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Rafael Squillantini, Brielle Ringle and Julie Cavallario

Clinical Question: In patients with acute knee injuries, is there evidence to support that the lever sign test is more accurate in diagnosing an anterior cruciate ligament sprain than the Lachman test? Clinical Bottom Line: The evidence does not indicate that the lever sign test can be used in isolation in lieu of the Lachman test, but there is sufficient evidence to support adding the lever sign test to the examination of potential anterior cruciate ligament sprains.

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Riana R. Pryor, Summer Runestad, Bethany A. Chong Gum, Nathan J. Fuller, Moon Kang and Jennifer J. Beck

Athletic trainers (ATs) prevent and treat sport-related and catastrophic injuries due to physical activity. However, not all secondary schools hire ATs to provide medical care. The purpose of this study was to determine athletic training services available in California secondary schools. Approximately half (51%, 143/278) of California secondary schools reported hiring an AT, however, only 35% (87/251) of schools hired a certified AT. Schools without an AT most commonly hired a paramedic, emergency medical technician, coach, or athletic director to provide medical care. Nearly two-thirds of California secondary schools lack an AT, dramatically fewer schools than the nationwide average of 70% of public and 58% of private secondary schools with a certified AT.

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ZáNean McClain, E. Andrew Pitchford and Jill Pawlowski

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Kelley D. Henderson, Sarah A. Manspeaker and Zevon Stubblefield

A 19-year-old female tennis athlete with a history of hypohydration presented with cottonmouth, tunnel vision, and muscle cramping following an in-season tennis match. The patient was referred to the emergency department where she was subsequently diagnosed with exertional rhabdomyolysis (ER). Both clinical presentation and laboratory values are pertinent considerations leading to the diagnosis of ER. Specifically, creatine kinase (CK) levels and urine-specific gravity (USG) should be monitored during treatment and recovery, particularly in patients seeking to return to activity. This case presents a unique case of ER in a female individual sport athlete as well as a documented protocol for return to activity supported by current evidence.

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Jacob T. Hartzell, Kyle B. Kosik, Matthew C. Hoch and Phillip A. Gribble

Clinical Scenario: Chronic ankle instability (CAI) is characterized by the residual symptoms and feelings of instability that persist after an acute ankle sprain. Current literature has identified several neuromuscular impairments associated with CAI that may negatively impact sagittal plane knee kinematics during dynamic activities. This has led researchers to begin examining sagittal plane knee kinematics during jump landing tasks. Understanding changes in movement patterns at the knee may assist clinicians in designing rehabilitation plans that target both the ankle and more proximal joints, such as the knee. Clinical Question: What is the evidence to support the notion that patients with CAI have decreased sagittal plane knee flexion angle at initial contact during a jump-landing task compared to healthy individuals? Summary of Key Findings: The literature was systematically searched for level 4 evidence or higher. The search yielded two case-control studies which met the inclusion criteria. Based on limited evidence, there are mixed results for whether sagittal plane knee kinematic at initial contact differ between those with and without CAI. Clinical Bottom Line: There is weak evidence to support changes in sagittal plane knee kinematics at initial contact during a jump landing in individuals with CAI compared to healthy controls. Strength of Recommendation: In accordance with the Centre for Evidence-Based Medicine, a grade of C for level 4 evidence is recommended due to variable findings.

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Anna C. Gutierrez and Monica R. Lininger

Injuries to the ankle joint in soccer athletes are extremely common. Twenty-two female collegiate soccer athletes performed ankle corrective exercises for 3 months to attempt to establish and maintain optimal ankle joint function. The corrective exercises were devised to improve ankle range of motion (ROM) and Star-Excursion Balance Test (SEBT) scores. Statistically significant improvements were seen in ankle ROM and in the SEBT for the posteromedial, posterolateral, and composite reach portions of the test; the anterior reach direction failed to show significant changes. These results have clinical implications which suggest that corrective exercises may promote optimal ankle joint function and potentially reduce the risk of injury to the ankle.

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Kyle Southall, Matt Price and Courtney Wisler

A 20-year-old male collegiate football athlete reported a remarkably swollen elbow after direct contact with the ground. Initial radiographs and magnetic resonance imaging were negative for a fracture and soft tissue structural damage. After 2 weeks of conservative treatment, the athlete had no decrease in swelling and associated symptoms. He was diagnosed with a Morel-Lavallée lesion, later confirmed by diagnostic ultrasound imaging. The lesion was initially treated with compression therapy and cryotherapy to reduce swelling. Upon the final diagnosis the lesion was eventually incised, drained, and packed with iodoform sterile strips. It is hypothesized that many minor Morel-Lavallée cases are under- or misdiagnosed due to overlapping of signs and symptoms with other soft tissue traumas common in athletic populations. The procedures of this case can be utilized to optimize outcomes in future cases. While rare, Morel-Lavallée lesions can occur in athletic activities involving the upper extremity, and not solely crush injuries or traumatic and high-intensity accidents. This knowledge, along with the presented signs and symptoms, can give future healthcare professionals knowledge to include this diagnosis in their working differential diagnosis of injuries with similar presentations.