ATC Clinical Evaluation & Diagnosis 5 — Questions and Answers
Question 1: An athlete presents with sudden sharp pain in the posterior thigh during sprinting. Ecchymosis appears distal to the ischial tuberosity 24 hours later. The most likely diagnosis is:
- Proximal hamstring avulsion (Correct answer)
- Biceps femoris distal strain
- Semimembranosus musculotendinous junction strain
- Sciatic nerve contusion
Correct answer: Proximal hamstring avulsion
Proximal hamstring avulsions often cause ecchymosis tracking distally due to bleeding from the ischial tuberosity attachment site.
Question 2: When using the Ottawa Ankle Rules, which finding indicates the need for radiographic imaging?
- Anterior drawer laxity
- Bone tenderness at the posterior edge of the lateral malleolus (Correct answer)
- Soft tissue swelling around the lateral malleolus
- Pain with inversion stress testing
Correct answer: Bone tenderness at the posterior edge of the lateral malleolus
Ottawa Ankle Rules call for X-rays if there is bone tenderness at the posterior or distal 6 cm of either malleolus or at the base of the fifth metatarsal or navicular.
Question 3: Which clinical sign would raise concern for an acute compartment syndrome following a lower leg injury?
- Pain relieved by elevation
- Pain with passive stretch of muscles within the compartment (Correct answer)
- Decreased skin temperature over the compartment
- Immediate ecchymosis at the injury site
Correct answer: Pain with passive stretch of muscles within the compartment
Pain disproportionate to injury and worsening with passive stretch is a hallmark of acute compartment syndrome due to elevated intracompartmental pressure.
Question 4: During a shoulder evaluation, a patient demonstrates a 'sulcus sign' with downward traction on the arm. This finding indicates:
- Rotator cuff tear
- Multidirectional instability (Correct answer)
- AC joint separation
- Biceps tendon rupture
Correct answer: Multidirectional instability
The sulcus sign (indentation below the acromion during inferior traction) indicates inferior glenohumeral laxity, a hallmark of multidirectional instability.
Question 5: A gymnast reports anterior knee pain that is worse going down stairs. Palpation reveals tenderness at the inferior pole of the patella. The most likely diagnosis is:
- Osgood-Schlatter disease
- Patellofemoral pain syndrome
- Patellar tendinopathy (Correct answer)
- Bipartite patella
Correct answer: Patellar tendinopathy
Patellar tendinopathy (jumper's knee) classically presents with inferior patellar pole tenderness exacerbated by eccentric loading such as descending stairs.
Question 6: Which cranial nerve assessment is most critical following a facial impact that results in loss of smell?
- Cranial nerve II (optic)
- Cranial nerve I (olfactory) (Correct answer)
- Cranial nerve VII (facial)
- Cranial nerve V (trigeminal)
Correct answer: Cranial nerve I (olfactory)
Anosmia (loss of smell) following head trauma indicates disruption of cranial nerve I, the olfactory nerve.
Question 7: When evaluating a suspected acromioclavicular (AC) joint sprain, which test assesses AC joint integrity by applying horizontal adduction force?
- Cross-body adduction test (Correct answer)
- Apprehension test
- Empty can test
- Relocation test
Correct answer: Cross-body adduction test
The cross-body adduction test compresses the AC joint by horizontally adducting the shoulder, reproducing pain if the AC joint is involved.
ATC Clinical Evaluation & Diagnosis 5
An athlete presents with sudden sharp pain in the posterior thigh during sprinting.
Ecchymosis appears distal to the ischial tuberosity 24 hours later.
The most likely diagnosis is: