and mobility impairments: Meniscal and articular cartilage lesions. Journal of Orthopaedic & Sports Physical Therapy, 40(6), A1-597.]
The MCL was not repaired during the surgical procedure, and the patient is now three weeks from the time of injury and two weeks from the time of surgery. Which of the following are the correct ROM restrictions for a grade 3 MCL injury?
0-110 for the first three weeks Reason: ROM of 0-110 for the first three weeks is correct. [Adams, D., Logerstedt, D., Hunter-Giordano, A., Axe, M. J., & Snyder-Mackler, L. (2012). Current concepts for anterior cruciate ligament reconstruction: A criterion-based rehabilitation progression. Journal of Orthopaedic & Sports Physical Therapy, 42(7), 601-614.]
You have a client who is recovering from a high ankle sprain. The client has fundamental strength and is ready to begin a more intense training schedule. Based on this athlete's objectives, you decide you want to train relative power. What set/rep/time scheme would you prescribe?
1-10 reps, 0-10 seconds per set Reason: Correct. This set/rep/time scheme is used for relative power.
A player falls on his right shoulder during a soccer match. He comes to you on the sidelines with his arm hanging loosely at his side. Evaluation of this player reveals that he has no indication of fracture of the clavicle or humerus and no complete dislocation of the A/C joint. He does, however, have some elevation of the distal clavicle with localized tenderness. You diagnose this as a grade 1 A/C joint sprain. Which of the following represents your criteria for return to play?
Ability to run, plant, and cut without pain Reason: Running has nothing to do with the A/C joint.
Which of the following surgical procedures is most likely to restore anteromedial and rotary stability of the tibiofemoral joint with the lowest risk of reinjury?
Anatomic autograft reconstruction Reason: Anatomic autograft reconstruction demonstrated anteromedial and rotatry stability following reconstruction. [Murawski, C. D., van Eck, C. F., Irrgang, J. J., Tashman, S., & Fu, F. H. (2014). Operative treatment of primary anterior cruciate ligament rupture in adults. The Journal of Bone and Joint Surgery-American Volume, 96(8), 685-694.]
Following radiographs, it was determined that no fractures were present in the ankle or foot. An subsequent MRI was performed, in which it was determined that the ATFL was partially torn and the calcaneofibular ligament was "stretched." Based on the MRI findings, which test would be positive, and what is the corresponding ankle sprain grade for this injury?
Anterior drawer, grade 2 Reason: According to Wolfe et al. (2001), grade 2 lateral ankle sprains are classified as the anterior talofibular ligament tearing partially and the calcaneofibular ligament stretching. This same article states that the integrity of the ATFL is assessed using the anterior drawer test, while the inversion stress test or the talar tilt test assesses the integrity of the calcaneofibular ligament.
Someone exposed to cold weather for an extended period of time has developed blisters on his fingers and toes. How would you treat the affected area?
Avoid breaking the blisters Reason: The sports medicine professional should avoid breaking the skin that is covering the blister in order to avoid fluid loss and exposing the area to possible infection.
A college soccer player is working with you. During your sessions, you learn that she tends to eat a lot of food at night and then engages in training above and beyond her typical practice the following day. As you listen, you think her training habits seem excessive and mostly occur after a night of heavy eating. You start to suspect that the patient might be expressing signs of:
Bulimia nervosa Reason: Bulimia nervosa is characterized as binge eating followed by some type of purge or compensatory behavior. This athlete's behaviors of binging at night followed by excessive exercise would qualify as the binge-purge pattern characteristic this disorder.
Your initial images come back as normal or inconclusive, yet you still suspect the same diagnosis. Which imaging modality would be most appropriate to order now?
CT scan Reason: According to ACR guidelines, CT scan gives the best visualization of occult bone pathology and fractures.
You are working with a client who is preparing for an upcoming marathon. The client is recovering from a herniated disk in her low back, which has made training difficult over the last several months. She is generally weak in the lower body due to the inability to exercise during her rehabilitation. What is it called when you are training one trait that may interfere with another trait being developed?
Concurrent training Reason: Correct, concurrent training is defined as the training of endurance and strength capacities at the same time or within a 24-hour recovery period. Development of one trait may interfere with the development of the other.
