Answers to case studies
1. If and when there is a significant structural deformity to any body part, especially the femur, it is imperative that the patient be referred to the emergency room immediately. The femur is the strongest bone in the human body, and fractures to the femur can put a patient into immediate shock. Furthermore, a fractured femur can cause an obstruction of the femoral artery, which may be life threatening.
2a. Based on the information provided, this patient may be experiencing Patellofemoral Joint Pain or Osteoarthritis.
2b. All of the aforementioned injuries/conditions can be ruled out for this simple quadriceps contusion.
2a. Based on the information provided, this patient may be experiencing Patellofemoral Joint Pain or Osteoarthritis.
2b. All of the aforementioned injuries/conditions can be ruled out for this simple quadriceps contusion.
Answers to boc exam questions
1. B - The Q-angle is taken by first drawing an imaginary line from the anterior superior iliac spine, down the thigh and through the midpoint of the patella. A second line is drawn down the midline of the anterior thigh to the tibial tubercle. The angle created by the intersection of the two lines is then recorded. An angle greater than 20 degrees is abnormal, causing excessive genu valgus. Excessive genu valgus may lead to patellar problems in the athlete.
2. D - Shortening the stride during running may actually decrease the incidence of an overuse syndrome. Overstriding may result in a hamstring pull or knee pain.
3. C- As per universal precautions, the athletic trainer should always wear gloves when treating a bleeding athlete
4. C- Trendelenburg's test is used to test for gluteus medius weakness of the hip. The athlete is asked to stand on one leg for approximately 10 seconds and then switch to the other leg. If the pelvis on the unsupported side drops noticeably lower than the pelvis on the supported side, it is a positive finding (i.e., weakness of the gluteus medius on the supported side.
5. D - The varus stress test is used to test the integrity of the lateral collateral ligament of the knee. The athlete is asked to lie supine with the knee in full extension. The athletic trainer places his or her hand distally on the lateral ankle and the other hand proximally on the knee medially. With the ankle stabilized, a varus force is applied with the proximal hand. Lateral joint pain and/or increased varus movement with an absent or poor endpoint when compared to the uninvolved side are positive findings for a torn lateral collateral ligament.
6. B - The American College of Sports Medicine (ACSM) recommends that when performing flexibility exercises, a stretch should only be held 10 to 30 seconds -- only as long as it is comfortable -- to obtain optimal results.
7. B - The secondary stage of disease prevention focuses on early detection of an illness or disease and preventing or reversing progression of the disease.
8. E - Constant pain, insomnia, malaise, and fatigue are all considered red flags that should alert the athletic trainer to certain pathologies.
9. A - Ballistic stretching is not recommended.
10. E - Russian stimulation prevents atrophy by contracting the muscles
11. C - Tertiary prevention is the prevention of a chronic or debilitating illness or injury through appropriate care and rehabilitation.
12. A - Sag sign is positive for a torn posterior cruciate ligament when the tibial plateau sags posteriorly as the athlete is lying and the knee is flexed to 45 degrees, causing a sulcus just inferior to the inferior border of the patella of the affected leg.
13. A - An athletic trainer's initial evaluation of an injury should begin the moment the injury is witnessed or upon initial contact with the athlete or another individual who might have witnessed the injury.
14. C - The L5 nerve root innervates the extensor hallucis longus muscle.
15. D - Tactile information alone will not provide the athletic trainer with enough information to adequately assess the athlete's functional status. It is crucial that a well-planned, comprehensive evaluation is performed to assess all aspects of the athlete's condition prior to treatment.
16. A - The posterior tibial and dorsalis pedis pulses should always be palpated after an acute knee injury to ensure the peripheral circulation of the involved limb is intact.
17. E - Signs of inflammation include redness (rubor), pain (dolor), warmth (calor), and swelling (tumor).
18. D -Measuring the amount of motion available at a joint will provide the athletic trainer with no significant information regarding the neurovascular status of the injured limb.
19. A - To test the strength of the piriformis, the athlete should be sitting. The lower leg is resisted as the athlete attempts to externally rotate the hip.
20. B - The biceps femoris is tested with the athlete lying in the prone position. Knee flexion is then resisted with the tibia in full external rotation.
21. A - The SI nerve root innervates the posterior tibialis, plantaris, peroneus longus, and peroneus brevis muscles, which act to plantar flex the ankle and foot.
22. A - Hip abduction occur in the frontal plane.
23. E - The gastrocnemius muscle plantar flexes the foot and flexes the knee.
24. D - The rectus femoris muscle flexes the hip and extends the knee when it contracts.
25. B - The gluteus maximus externally rotates the hip.
26. C - The femoral nerve innervates the pectineus muscle, and the obturator innervates the adductor longus, magnus, brevis, and gracilis.
27. A - To test the gluteus medius in an antigravity position against resistance, the athlete must be side lying with the affected limb on top.
28. E - The average range of motion of the knee is 0 to 135 degrees.
29. C - To test the hip flexor musculature, the athlete should be sitting. The athletic trainer then applies a force down onto the anterior aspect of the thigh as the athlete resists the movement.
30. D - True leg length discrepancy is measure between the anterior superior iliac spine to the medial malleolus of the ankle.
31. A - A goniometer is the instrument most commonly used for measuring joint range of motion in the clinical setting. A goiniometer may come in a variety of shapes and sizes and may be made of metal or plastic.
32. C - Periostitis, myositis, tendinitis, or a combination of conditions may cause tenderness and pain with induration and swelling of the pretibial musculature of the athlete's lower leg. They may be classified as anterior or posteromedial "shin splints", depending on which group of structures are involved.
33. A - A physician is the only person who can legally diagnose a medical condition or problem.
34. D - Whether or not the athlete has medical insurance should not be an immediate concern of the athletic trainer during the history-taking portion of the initial evaluation. Only those pieces of information that assist the athletic trainer in developing a course of action or treatment plan for the athlete should be considered pertinent.
35. C - The L4 nerve root innervates the rectus femoris muscle and the vastus medialis, intermedius, and lateralis muscle, all of which extend the knee.
36. E - McMurray's test is used to test the knee for a tear in the medial or lateral meniscus with the athlete lying in supine. The knee is fully flexed , and the tibia is externally rotated with a valgus force and extended, or internally rotated with a varus force and extended. A palpable "click" is indicative of a positive test.
37. A - When the tibia is stabilized in an externally rotated position and a strong valugs force is applied, the medial collateral ligament, medial meniscus and anterior cruciate ligament are vulnerable to injury.
38. D - The iliotibial band moves back and forth over the lateral epicondyle of the femur as the knee is flexed and extended. If the iliotibial band is too tight or it overrides and rubs on the lateral epicondyle during downhill running, the bursa between the iliotibial band and epicondyle becomes inflamed. Pain is elicited as the knee is brought into about 30 degrees of flexion. A popping sensation is not a consistent finding with this syndrome.
39. B - Pain with resisted hip adduction and hip flexion with diffuse tenderness and ecchymosis of the medial thigh is indicative of a strain of the groin area.
40. C - With a rupture of the rectus femoris muscle, a large bulge is seen in the upper thigh, and there is pain along the entire muscle belly. Extension is limited because of the inability to contract the rest of the quadriceps musculature.
41. C - Burning pain with tenderness to palpation over the lateral epicondyle of the femur is associated with iliotibial band syndrome. If the iliotibial band is too tight, it will rub over this area during running, causing localized inflammation. Ober's test is appropriate for a tight iliotibial band.
42. E - The quadriceps musculature is innervated by the femoral nerve, which originates at the L2, L3, and L4 nerve levels.
43. A - The pes anserinus (sartorius, gracilis, semitendinosis) flexes the knee and will weakly internally rotate the tibia.
44. D - It is appropriate during the acute stages of a quadriceps contusion to apply ice to the injured area and put the knee into a slight amount of passive flexion to maintain the flexibility of the quadriceps muscle.
45. D - Shock after a severe injury can result from hemorrhage or stagnation of blood.
46. E - During emergency care of the unconscious athlete, the athletic trainer should make sure the athlete's airway is clear and he or she is breathing normally.
