Jeannette is an 18-year-old female gymnast.
Case Study 2
Jeannette is an 18-year-old female gymnast. While warming up with tumbling pass on the floor during practice, she did not complete a full rotation when performing a back flip and landed on her right knee. At the time of injury, she did not feel any substantial pain. When she went to complete another tumbling pass 10 minutes later she was unable to, and she was not able to complete the rest of the competition. She then sought the assistance of Sue, the University’s new athletic trainer, who was covering the event. Sue begins by questioning Jeannette about the MOI. Jeannette answers that she did not fully rotate during her back flip and landed straight down on her right knee. Jeannette says she attempted another pass and was unable to complete the pass because “my knee felt unstable.” Sue then proceeds to question Jeannette about her pain level on a 0 to 10-point scale. Jeannette states that her pain level is 5/10 at rest. Sue observes Jeannette’s gait and notes an increased in right knee flexion during the stance phase of the right lower extremity. There is a slight antalgic gait pattern. Upon observation of the right knee, there is minimal-to-moderate general effusion noted of the right knee. Palpation reveals tenderness and guarding of the distal hamstrings. Neurologically, there is no deficit. Ligamentous testing reveals a positive Godfrey’s test, a positive posterior drawer, and a positive active quadriceps’s test. Sue also performing a Lachman’s test, which is negative. A McMurray’s test and Apley’s compression and distraction tests are also negative. Sue decides, based on her findings, to begin immediate care using RICE. Jeannette and Sue then discuss the options for best course of action for competing in tomorrow’s competition and decide it would be most appropriate to continue resting and to be evaluated by the team physician when possible. At the completion of treatment, Sue and Jeannette arrange a time when they can meet to perform further treatment the next day. Jeannette then walks out of the training room to watch her teammates finish practice.
Motion Joint Motion Findings in degrees
AROM Right Left
Knee flexion 115 140
Knee extension 5 5-0
PROM Knee flexion Minor-to-moderate discomfort at end range
Knee extension Minor-to-moderate discomfort at end range
RROM Knee flexion 4-/5
Knee extension 4/5
conclude a detailed Soap note complete with subjective, assessment, and plan. Include diagnosis, practice accommodations, rehabilitation exercises, etc.
Based on the information presented in the case, determine a. the differential diagnoses and the b. clinical diagnosis.
A. In your opinion, and based on the information given in the case, explain whether you think Sue took an appropriate history. B. What other questions would you have asked as the evaluating clinician.
According to the case, it was reported that there was an antalgic gait pattern, but Jeannette’s location of pain was not addressed. In what area do you think Jeannette would complain most about pain with gait.
What could Sue have done to address the antalgic gait pattern?
The clinical diagnosis can be classified into one of three different grades. Describe the classification of each grade. Based on the information, what grade do you think Jeanette sustained?
Based on the information, do you think that Jeannette will need surgery? Why or Why not?
Overall, do you think that Sue managed the condition appropriately? What else could have been done to assist with Jeannette’s recover?
Below is my answers to the case study but after my professor reviewed my document she made a statement;
You do not complete the SOAP note
S – is good start, what they athlete tells you
O – objective, all of the special test, MMT, ROM testingA – assessment, clinical and differential diagnosis
P – plan. This is where the goal, practice accommodations, include specific exercises that you would do
The questions are good just fix the SOAP note and put in clear sections. Please this needs to be corrected
Question 1
Subjective: 18-year-old gymnast Jeannette injured her right knee training floor tumbling passes. Jeannette backflipped on her right knee without spinning. Knee pain and instability caused her to fail again 10 minutes later. Jeannette has 5/10 resting discomfort and antalgic gait. Her right knee stiffens.
Goal. Mild-to-moderate right knee effusion. Palpable distal hamstring guarding. Neurodeficit-free. Ligaments show Godfrey’s, posterior drawer, and strong quadriceps. Negative Lachman’s. Compression and distraction fail McMurray and Apley.
Jeannette may have an MCL sprain. Godfrey’s, posterior drawer, and strong quadriceps confirm this diagnosis. MCL damage indicates negative Lachman’s test.
