NATA-BOC Lower Extremity Injury Assessment Questions and Answers 1 — Questions and Answers
Question 1: An athletic trainer performs the Thompson test on an athlete who felt a sudden 'pop' in their lower leg while sprinting. A positive test is indicated by which of the following findings?
- Inability to actively dorsiflex the foot.
- A palpable defect in the gastrocnemius muscle.
- Absence of plantar flexion when the calf is squeezed. (Correct answer)
- Pain with passive stretching of the Achilles tendon.
Correct answer: Absence of plantar flexion when the calf is squeezed.
The Thompson test assesses the integrity of the Achilles tendon. When the calf muscle (gastrocnemius-soleus complex) is squeezed, the foot should plantar flex if the tendon is intact. The absence of this movement indicates a likely complete rupture of the Achilles tendon.
Question 2: A soccer player presents with knee pain and instability after a non-contact pivoting injury. The athletic trainer performs a Lachman test. Which of the following best describes the proper procedure and a positive sign for this test?
- Knee flexed to 90 degrees, anterior translation of the tibia with a firm endpoint.
- Knee flexed to 20-30 degrees, anterior translation of the tibia with a soft or mushy endpoint. (Correct answer)
- Knee fully extended, posterior translation of the tibia with a distinct clunk.
- Knee flexed to 70 degrees, valgus force applied with tibial external rotation.
Correct answer: Knee flexed to 20-30 degrees, anterior translation of the tibia with a soft or mushy endpoint.
The Lachman test is considered the most sensitive clinical test for an anterior cruciate ligament (ACL) tear. It is performed with the knee in 20-30 degrees of flexion to minimize the secondary stabilizing contribution of other structures. A positive test is characterized by increased anterior tibial translation compared to the uninjured side and a 'soft' or 'mushy' endpoint, indicating loss of ligamentous restraint.
Question 3: When performing the McMurray test to assess for a meniscal tear, what combination of movements specifically stresses the medial meniscus?
- Tibial internal rotation with a valgus stress as the knee is extended.
- Tibial external rotation with a varus stress as the knee is extended.
- Tibial internal rotation with a varus stress as the knee is extended.
- Tibial external rotation with a valgus stress as the knee is extended. (Correct answer)
Correct answer: Tibial external rotation with a valgus stress as the knee is extended.
To test the medial meniscus using the McMurray test, the examiner applies a valgus stress to the knee while externally rotating the tibia and moving the knee from a fully flexed to an extended position. A palpable or audible click, pop, or pain is indicative of a positive test for a medial meniscus tear.
Question 4: A basketball player lands awkwardly and complains of immediate, severe ankle pain. They are unable to bear weight. According to the Ottawa Ankle Rules, which of the following findings would NOT, by itself, warrant a referral for radiographic imaging?
- Point tenderness over the posterior edge of the medial malleolus.
- Inability to walk four steps both immediately after the injury and in the clinic.
- Significant swelling and discoloration around the entire ankle joint. (Correct answer)
- Point tenderness at the base of the fifth metatarsal.
Correct answer: Significant swelling and discoloration around the entire ankle joint.
The Ottawa Ankle Rules are a clinical decision tool to determine the need for X-rays. The rules state that radiographs are indicated if there is pain in the malleolar or midfoot zone AND one of the following: bone tenderness at the posterior edge or tip of the lateral or medial malleolus, bone tenderness at the base of the fifth metatarsal, bone tenderness at the navicular bone, or an inability to bear weight for four steps. Diffuse swelling and discoloration alone are not specific criteria within the rules.
Question 5: An athletic trainer is performing an anterior drawer test of the ankle. To specifically isolate and test the integrity of the anterior talofibular ligament (ATFL), the foot should be positioned in:
- Maximal dorsiflexion and inversion.
- Slight plantar flexion and inversion. (Correct answer)
- Neutral (90 degrees) and eversion.
- Maximal plantar flexion and eversion.
Correct answer: Slight plantar flexion and inversion.
The anterior drawer test for the ankle primarily assesses the stability of the anterior talofibular ligament (ATFL), the most commonly injured ligament in an inversion ankle sprain. To perform this test effectively, the ankle should be placed in a position of slight plantar flexion (around 10-20 degrees) and some inversion to bring the ATFL perpendicular to the direction of the applied anterior force.
Question 6: Which of the following describes a positive Trendelenburg test, indicating weakness of the gluteus medius muscle?
- The pelvis on the non-stance leg rises when the patient stands on the affected leg.
- The patient is unable to bridge off the table using the affected leg.
- The patient demonstrates an anterior pelvic tilt while in a unilateral stance.
- The pelvis on the non-stance leg drops when the patient stands on the affected leg. (Correct answer)
Correct answer: The pelvis on the non-stance leg drops when the patient stands on the affected leg.
The Trendelenburg test assesses the strength and function of the hip abductor muscles, primarily the gluteus medius. When a patient stands on one leg, the gluteus medius of the stance leg should contract to keep the pelvis level. If the muscle is weak, it is unable to support the pelvis, causing the contralateral (non-stance) side of the pelvis to drop.
NATA-BOC Lower Extremity Injury Assessment Questions and Answers 1
An athletic trainer performs the Thompson test on an athlete who felt a sudden 'pop' in their lower leg while sprinting.
A positive test is indicated by which of the following findings?