Maxwell is a 17-year-old male who sustained a right elbow injury six weeks ago during preseason high school tennis practice. SUBJECTIVE: Mechanism of injury: gradual onset He has had this pain in the past, but with rest it goes away. OBJECTIVE: Elbow exam: moderate soft-tissue tenderness to lateral epicondyle, no ecchymosis noted, no pain with full range of motion of elbow, pain with full range of motion of wrist. He is diagnosed with lateral epicondylitis. Which structures are most likely involved, in order of highest to lowest likelihood of occurrence?
ECRB, EDC, ECRL, ECU Reason: The order is based on the epidemiological data. The possible mechanism is the origin of those extensors that leads to shear stress when power is required for the elbow and hand region, e.g., tennis strokes.
A 35-year-old male hockey player has undergone arthroscopic hip surgery for femoroacetabular impingement, labral tear, and early osteoarthritis. Procedures performed include acetabuloplasty, labral repair, femoroplasty, synovectomy, and microfracture of both the acetabulum and femoral neck. The patient is present for his day 1 postoperative physical therapy assessment and treatment. Of the above noted procedures, which creates the most restrictive precautions/restrictions in order to allow for appropriate biological healing time?
Eight weeks of no more than 30 pounds weight-bearing due to microfracture Reason: The microfracture requires eight weeks of no more than 30 pounds weight-bearing to neutralize the joint forces and protect the healing microfracture site(s).
The multiple-ligament-injury patient presentation requires the surgeon to consider very unique challenges when the cruciate(s) is/are torn. As they have assessed outcomes, the value of returning the joint to as anatomically and biomechanically normal a state as possible has emerged. To date, the use of double-bundle cruciate reconstruction has led to:
Equivalent clinical outcomes to single-bundle surgery Reason: The results have been equivalent: cadaver studies point to possibly better rotational control but it has not resulted in any measurable clinical differences in live subjects.
Weakness of the infraspinatus would most likely result in a deficit of which upper extremity movements?
External rotation and extension of the humerus Reason: The infraspinatus does create extra location and adds to the extension of the humerus.
Because of challenges to intra-articular surgical procedures to reconstruct the anterior cruciate ligament, surgeons looked to other alternatives. These early difficulties included significant immobilization of the extremity postsurgery to protect the healing structures but also created secondary issues often resulting in significant loss of motion. One early solution to these challenges for anterolateral rotatory instability was the extra-articular or lateral capsular surgeries, which:
Failed as they attenuated over time Reason: Correct. They all failed as they were collagen-based tissues that were now attempting to function as primary restraints. Since the joint was not returned to a normal biomechanical state—in fact it was altered as a part of these surgeries—all of these surgeries failed. No ACL graft was used, but rather an extra-articular restraint was created. Because this tissue was being loaded, it attenuated over time.
Sean rested from pitching to go through rehab, with a focus on proper progression of an interval-throwing program. Pitching generates the greatest forces and torque versus football throwing. Which choice represents pitches in order from most to least forces and torque generated?
Fastball, curveball, slider, changeup Reason: Based on epidemiological data, the fastball and curveball require more rotational movements, so more forces and torque are generated.
Your 25-year-old female patient presents with insidious intermittent pain in the gluteal region. She denies any history of injury. You suspect that your patient may be suffering from soft-tissue muscle dysfunction. Which of the following tests would you suspect to be positive?
Freiberg's test Reason: Passive internal rotation of the extended hip places tension on the piriformis, which would result in a positive Freiberg's test.
A 15-year-old male cross-country runner collapses in the last 400 meters of a 5K high school cross-country meet. As the event's covering sports physical therapist, you respond to the runner, who is struggling to get up to finish the race. The athlete is flushed and breathing rapidly. He denies your offer of assistance, and he slowly shuffles to the finish line. Immediately after finishing, he drops the ground in the finishing chute. He is still gasping for air several minutes later. His singlet appears wet, but the skin on his face looks dry. He grabs his legs and states he is cramping everywhere. You assist him out of the chute to clear him from incoming runners and to examine him. Your next step should be:
Give him water to treat him for dehydration Reason: Cramping and hypohidrosis are consistent with dehydration. This would be a reasonable result of running in a cross-country race if not properly hydrated.
In discussions with the athletic administration, the legal aspects of the preparticipation physical exam are discussed in detail. The administration has worked in schools for years and recognize that FERPA is important. HIPAA, the rules and regulations related to the transmission of health-related information that can identify individuals, is also important. Which of the following statements applies regarding preparticipation physical exams?
HIPAA rules apply in this situation just as they would for any medical contact in the clinic Reason: Correct. These rules and regulations apply for any medical contact in the clinic or outside the clinic.
During the on-field evaluation, the athlete reports pain with AROM, especially into inversion. He has pain with palpation over the anterior talofibular ligament and the calcaneofibular ligament. He has a negative syndesmotic squeeze and a negative tibial external rotation test. Which of the following is the best chooice for initial management of this individual?
Ice and AROM exercises, WBAT with crutches Reason: Through RICE and AROM is indicated for lateral ankle sprains, according to BMJ 2010, NWB after a lateral ankle sprain is not ideal for managing grade 1 and grade 2 ankle sprains. This article also suggests that early mobilization is beneficial for the long-term prognosis. Calling EMS would not be necessary for this type of injury. [Bleakley, C. M., O'Connor, S. R., Tully, M. A., Rocke, L. G., MacAuley, D. C., Bradbury, I., Keegan, S., & McDonough, S. M. (2010). Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ, 340(May 10 1), c1964-c1964.]
Folliculitis is an infection of the hair follicle base. Hot tub folliculitis is important to recognize as a specific infection because:
It is caused by Pseudomonas aeruginosa, requiring specific antibiotics for treatment Reason: Correct. The infection is caused by this very specific organism, which requires very specific antibiotics.
You are covering a collegiate wrestling match being held over the weekend. A wrestler comes to the sideline holding his right shoulder in pain. You suspect he experienced some kind of subluxation or dislocation. You suspect he had a posterior subluxation or dislocation.What tests would be best to determine the extent of his injury?
Jerk test and Kim test Reason: The jerk test and the Kim test have the best statistical utility data that met the proposed posttest probability parameters. Posttest probabilities for these tests are 94.8% and 86.9%, respectively. The posttest probabilities that the patient will exhibit posterior/posterior-inferior glenohumeral instability and/or a labral lesion when the above tests do not indicate such are respectively 12.3% and 9.5%. Special tests that have reported data for posterior/posterior-inferior instability and labral lesion tests that fail to consistently meet the diagnostic threshold for use in this study include the posterior slide test and the posterior load and shift test. Load and shift tests, when positive, are extremely predictive for instability (LR > 80), but when absent are poor at ruling out posterior and inferior instability. [Biederwolf N. E. (2013). A proposed evidence-based shoulder special testing examination algorithm: Clinical utility based on a systematic review of the literature. International Journal of Sports Physical Therapy, 8(4), 427-440.] [Tzannes, A., & Murrell, G. A. C. (2002). Clinical examination of the unstable shoulder. Sports Medicine, 32(7), 447-457.]
As you proceed with your exam, you notice he is tender to palpation around the shoulder. At which location would tenderness heighten your concern?
Lateral aspect of the proximal humerus Reason: Physical examination revealed tenderness to palpation over the proximal humerus in 20 patients (87%), with 16 (70%) demonstrating specific tenderness over the lateral aspect of the proximal humerus. Swelling, weakness, atrophy, and loss of motion were uncommon findings. [Carson, W. G., Jr, & Gasser, S. I. (1998). Little Leaguer's shoulder. A report of 23 cases. The American journal of sports medicine, 26(4), 575-580.]
An amateur skier lost control and impacted with a fence last Friday night. She felt a blow to her lower rib cage on the right side. She comes into the clinic complaining of right-sided rib pain and is concerned that she may have a rib fracture. She reports that she has heard that not much can be done for a rib fracture, so she did not even bother going to the emergency room for an X-ray. What is the most likely abdominal organ to be injured by a direct blow to the right upper quadrant?
Liver Reason: The liver is positioned in the abdomen in the right upper quadrant and is obviously a risk with direct contact in this region.
Posterior instability can also be associated with which of the following? (Choose the BEST answer.)