RICE and team doctor referral for Jeannette. Jeannette should avoid knee pain and rest. Ice 20 minutes every 2-3 hours. Bandages stretch. Pillow the wounded leg. Jeannette should see the team doctor immediately.
Question 2
1) Hamstring strain 2) Quadriceps strain 3) ACL tear 4) MCL tear 5) Meniscus tear
Question 3
A
Sue conducted a thorough examination of Jeannette, which enabled her to comprehend how the harm had developed. She saw that the right knee flexed more during the stance phase of the right lower extremity. Additionally, when she palpated the distal hamstrings, they were painful and guarded.
B
When did the discomfort begin? -Is the discomfort ongoing or sporadic? -What worsens or lessens the pain?
Question 4
The region surrounding Jeannette’s right knee is probably the source of discomfort that she describes as being the worst. This conclusion was reached as a result of the information presented in the case study. The case report indicates that there was an increased amount of right knee flexion during the stance phase of the right lower extremity.
Question 5
There are a number of ways that Sue could have addressed Jeannette’s walking problems. She could have asked her to walk in a different way, or had her knee fitted with a brace or immobilizer. The use of crutches was yet another choice that may have helped alleviate some of the discomfort she was experiencing.
Question 6
Grade 1 Sprained knees are minor. The ligaments are stretched but not torn. You can walk and put weight on your knee despite bruising and swelling.
II. Grade II knee sprains are moderate. Damaged ligaments. More bruising and swelling than a grade I sprain. This may make walking difficult.
III. Grade III knee sprains are serious. Ligaments ruptured completely. This causes considerable bruising and edema. Until the discomfort diminishes, you can’t weight your knee.
Question 7
It appears that Jeannette has suffered a mild-to-moderate hamstring strain. RICE (rest, ice, compression, elevation) will be the best course of treatment at this time. Surgery would not be warranted unless there was a more significant tear of the hamstring.
Question 8
Sue notices an increase in right knee flexion during the stance phase of the right lower extremity. There is a minimal-to-moderate overall effusion seen in the right knee upon inspection. Jeannette most certainly has a ruptured anterior cruciate ligament (ACL).
Question 9
Subjective: 18-year-old gymnast Jeannette has a right knee injury. She fell on her right knee during a floor tumbling pass. The injury caused no pain. She failed another tumble 10 minutes later and feared her knee was unstable. Jeannette’s pain is 5/10.
Objective: The sports trainer sees antalgic gait and increased right knee flexion during right lower extremity stance. Right knee effusion is mild-to-moderate. Distal hamstring guarding is palpable. Neurodeficit-free. Ligamentous tests demonstrate positive Godfrey’s, posterior drawer, and vigorous quadriceps. Negative Lachman’s. McMurray and Apley’s compression and distraction tests fail.
Jeannette’s sports trainer diagnoses a right knee injury. Grade II sprains have positive ligamentous tests.
The trainer quickly applies RICE (rest, ice, compression, elevation). Jeannette and the sports trainer discuss how to prepare for tomorrow’s competition and decide to rest and consult the team physicians. Jeannette and the sports trainer arrange for treatment the following day.
Plan: RICE and team doctor. Jeannette and the trainer will treat again tomorrow. Jeannette wants to compete tomorrow.
Further Explanation:
Question 1
Subjective: Gymnast Jeannette, age 18, suffered a right knee injury while honing her tumbling passes on the floor. When performing a back flip, according to Jeannette, she did not fully spin and landed on her right knee. Ten minutes later, she tried again, but her knee discomfort and instability prevented her from finishing. At rest, Jeannette reports a pain score of 5/10 and an antalgic gait. She can’t fully flex or extend her right knee.
Objective . Examination reveals a minimal-to-moderate overall effusion in the right knee. The distal hamstrings are sensitive and guarded when palpated. There is no deficit in terms of the brain. A positive Godfrey’s test, a positive posterior drawer, and a positive active quadriceps test are all results of ligamentous testing. The Lachman’s test yields no results. The McMurray test is negative, as are the Apley compression and distraction tests.
Assessment: It’s likely that Jeannette has a medial collateral ligament (MCL) sprain based on subjective information and physical examination. This diagnosis is supported by positive results from the Godfrey’s, posterior drawer, and active quadriceps tests. A negative Lachman’s test is another factor supporting an MCL damage.