47. A - Applying pressure will minimize the bleeding. Keep the area clean with sterile saline or hydrogen peroxide; apply Steri-Strips for temporary closure, and use ice and a compressive dressing to minimize further bleeding. Refer the athlete to the physician for sutures, if necessary.
48. D - With a suspected fracture of the knee joint or of the surrounding area, the splint should stabilize all the lower limb joints and one side of the trunk.
49. A - The brace should be adaptable to a variety of anatomic shapes and sizes. Not all prophylactic braces need to be custom-molded to achieve this goal.
50. D - Most often a "pop" is associated with an anterior cruciate ligament injury and less frequently with a subluxed patella.
2. D - Shortening the stride during running may actually decrease the incidence of an overuse syndrome. Overstriding may result in a hamstring pull or knee pain.
3. C- As per universal precautions, the athletic trainer should always wear gloves when treating a bleeding athlete
4. C- Trendelenburg's test is used to test for gluteus medius weakness of the hip. The athlete is asked to stand on one leg for approximately 10 seconds and then switch to the other leg. If the pelvis on the unsupported side drops noticeably lower than the pelvis on the supported side, it is a positive finding (i.e., weakness of the gluteus medius on the supported side.
5. D - The varus stress test is used to test the integrity of the lateral collateral ligament of the knee. The athlete is asked to lie supine with the knee in full extension. The athletic trainer places his or her hand distally on the lateral ankle and the other hand proximally on the knee medially. With the ankle stabilized, a varus force is applied with the proximal hand. Lateral joint pain and/or increased varus movement with an absent or poor endpoint when compared to the uninvolved side are positive findings for a torn lateral collateral ligament.
6. B - The American College of Sports Medicine (ACSM) recommends that when performing flexibility exercises, a stretch should only be held 10 to 30 seconds -- only as long as it is comfortable -- to obtain optimal results.
7. B - The secondary stage of disease prevention focuses on early detection of an illness or disease and preventing or reversing progression of the disease.
8. E - Constant pain, insomnia, malaise, and fatigue are all considered red flags that should alert the athletic trainer to certain pathologies.
9. A - Ballistic stretching is not recommended.
10. E - Russian stimulation prevents atrophy by contracting the muscles
11. C - Tertiary prevention is the prevention of a chronic or debilitating illness or injury through appropriate care and rehabilitation.
12. A - Sag sign is positive for a torn posterior cruciate ligament when the tibial plateau sags posteriorly as the athlete is lying and the knee is flexed to 45 degrees, causing a sulcus just inferior to the inferior border of the patella of the affected leg.
13. A - An athletic trainer's initial evaluation of an injury should begin the moment the injury is witnessed or upon initial contact with the athlete or another individual who might have witnessed the injury.
14. C - The L5 nerve root innervates the extensor hallucis longus muscle.
15. D - Tactile information alone will not provide the athletic trainer with enough information to adequately assess the athlete's functional status. It is crucial that a well-planned, comprehensive evaluation is performed to assess all aspects of the athlete's condition prior to treatment.
16. A - The posterior tibial and dorsalis pedis pulses should always be palpated after an acute knee injury to ensure the peripheral circulation of the involved limb is intact.
17. E - Signs of inflammation include redness (rubor), pain (dolor), warmth (calor), and swelling (tumor).
18. D -Measuring the amount of motion available at a joint will provide the athletic trainer with no significant information regarding the neurovascular status of the injured limb.
19. A - To test the strength of the piriformis, the athlete should be sitting. The lower leg is resisted as the athlete attempts to externally rotate the hip.
20. B - The biceps femoris is tested with the athlete lying in the prone position. Knee flexion is then resisted with the tibia in full external rotation.
21. A - The SI nerve root innervates the posterior tibialis, plantaris, peroneus longus, and peroneus brevis muscles, which act to plantar flex the ankle and foot.
22. A - Hip abduction occur in the frontal plane.
23. E - The gastrocnemius muscle plantar flexes the foot and flexes the knee.
24. D - The rectus femoris muscle flexes the hip and extends the knee when it contracts.
25. B - The gluteus maximus externally rotates the hip.
26. C - The femoral nerve innervates the pectineus muscle, and the obturator innervates the adductor longus, magnus, brevis, and gracilis.
