NATA-BOC Upper Extremity Injury Assessment Questions and Answers 1 — Questions and Answers
Question 1: An athlete falls on an outstretched hand (FOOSH) and reports localized wrist pain. Examination reveals marked tenderness to palpation in the anatomical snuffbox. Initial radiographs of the wrist are negative for a fracture. What is the most appropriate immediate course of action?
- Apply a compression wrap, provide ice, and advise the athlete to monitor symptoms.
- Begin gentle active range of motion exercises to prevent stiffness.
- Immobilize the wrist and thumb in a spica splint and refer for follow-up evaluation and potential repeat imaging. (Correct answer)
- Administer an over-the-counter NSAID and clear the athlete for return to play as tolerated.
Correct answer: Immobilize the wrist and thumb in a spica splint and refer for follow-up evaluation and potential repeat imaging.
Tenderness in the anatomical snuffbox is the classic sign of a scaphoid fracture, which is notorious for not appearing on initial radiographs. Due to the scaphoid's tenuous retrograde blood supply, a missed fracture can lead to avascular necrosis and nonunion. Therefore, the standard of care is to treat a suspected scaphoid fracture as a true fracture by immobilizing it in a thumb spica splint and referring the athlete for further evaluation, which may include repeat radiographs or advanced imaging in 7-14 days.
Question 2: An athletic trainer performs a valgus stress test on an elbow flexed to 20-30 degrees. Increased laxity and/or pain with this maneuver primarily indicates an injury to which structure?
- Annular ligament
- Ulnar collateral ligament (UCL) (Correct answer)
- Radial collateral ligament (RCL)
- Lateral ulnar collateral ligament (LUCL)
Correct answer: Ulnar collateral ligament (UCL)
The valgus stress test applies a medially directed (valgus) force to the elbow, which specifically stresses the structures on the medial side. The primary stabilizer against this force is the ulnar collateral ligament (UCL). Performing the test in 20-30 degrees of flexion isolates the UCL by unlocking the olecranon from its fossa, making it the most specific position to test the ligament's integrity.
Question 3: A patient reports numbness and tingling in their thumb, index finger, and middle finger, which often worsens at night and is temporarily relieved by shaking their hand. Which of the following conditions is most consistent with this presentation?
- Cubital tunnel syndrome
- Thoracic outlet syndrome
- Cervical radiculopathy (C6)
- Carpal tunnel syndrome (Correct answer)
Correct answer: Carpal tunnel syndrome
Carpal tunnel syndrome is a compression neuropathy of the median nerve as it passes through the carpal tunnel. The classic sensory distribution of the median nerve includes the thumb, index finger, middle finger, and the radial half of the ring finger. Nocturnal paresthesia is a hallmark symptom, as wrist flexion during sleep can increase pressure on the nerve.
Question 4: The Empty Can (Jobe) test is performed by placing the athlete's shoulder in 90 degrees of scaption with full internal rotation (thumb pointing down) and applying downward pressure. Pain or weakness during this test is most indicative of pathology in which muscle?
- Infraspinatus
- Teres minor
- Supraspinatus (Correct answer)
- Subscapularis
Correct answer: Supraspinatus
The Empty Can test is specifically designed to isolate and assess the integrity of the supraspinatus muscle and its tendon. Placing the shoulder in the 'empty can' position (scaption and internal rotation) directs the fibers of the supraspinatus for optimal testing against resistance, making it a key diagnostic tool for supraspinatus impingement or tears.
Question 5: A baseball pitcher complains of a deep, 'clicking' pain in the shoulder during the late cocking phase of throwing. The athletic trainer performs an active compression (O'Brien's) test. A positive test for a SLAP lesion is indicated by pain in the first position (shoulder flexed, adducted, and internally rotated) that is significantly reduced or eliminated in the second position (shoulder flexed, adducted, and externally rotated). This test implicates which structure?
- Superior labrum and biceps anchor complex (Correct answer)
- Acromioclavicular joint
- Posterior rotator cuff
- Subacromial bursa
Correct answer: Superior labrum and biceps anchor complex
The O'Brien's test is designed to detect Superior Labral Anterior-Posterior (SLAP) lesions. The first position tensions the long head of the biceps tendon at its anchor point on the superior labrum, eliciting pain if a tear is present. The second position, with the forearm supinated, reduces this tension, causing the pain to decrease or resolve, which is a positive finding for a SLAP lesion.
Question 6: An athlete with a history of anterior shoulder subluxations is being evaluated. The athletic trainer places the shoulder in 90 degrees of abduction and slowly externally rotates it, causing the athlete to become apprehensive. The athletic trainer then applies a posteriorly directed force to the humeral head, which relieves the athlete's apprehension. This sequence of maneuvers is best described as which special test?
- Sulcus Sign
- Jerk Test
- Apprehension and Relocation Test (Correct answer)
- Neer's Impingement Test
Correct answer: Apprehension and Relocation Test
This describes the Apprehension and Relocation test for anterior glenohumeral instability. The apprehension portion involves passively externally rotating the abducted shoulder, which stresses the anterior capsule and makes the athlete fearful of dislocation. The relocation portion involves applying a posterior force to the humeral head, which 'relocates' it in the glenoid and alleviates the apprehension, confirming anterior instability.
NATA-BOC Upper Extremity Injury Assessment Questions and Answers 1
An athlete falls on an outstretched hand (FOOSH) and reports localized wrist pain.
Examination reveals marked tenderness to palpation in the anatomical snuffbox.
Initial radiographs of the wrist are negative for a fracture.
What is the most appropriate immediate course of action?