RICE (rest, ice, compression, and elevation) is part of Jeannette’s care plan, along with a referral to the team doctor for additional assessment. Jeannette has to keep her knee resting and stay away from any activities that can make her discomfort worse. Every two to three hours, ice should be applied for 20 minutes. An elastic bandage can be used to apply compression. When possible, elevate the injured leg on a pillow. The team doctor needs to see Jeannette as soon as possible for additional assessment and care.
Question 2
Clinical diagnosis: hamstring strain. Based on injury mechanism, physical examination, and positive Godfrey’s and posterior drawer tests.
A hamstring strain is a muscular tear. Biceps femoris, semitendinosus, and semimembranosus are hamstring muscles. These muscles link to the pelvic ischial tuberosity and go down the back of the thigh to the tibia and fibula. Biceps femoris has two heads, long and short. The ischiofemoral ligament connects the biceps femoris long head to the ischial tuberosity. Biceps femoris’ short head joins to the femur’s linea aspera. The obturator internus tendon attaches the semitendinosus and semimembranosus to the ischial tuberosity. The semitendinosus joins medially to the tibia.
Hamstrings bend knees and extend hips. Hamstring strains have three classifications based on muscle damage. Grade I stresses break muscle fibers partially. Grade II strains destroy certain muscle fibers completely. Grade III strains rupture all muscle fibers.
Hamstring strains cause back-of-the-thigh pain, muscle spasms, weakness, and restricted range of motion. Overstretching, abrupt contraction, or trauma cause hamstring strains. Lunging or high-kicking can overstretch muscles. Sprinting or jumping might cause muscular contractions. A fall or leg blow might cause muscular trauma.
History and examination diagnose hamstring strains. MRIs can confirm the diagnosis. Rest, ice, compression, and elevation treat hamstring strains (RICE). Physical therapy may stretch and strengthen muscles. Surgery is infrequent.
quadriceps strain. Quadriceps strains are muscular tears. Rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis are quadriceps muscles. The quadriceps tendon connects the femur to the patella. Only the rectus femoris of the quadriceps joins to the hip. Quadriceps extend knees.
Muscle damage levels classify quadriceps strains into three classes. Grade I stresses break muscle fibers partially. Grade II strains destroy certain muscle fibers completely. Grade III strains rupture all muscle fibers.
Quadriceps strains cause front-thigh pain, muscle spasms, weakness, and restricted range of motion. Overstretching, abrupt contraction, or trauma cause quadriceps strains. Lunging or high-kicking can overstretch muscles. Sprinting or jumping might cause muscular contractions. A fall or leg blow might cause muscular trauma.
History and examination identify quadriceps strains. MRIs can confirm the diagnosis. Rest, ice, compression, and elevation treat quadriceps strains (RICE). Physical therapy may stretch and strengthen muscles. Surgery is infrequent.
ACL tear. Knee ligaments include the ACL. It connects the femur and tibia in the center of the knee. The ACL stabilizes the knee and keeps the tibia from sliding forward.
Three grades of ACL tears are dependent on ligament injury. Grade I ligament rips are partial. Grade II ligament rips are complete. Grade III ligament and tissue rips are complete.
ACL tears cause discomfort, edema, instability, and restricted range of motion. Pivoting or cutting can cause ACL injuries. Collisions can also cause them.
History, physical exam, and imaging diagnose ACL tears. Rest, ice, compression, and elevation treat ACL tears (RICE). Physical therapy may stretch and strengthen muscles. The ACL may require surgery.
tear. Knee ligaments include the MCL. It connects the femur and tibia inside the knee. The MCL stabilizes the knee and prevents the tibia from slipping.
Three grades of MCL rips are depending on ligament injury. Grade I ligament rips are partial. Grade II ligament rips are complete. Grade III ligament and tissue rips are complete.
MCL tears cause discomfort, edema, instability, and restricted range of motion. Collisions often cause MCL tears. Knee twists might also cause them.
History, physical exam, and imaging diagnose MCL tears. Rest, ice, compression, and elevation treat MCL tears (RICE). Physical therapy may stretch and strengthen muscles. MCL reconstruction may require surgery.