MDI Reason: In a study by Tibone and Bradley (1993), a 40% failure rate was related to ligamentous laxity and unrecognized multidirectional instability not treated at the time of surgery. Capsular laxity is the most common pathologic finding per Pollock and Bigliani (1993). [Tibone, J. E. & Bradley, J. P. (1993). The treatment of posterior subluxation in athletes. Clinical Orthopaedics and Related Research (291), 124-137.] [Pollock, R. G. & Bigliani, L. U. (1993). Recurrent posterior shoulder instability. Diagnosis and treatment. Clinical Orthopaedics and Related Research (291), 85-96.]
What would you order if you were certain he was stable with ligamentous exam and you were more concerned about an OCD lesion?
MRI Reason: This may be an appropriate intervention; however, we are not given any information regarding the mobility of the thoracic spine.
Your patient complains of anterior hip pain radiating into the L3 dermatome. You suspect an anterior acetabular labral tear as the potential anatomical reason for the patient's complaint. Which of the following diagnostic tests would be the most sensitive in detecting this pathology?
Magnetic resonance arthrography Reason: Magnetic resonance arthrography has a much greater sensitivity (8% false negative), which is a valuable indicator of clinically relevant pathology, most specifically soft-tissue injury such as labral pathology.Magnetic resonance arthrography
Beth is a regular patient who has grown comfortable enough with you to discuss her weekend plans and activities. Frequently, she talks about how she and her college roommates go to parties on the weekends. She often mentions how she is excited to get "messed up" this weekend, and she reports the next week how crazy it was and that she couldn't remember periods of the night. In fact, she elaborates on how she and her roommates have fun trying to piece the timeline together after a party night. You suspect that a patient is struggling with substance abuse. You can support this individual by:
Making a mental health referral and following up with it Reason: This is a great intervention, as is encouraging discussion with family members and expressing your sincere concern.
A collegiate athlete presents to the preseason physical examinations with a note from her primary care physician regarding a new murmur that was discovered over the summer. The note clears the athlete to resume sports activity with no restrictions. The most likely diagnosis allowing this athlete to play would be:
Mitral valve prolapse Reason: Mitral valve prolapse is relatively common and is a valvular disorder that can create a new-onset murmur. Many of these athletes will be cleared to resume physical activity with no restrictions.
Which of the following statements regarding nerve conduction study (NCS) is correct?
NCS determines how fast and how well a nerve responds to stimulation Reason: NCS assesses the response of a nerve to stimulation and how fast and how well it responds.
He decides to have surgery when the season is over. When do you expect him to return to competition?
Nine months Reason: Postoperatively he may expect to return to play at nine months. [Ward, J. P., & Bradley, J. P. (2013). Decision making in the in-season athlete with shoulder instability. Clinics in Sports Medicine, 32(4), 685-696.]
Your patient is a 19-year-old male collegiate soccer player who is 16 weeks post left ACL reconstruction (patellar tendon-bone graft from ipsilateral side). The athlete has full range of motion, full strength on manual muscle testing, and no joint edema, but he continues to have quad and hamstring atrophy. The prescribing physician has given the clear for the patient to begin running and performing more dynamic activity. You decide to initiate a rapid-response plyometric program with the patient. When initiating long-response plyometric movements for the first time with your patient, which type of execution will you begin with?
Noncounter movement Reason: Correct. A noncounter movement is the easiest to teach as it takes out the eccentric component of the movement. This is a good type of movement to begin with.
The best diet for this athlete who is trying to lose weight but increase performance would focus on which of the following?
Observing suggested % distribution of macronutrients while choosing excellent food sources Reason: Focus on food choices and general information consistent with scope of practice for PT rather than getting into specific percentages, recommendations, etc. that should be reserved for a registered dietician.
Curtis is a 16-year-old male pitcher for a high school baseball team who sustained a right elbow injury two weeks ago. SUBJECTIVE: Mechanism of injury: unsure Patient has had this pain in the past, but with rest it goes away. Two days ago he was pitching in a game and it hurt acutely near the medial aspect of the elbow. OBJECTIVE: Elbow exam: medial epicondylar tenderness and soft-tissue tenderness just distal to medial epicondyle, no ecchymosis/effusion noted, no pain with full range of motion of elbow, pain with full range of motion of wrist, and no olecranon tenderness. Which structures are likely involved?
PT, FCR Reason: Pronator teres and flexor carpi radialis are the main tendons along the medial aspect of the elbow. When they are activated, they assist in minimizing valgus stress to the medial elbow region.
