CCSP - Certified Chiropractic Sports Physician Sports Injury Diagnosis Questions and Answers — Questions and Answers
Question 1: A 19-year-old soccer player presents with acute knee pain after a valgus force and external rotation of the tibia while their foot was planted. The athlete reports hearing a 'pop' and describes significant swelling and instability. Based on this mechanism of injury, which combination of structures, known as the 'unhappy triad,' is most likely injured?
- Anterior cruciate ligament, lateral collateral ligament, and lateral meniscus
- Posterior cruciate ligament, medial collateral ligament, and medial meniscus
- Anterior cruciate ligament, medial collateral ligament, and medial meniscus (Correct answer)
- Posterior cruciate ligament, lateral collateral ligament, and medial meniscus
Correct answer: Anterior cruciate ligament, medial collateral ligament, and medial meniscus
The 'unhappy triad,' or O'Donoghue's triad, classically involves injury to the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and the medial meniscus. [4, 6, 7] This combination of injuries typically results from a valgus force applied to the knee, often combined with tibial external rotation, a common mechanism in contact sports. [4, 6]
Question 2: A 14-year-old gymnast presents with severe wrist pain after a fall onto an outstretched hand. Radiographs reveal a fracture that extends through the physis (growth plate) and exits through the metaphysis. According to the Salter-Harris classification, what type of fracture is this?
- Type I
- Type IV
- Type III
- Type II (Correct answer)
Correct answer: Type II
A Salter-Harris Type II fracture is the most common type and involves a fracture line that runs across the physis and then exits through the metaphysis, creating a triangular metaphyseal fragment (the Thurston-Holland fragment). [2, 3, 9] Type I is a slip through the physis, Type III is an intra-articular fracture through the epiphysis and physis, and Type IV goes through the epiphysis, physis, and metaphysis. [3, 8, 9]
Question 3: A 28-year-old baseball pitcher complains of deep, anterior shoulder pain and a 'clicking' sensation during the late cocking phase of throwing. Which of the following orthopedic tests is most specific for diagnosing a Superior Labral Anterior-Posterior (SLAP) lesion?
- Neer's Test
- Biceps Load II Test (Correct answer)
- Hawkins-Kennedy Test
- Empty Can Test
Correct answer: Biceps Load II Test
The Biceps Load II Test is a highly specific clinical test for diagnosing SLAP lesions, particularly Type II. [5, 23] The test is performed with the patient supine, the shoulder abducted to 120 degrees and externally rotated, and the elbow flexed to 90 degrees. Pain with resisted elbow flexion indicates a positive test. [5, 23] Neer's and Hawkins-Kennedy are primarily for impingement, and the Empty Can test assesses the supraspinatus.
Question 4: A track and field sprinter pulls up suddenly during a 100-meter dash, grabbing the back of their thigh. They report a sharp, tearing sensation. A clinical examination reveals significant ecchymosis, a palpable defect in the hamstring muscle belly, and a considerable loss of strength in knee flexion. What is the most appropriate grade for this muscle strain?
- Grade I
- Grade II
- Grade IV
- Grade III (Correct answer)
Correct answer: Grade III
This presentation is characteristic of a Grade III muscle strain, which involves a complete rupture of the muscle. [14, 15, 17] Key clinical findings include a palpable defect, severe pain, extensive bruising (ecchymosis), and a complete or near-complete loss of function and strength. [15, 17] Grade I involves microscopic tearing, and Grade II is a partial tear with moderate strength loss. [14, 15] Grade IV is not a standard part of the traditional 3-grade clinical system but is used in some imaging-based classifications. [21]
Question 5: Which of the following findings would mandate immediate referral for ankle radiographs according to the Ottawa Ankle Rules?
- Inability to bear weight for four consecutive steps immediately after the injury and in the clinic (Correct answer)
- Significant swelling and discoloration around the lateral malleolus
- Pain rated as 8/10 on the visual analog scale
- A positive anterior drawer test indicating ligamentous laxity
Correct answer: Inability to bear weight for four consecutive steps immediately after the injury and in the clinic
The Ottawa Ankle Rules are a clinical decision tool to determine the need for X-rays. One of the key criteria is the inability to bear weight both immediately after the injury and for four steps during the examination. [25, 31, 32] The other criteria include bony tenderness at specific locations (posterior edge of medial or lateral malleolus, base of the 5th metatarsal, or navicular). [25, 32] Swelling, pain level, and ligamentous laxity alone are not criteria that mandate radiography according to these rules. [31]
Question 6: A high school hockey player is 'checked' into the boards and appears dazed. As a Certified Chiropractic Sports Physician on the sideline, your initial on-field assessment for a suspected concussion should include all of the following EXCEPT:
- Asking orientation questions (e.g., 'Where are we?', 'What period is it?')
- Performing a detailed cranial nerve examination (Correct answer)
- Observing for any focal neurological deficits like slurred speech or ataxia
- Assessing for gross motor instability and balance
Correct answer: Performing a detailed cranial nerve examination
While a comprehensive cranial nerve exam is part of a full clinical evaluation, it is not typically performed in its entirety during the immediate on-field assessment. [30, 36] The priority on the field is to quickly assess for red flags, check orientation, and evaluate for gross neurological and balance deficits to make a 'remove from play' decision. [30] Tools like the SCAT5 are used for sideline assessment, which includes orientation, immediate memory, and balance, but not a full 12-cranial nerve workup. [16, 30]
CCSP - Certified Chiropractic Sports Physician Sports Injury Diagnosis Questions and Answers
A 19-year-old soccer player presents with acute knee pain after a valgus force and external rotation of the tibia while their foot was planted.
The athlete reports hearing a 'pop' and describes significant swelling and instability.
Based on this mechanism of injury, which combination of structures, known as the 'unhappy triad,' is most likely injured?