Meniscus tear Between the femur and tibia is the crescent-shaped meniscus. Knees have medial and lateral menisci. Shock-absorbing menisci stabilize the knee.
Meniscus rips have three classifications based on cartilage damage. Grade I cartilage tears are partial. Grade II cartilage tears are complete. Grade III tears involve total cartilage and tissue tears.
Meniscus tears cause pain, swelling, instability, and restricted mobility. Knee twists cause meniscus tears. Collisions can also cause them.
Imaging, history, and physical examination diagnose meniscus tears. Rest, ice, compression, and elevation treat meniscus tears (RICE). Physical therapy may stretch and strengthen muscles. Meniscus surgery may be required.
Question 3
A.
Given the information provided in the case, it is reasonable to assume that Sue took a thorough history. She inquired about the MOI with Jeannette, which enabled her to comprehend how the harm had developed.
She also inquired about Jeannette’s level of discomfort, which enabled her to determine the severity of the harm. She also watched Jeannette walk, and she saw that the right knee flexed more during the stance phase of the right lower extremity.
Additionally, she noticed a little antalgic gait pattern. She was able to infer Jeannette was in some pain and suffering based on these observations.
Additionally, when she palpated the region, the distal hamstrings were painful and guarded. She also conducted a variety of tests that enabled her to ascertain the severity of the injuries. Considering everything here, one might conclude that Sue took a proper history.
B. Additional inquiries Sue might have made include:
-When did the discomfort begin? Is the discomfort ongoing or sporadic? What worsens or lessens the pain? If anything, what causes the knee to feel unsteady?
Has Jeannette ever sustained an injury like this before? What’s Jeannette’s general state of health? Does Jeannette have any further medical issues that might be causing her pain?
If Jeannette is now taking any medicine, what is it? Is Jeannette allergic to anything? Has Jeannette recently suffered from any illnesses, injuries, or surgeries?
Question 4
The region surrounding Jeannette’s right knee is probably the source of the discomfort that she describes as being the worst. This is based on the information that is presented in the case study, which states that Jeannette landed on her right knee when she did not fully rotate during her back flip, and that she felt pain in her right knee when she attempted another pass.
This conclusion was reached as a result of the information presented in the case study. In addition, the case report indicates that Sue detected a mild antalgic gait pattern and that there was an increased amount of right knee flexion during the stance phase of the right lower extremity.
Both of these observations are related to the right lower extremity. Given this information, it is possible to draw the conclusion that the source of the pain is the right knee, and it is also plausible that the antalgic gait pattern is caused by the source of the pain in the right knee.
Question 5
There are a few various approaches that Sue might have used in order to address the antalgic gait pattern that Jeannette was exhibiting. Sue could have asked Jeannette to walk in a different way. Jeannette may have been fitted with a knee immobilizer or knee brace, which would have helped to keep her knee stable while also reducing the range of motion it was capable of.
This would have been of assistance in reducing the amount of discomfort that Jeannette was feeling when she was walking. The use of crutches was yet another choice that may have been made to facilitate Jeannette’s walking.
This would have alleviated some of the pressure that was being placed on the afflicted knee, which in turn would have made the discomfort more bearable. Last but not least, Sue had the opportunity to suggest that Jeannette undergo further evaluation and treatment in physical therapy. Jeannette could have benefited from exercises to increase her range of motion, strengthen her muscles, and reduce her level of pain if she had seen a physical therapist.
Question 6
Grade I A grade A sprained knee is considered to be a very minor injury. There is no indication that the ligaments have been ruptured; nonetheless, it is possible that they have been strained. You should be able to walk and put weight on your knee, even if there is a risk that you will bruise and swell after the injury.
Grade II . A grade II knee sprain is an injury that is regarded to be moderate in severity. The ligaments have been compromised to some extent as a result of the injury. It is expected that there will be substantially greater bruising and swelling as opposed to a grade I sprain. As a result of this, you could find that walking becomes difficult for you.
Grade III . A severe knee sprain, often known as a grade III injury, can be quite painful. The ligaments have completely separated from one another. Following this, you should expect considerable bruising as well as swelling. Until the discomfort in your knee has subsided, you won’t be able to put any pressure or weight on it.