What adaptations to your football team's strength and conditioning program would be most appropriate to help you prevent these back injuries in healthy athletes?
Perform dynamic functional activities in various positions that challenge the strength and endurance of the core musculature to resist lumbar spine extension, rotation, and lateral flexion Reason: Core muscle performance in sport should be able to appropriately stabilize the spine and limit the degree of rotation of the trunk, maintain optimal alignment and movement relationships between the pelvis and spine, and prevent excessive stress and compensatory motions of the pelvis during movements of the extremities. Football players, especially offensive linemen, undergo high amounts of AP shear forces, lateral shear forces, and compressive forces that can lead to injuries and cost a mean loss of playing time of more than half the season. The above program design that most appropriately addresses the function of the core in sport is answer C. Answer A details a progressive plan that would be more appropriately suited for rehabilitation addressing spinal instability at low levels of intensity and movement, which is not appropriate for a healthy football player. Answer B details a core strengthening program to improve the core's ability to produce force through movement, rather than resist movement, which would be more appropriate for throwing sports.
Approximately 2 weeks after the injury, the athlete reports to the clinic with an 8-degree loss of active and passive dorsiflexion with the knee flexed and extended when compared to the uninvolved ankle. Overpressure causes pain after the resistance is met. Which of the following mobilization techniques will be the most effective in helping this athlete regain his dorsiflexion ROM?
Posterior talocrural mobilization with the foot in dorsiflexion Reason: Since pain is experienced after resistance is met with overpressure, the athlete can be taken into dorsiflexion for this mobilization. If pain were to be experienced before end range, then mobilizations would be indicated in the resting position. With regard to the directions of the mobilizations, the convex-concave rule of the ta
You come to the conclusion that the athlete has Little League shoulder. When would you return him to play?
Return to play should be based on time Reason: A three-month period of rest is recommended, which correlates with bony healing timelines. Then it is recommended to initiate a throwing program. [Osbahr, D. C., Kim, H. J., & Dugas, J. R. (2010). Little league shoulder. Current Opinion in Pediatrics, 22(1), 35-40.] [Carson, W. G., Jr, & Gasser, S. I. (1998). Little Leaguer's shoulder. A report of 23 cases. The American journal of sports medicine, 26(4), 575-580.]
Your patient is a 26-year-old runner who presents with hip pain. Upon examination of the patient, you notice that the pelvis drops on the right side during the midstance portion of gait. What exercises should you have your patient focus on?
Right sidelying hip abduction Reason: This exercise targets the left gluteus medius, which is the muscle that is the primary stabilizer to control against right-side pelvic hip drop in the midstance portion of gait.
The athlete has been progressing well in postoperative management and is cleared to begin jumping tasks. You note frontal and sagittal plane deviations during a jump landing task. Which of the below has not been associated with increased ACL injury rates?
Sagittal knee flexion angles at initial contact Reason: Answers B, C, and D have been shown to increase risk of sustaining an injury to ACL. [Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., van den Bogert, A. J., Paterno, M. V., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: A prospective study. The American Journal of Sports Medicine, 33(4), 492-501.]
You are the sports physical therapist assigned to cover a high school football game. While watching the game, you watch a wide receiver catch a pass across the middle of the field and get hit in the chest by the helmet of the defensive back. The receiver goes down and holds onto the ball. The defensive back from your team is prone and not responding. The player from the other team regains consciousness and removes himself from the field without assistance. The other team doesn't have a health care professional on their sideline. The coach from the other team comes to you to inform you that his player is complaining of nausea, dizziness, and light-headedness and looks very pale. What do you suspect is the problem with the opposing player based on what his coach has told you?
Shock Reason: This athlete is showing classic signs and symptoms of shock, which are nausea, dizziness, light-headedness, and pallo
Given the findings on the examination, you are confident in your diagnosis of concussion and refer the athlete to her physician to order further imaging to rule out more substantial brain injury. The physician, her PCP who does not specialize in concussion or sports injury, reports no structural damage on the MRI and would like to clear the athlete for sport per the athlete's request to play in a game this Saturday. As the sports PT handling the case, what is your recommendation?
Since concussion is a functional injury to the brain, you recommend rest and academic accommodations to the athlete to allow for healing Reason: Correct. Concussion is functional, and she cannot begin a progression until she is symptom-free.