27. A - To test the gluteus medius in an antigravity position against resistance, the athlete must be side lying with the affected limb on top.
28. E - The average range of motion of the knee is 0 to 135 degrees.
29. C - To test the hip flexor musculature, the athlete should be sitting. The athletic trainer then applies a force down onto the anterior aspect of the thigh as the athlete resists the movement.
30. D - True leg length discrepancy is measure between the anterior superior iliac spine to the medial malleolus of the ankle.
31. A - A goniometer is the instrument most commonly used for measuring joint range of motion in the clinical setting. A goiniometer may come in a variety of shapes and sizes and may be made of metal or plastic.
32. C - Periostitis, myositis, tendinitis, or a combination of conditions may cause tenderness and pain with induration and swelling of the pretibial musculature of the athlete's lower leg. They may be classified as anterior or posteromedial "shin splints", depending on which group of structures are involved.
33. A - A physician is the only person who can legally diagnose a medical condition or problem.
34. D - Whether or not the athlete has medical insurance should not be an immediate concern of the athletic trainer during the history-taking portion of the initial evaluation. Only those pieces of information that assist the athletic trainer in developing a course of action or treatment plan for the athlete should be considered pertinent.
35. C - The L4 nerve root innervates the rectus femoris muscle and the vastus medialis, intermedius, and lateralis muscle, all of which extend the knee.
36. E - McMurray's test is used to test the knee for a tear in the medial or lateral meniscus with the athlete lying in supine. The knee is fully flexed , and the tibia is externally rotated with a valgus force and extended, or internally rotated with a varus force and extended. A palpable "click" is indicative of a positive test.
37. A - When the tibia is stabilized in an externally rotated position and a strong valugs force is applied, the medial collateral ligament, medial meniscus and anterior cruciate ligament are vulnerable to injury.
38. D - The iliotibial band moves back and forth over the lateral epicondyle of the femur as the knee is flexed and extended. If the iliotibial band is too tight or it overrides and rubs on the lateral epicondyle during downhill running, the bursa between the iliotibial band and epicondyle becomes inflamed. Pain is elicited as the knee is brought into about 30 degrees of flexion. A popping sensation is not a consistent finding with this syndrome.
39. B - Pain with resisted hip adduction and hip flexion with diffuse tenderness and ecchymosis of the medial thigh is indicative of a strain of the groin area.
40. C - With a rupture of the rectus femoris muscle, a large bulge is seen in the upper thigh, and there is pain along the entire muscle belly. Extension is limited because of the inability to contract the rest of the quadriceps musculature.
41. C - Burning pain with tenderness to palpation over the lateral epicondyle of the femur is associated with iliotibial band syndrome. If the iliotibial band is too tight, it will rub over this area during running, causing localized inflammation. Ober's test is appropriate for a tight iliotibial band.
42. E - The quadriceps musculature is innervated by the femoral nerve, which originates at the L2, L3, and L4 nerve levels.
43. A - The pes anserinus (sartorius, gracilis, semitendinosis) flexes the knee and will weakly internally rotate the tibia.
44. D - It is appropriate during the acute stages of a quadriceps contusion to apply ice to the injured area and put the knee into a slight amount of passive flexion to maintain the flexibility of the quadriceps muscle.
45. D - Shock after a severe injury can result from hemorrhage or stagnation of blood.
46. E - During emergency care of the unconscious athlete, the athletic trainer should make sure the athlete's airway is clear and he or she is breathing normally.
47. A - Applying pressure will minimize the bleeding. Keep the area clean with sterile saline or hydrogen peroxide; apply Steri-Strips for temporary closure, and use ice and a compressive dressing to minimize further bleeding. Refer the athlete to the physician for sutures, if necessary.
48. D - With a suspected fracture of the knee joint or of the surrounding area, the splint should stabilize all the lower limb joints and one side of the trunk.
49. A - The brace should be adaptable to a variety of anatomic shapes and sizes. Not all prophylactic braces need to be custom-molded to achieve this goal.
50. D - Most often a "pop" is associated with an anterior cruciate ligament injury and less frequently with a subluxed patella.