Sunday, January 28, 2018

An Evaluation that was Challenging

On January 13, 2018, I completed my first evaluation solely on my own. It was after a game of

the weekend of an Emory & Henry College Women’s Basketball Player. She walked into the

clinic with no antalgic gait. She did have history in the right knee which was the one bothering

her at that time. She had ACL reconstruction last year and has returned to play. She has had

many issues with her shins and calves this season. She had no palpable pain, very minimal

swelling just below the patella to the lateral side. Her pain would be recreated when walking at

some points but mostly when pivoting or cutting. Her pain was her lateral side of her knee just to

the side of the patella and from the joint line down the lateral leg a couple inches. No

discoloration and no noise was heard and no specific instance was reported. She claimed that she

was not hit or no direct blow. The main thing was that she continued to play through the rest of

the game. Palpation was within normal limits except I noted that IT band was tight and tender,

calves were tight as well. Her range of motion was within normal limits. So flexion, extension,

internal and external rotation met the normal range. I also did ankle range of motion. Active and

passive dorsiflexion, plantar flexion, internal rotation, and external rotation were good. When it

came time for resistive for the ankle, her pain was recreated. Her most pain was with plantar

flexion and external rotation. Manual muscle testing was next to test her strength. Quadriceps

and hamstring strength was graded five out of five. Ankle manual muscle testing was all graded

four out of five and recreated pain. Special tests were next on the list. I did the anterior drawer on

both legs, her right leg was more lax because of her history. Posterior drawer was negative for
both when compared bilaterally. Valgus stress test when knee flexed and almost in extension off

the table which was also negative. Varus stress test was positive for laxity in her right knee

compared to her left.

At this point in the evaluation, I was very confused. I had an idea of her LCL or lateral collateral

ligament was sprained grade one. But I knew that since her pain continued down her lateral leg

much after the area of the LCL and joint capsule down past gerdy’s tubercle and tibial tuberosity

and fibular head. I went back to palpated and mentally went over the strength and range of

motion before making an assessment. With the info I had collected, I had come to the conclusion

that she had a grade one LCL sprain and grade one peroneal strain. Her immediate treatment was

ice and the plan was to treat pain and strengthen peroneals and LCL over time.

This was a challenging evaluation because the athlete was unsure of what exactly happened and

when. She said she hadn’t stretched much all week and barely did before the game as well. I was

challenged because her evaluation had things that were pre existing which could have caused

these things to happen. I struggled to identify why there was lateral leg and knee pain and had to

go over the range of motion and strength once again.

I got two attempts and zero masteries but it is still early in our courses and will get more attempts

and hopefully masteries next week!