You have done a pre-participation screen on a 16-year-old female basketball player. The tests performed include the Functional Movement Screen, Lower Quarter Y-Balance Test, Upper Quarter Y-Balance Test, and injury history. According to the research, which of the following would be considered a passing test?
Star Excursion Balance Test composite reach distance greater than age/gender/sport risk cut point (in this case 94%) Reason: Plisky et al. found that female high school basketball players that scored less than the age/gender/sport-specific cut point were six times more likely to get injured. [Plisky, P. J., Rauh, M. J., Kaminski, T. W., & Underwood, F. B. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. The Journal of Orthopaedic and Sports Physical Therapy, 36(12), 911-919.]
Consider the classic unhappy triad of O'Donoghue: a blow to the lateral side of the weight-bearing extremity resulted in significant injury to the medial complex, which extended on to include the ACL. Classic teaching was that this resulted in MCL/ACL/medial meniscus. Shelbourne and Nitz clarified that it is better described as MCL/ACL and meniscal involvement. If the athlete also demonstrated a positive recurvatum test, what would this indicate? [Shelbourne, K. D., & Nitz, P. A. (1991). The O'Donoghue triad revisited: Combined knee injuries involving anterior cruciate and medial collateral ligament tears. The American Journal of Sports Medicine, 19(5), 474-477.]
Stretching/attenuation of the posterior lateral corner, the "capsule" Reason: Recurvatum shows the posterior capsule to be attenuated, allowing the knee to sag back into hyperextension and deviation into the posterior lateral corner /the lateral side. This requires that portion of the capsule to be attenuated.
The senior standout right-handed outside hitter from the local high school volleyball team is referred to your office with a diagnosis of shoulder impingement. She reports gradual weakening of her right shoulder during her summer travel season that did not improve with a month of rest in July. She denies a known injury or fall on her shoulder resulting in a pop or onset of pain. States that the first thing that she noticed was that her hitting power significantly decreased with an increase in training intensity. Upon further testing, you notice significant weakness of the supraspinatus and infraspinatus muscles; however, the teres major, teres minor, and subscapularis appear unaffected. What is the innervation of the supraspinatus and infraspinatus muscles?
Suprascapular nerve (C5, C6) Reason: The suprascapular nerve innervates both the infraspinatus and the supraspinatus. This nerve is a combination of the C5 and C6 nerve roots.
You are a sports certified specialist who is helping to cover a junior varsity football game when a receiver suffers a vicious spear tackle. You see him hobbling to the sideline and decide to check on him. The athlete has labored breathing and is bent over trying to catch his breath. He is complaining of pain while breathing. Following removal of his shoulder pads, you notice tenderness and crepitus over the lateral chest wall. Upon further examination and palpation, you note crepitus and paradoxical movement of the chest wall. He is continuing to complain of pain. The athlete is safely transported to the hospital, where it is discovered he has suffered a lacerated liver. When will the athlete be able to return to football?
The athlete should be held out of sports until normalization of liver enzymes Reason: There is currently no evidence to suggest a complete disqualification from contact sports following a return to baseline functioning. Normal anatomical healing times for liver injuries are estimated to be between thee and six months based on serial CT scans. However, normalization of liver enzymes is a better indicator of functional healing and may be the best determinant for clearance to return to play.
Your athlete is training for a marathon and has lots of questions about hydration, fluid choices, and timing schedules for hydration during his training and running competitions. You begin your conversation with informational/educational interventions. Which of the following statements about hydration is true?
Water is the most critical element consumed by the human, regardless of training status Reason: Without adequate intake of water, the human cannot exist.
Sickle cell anemia is a genetic disorder that alters the structure of hemoglobin. Which description most closely matches the cardiovascular collapse consistent with an athlete with sickle cell trait?
Worsening symptoms of shortness of breath and fatigue over several minutes Reason: The typical collapse with sickle cell trait occurs over several minutes, typically after a very hard exertional effort and often in warm conditions.
Methicillin-resistant Staph aureus is becoming more prevalent, and the frequency with which it is diagnosed in athletic populations is increasing. The best first-line treatment option while waiting for culture results for MRSA is:
ncision and drainage Reason: Correct. Sometimes incision and drainage is the only treatment required. This certainly is the first line of treatment if methicillin-resistant Staph aureus is considered.