Question 7
No, it does not appear at this moment that Jeannette will require surgery to address her condition. It would appear from the information that was gleaned from the case study that Jeannette has suffered a hamstring strain that falls somewhere between mild and severe severity.
At this point, the most effective treatment will be RICE, which stands for “rest, ice, compression, and elevation.” Unless the MRI revealed a more substantial rupture in the hamstring, surgical intervention would not be necessary in this case.
If Jeannette adheres to the RICE procedure and gives her hamstring the time it needs to recover completely, she should be able to go back to gymnastics without any further complications.
Question 8
You believe that Sue handled the situation well overall. She could have helped Jeannette recover more by explaining the injuries and what Jeannette may have done to speed up her own healing, in your opinion.
Sue questioned Jeannette about the MOI when she first hurt her knee. When asked why she didn’t completely spin on her backflip, Jeannette replied, “I landed straight on my right knee.” The second pass, according to Jeannette, was unsuccessful because “my knee felt unstable.” This information makes it obvious that Jeannette’s injury resulted from an impact force being applied to her right knee.
Sue then asks Jeannette to rate her level of discomfort from 0 to 10. At rest, according to Jeannette, her pain level is a 5 out of 10. Sue notices an increase in right knee flexion during the stance phase of the right lower extremity while watching Jeannette walk. A mild antalgic gait pattern is present. There is a minimal-to-moderate overall effusion seen in the right knee upon inspection. The distal hamstrings are sensitive and guarded when palpated. There is no deficit in terms of the brain.
A positive Godfrey’s test, a positive posterior drawer, and a positive active quadriceps test are all results of ligamentous testing. Sue also conducted a negative Lachman’s test. The McMurray test is negative, as are the Apley compression and distraction tests.
According to her medical history and physical examination results, Jeannette most certainly has a ruptured anterior cruciate ligament (ACL). This diagnosis is supported by the Godfrey’s test, posterior drawer, and active quadriceps tests. The Lachman’s test, which is frequently positive in individuals with an ACL tear but is not diagnostic for an ACL injury, is negative. The McMurray’s and Apley’s tests can be positive in patients with an ACL tear but are not diagnostic for an ACL tear alone.
Based on her research, Sue chooses to start RICE-based immediate care. The best course of action for competing in the competition tomorrow is then discussed by Jeannette and Sue, who determine that it would be best to continue sleeping and, if possible, be examined by the team doctor. When the treatment is over, Sue and Jeannette schedule a time to meet the following day to continue the treatment. After that, Jeannette exits the gym to watch her teammates complete their practice.
Question 9
Subjective: Gymnast Jeannette, age 18, comes to the athletic trainer with a right knee injury she picked up during practice. She claims that during a floor tumbling pass warm-up, she did not turn completely around during a back flip and landed on her right knee. When she was hurt, she didn’t experience any severe agony. Ten minutes later, she attempted another tumbling pass but was unable to finish it because she felt unstable in her knee. On a scale of 0 to 10, Jeannette gives her pain a rating of 5 out of 10.
Objective: The athletic trainer observes a right lower extremity antalgic gait pattern and greater right knee flexion during the stance phase. Additionally, the right knee has a minimal-to-moderate overall effusion. The distal hamstrings are sensitive and guarded when palpated. There is no deficit in terms of the brain. A positive Godfrey’s test, a positive posterior drawer, and a positive active quadriceps test are all results of ligamentous testing. The Lachman’s test yields no results. The McMurray test is negative, as are the Apley compression and distraction tests.
Assessment: The athletic trainer determines that Jeannette has a right knee injury based on the subjective and empirical results. Based on the positive ligamentous testing, the sprain is most likely a Grade II sprain.
Treatment: Using RICE, the sports trainer starts providing emergency care (rest, ice, compression, elevation). After deliberating on the best plan of action for competing in tomorrow’s tournament, Jeannette and the athletic trainer determine that it would be best to keep resting and, if possible, be examined by the team physician. After treatment is over, Jeannette and the athletic trainer schedule a time to meet so they may continue treatment the following day.
Plan: The strategy is to carry on with RICE and visit the team doctor for additional assessment. The next day, Jeannette will meet with the athletic trainer to continue her treatment. The objective is for Jeannette to be able to take part in the tournament tomorrow.
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