Florida International University s7

FLORIDA INTERNATIONAL UNIVERSITY DEPARTMENT OF HEALTH, PHYSICAL EDUCATION & RECREATION PET 4993C Orthopedic Assessment I – Lower Extremity Spring 2006 Course Syllabus

1. Course Information a. Instructor: Michelle L Odai, MS, LAT, ATC, CSCS Office: ZEB 251B Email address: [email protected] Phone: 786-543-4890 Office hours: Tuesday 1:00–3pm, Wednesday 11:00–12:00pm, or by appointment b. Classroom: GPA 117 c. Class Time: Monday and Wednesday 9:30 – 10:45am d. Lab Information: Section 01 - Tuesday/Thursday 8:00 – 9:15am in GPA 112 Instructors: Zevon Stubblefieldl/Eriko Senoo Section 02 – Tuesday/Thursday 9:30 – 10:45am in GPA 112 Instructors: Lindsey Eberman/Danny Ruiz e. Credit hours: 04 f. Co-Requisite: Clinical Education I for Athletic Training majors g. Course Fee: $50.00, payable upon course registration h. Class Web Page: http://www.fiu.edu/~dohertyj i. Textbooks: i.Starkey C, Ryan JL. Evaluation of Orthopedic and Athletic Injuries. 2nd ed. FA Davis, 2002. ii.Holcomb W. Practical Skills Manual for Evaluation of Athletic Injuries. FA Davis, 2002. iii.Gulick, D. Ortho Notes Clinical Examination Pocket Guide. FA Davis, 2005. 2. Course Format a. The course will be presented in traditional in-person lecture format with 3.0 contact hours per week constituting the lecture component and separate sections scheduled for 3.0 contact hours per week constituting the laboratory setting where clinical proficiencies will be introduced and evaluated. 3. Course Objectives a. The purpose of this course is to introduce students to the common types of orthopedic injuries and/or dysfunctions that occur to the lower extremity during physical activity and/or athletics. Injuries will be discussed from the following viewpoints: etiology and mechanism of injury; pathology; recognition and evaluation techniques; protocols; and prevention. b. The purpose of the laboratory component of this course is to allow students to apply the techniques of orthopedic injury prevention, recognition, and evaluation. 4. Course Fees a. This course requires a fee of $50, necessary to cover the cost of two lab instructors required to cover the lab sections with an 8:1 student to faculty ration as dictated by the CAAHEP accreditation standards. Due to the personnel required to instruct this course, a fee of $50 is assessed upon registration for PET 4993C: Orthopedic Assessment I – Lower Extremity. 2

5. Course Evaluation a. Final grades will be based on: 2 Written Exams 30% 1 Final Exam 20% 3 Clinical Proficiency Demonstrations 30% Lab Assignments/Participation 15% Completed Clinical Proficiency Evaluations 5%

Grading Scale: 93-100 A 73-76 C 90-92 A- 70-72 C- 87-89 B+ 67-69 D+ 83-86 B 63-66 D 80-82 B- 60-62 D- 77-79 C+ 0-59 F

b. Exam absences: i. Any student unable to take an exam at the regularly scheduled time AND is able to present an approved excuse for missing the exam, MUST notify the course instructor or the department secretary PRIOR TO THE TIME of the absence by voice mail message or email. ii. Make-up exams will be administered at the earliest convenience or during finals week. c. Exams iii. Exams are written and practical type tests. The last exam is given during finals week and will be a cumulative exam. iv. Exams are scheduled at logical breaks in the lecture material and dates are tentative. iii. Most of the material that will be on the exam will be covered in lecture. There will be sections or even chapters that the student will be required to read which may be on the exam. Material covered in the lecture or as part of an assignment is eligible to be included on the exams.

6. Course Schedule

Week Date Format Topic Introduction/Syllabus Overview/Chapter 1 – The 1/9/06 Lecture Injury Evaluation Process 1/10/06 Lab Introduction/Mock Evaluation 1 1/11/06 Lecture Chapter 1 - The Injury Evaluation Process Goniometric Evaluation, Girth Measurement, 1/12/06 Lab Neurologic Tests 1/16/06 Lecture NO CLASS – MLK Jr Day 1/17/06 Lab Range of Motion, Manual Muscle Testing 2 1/18/06 Lecture Chapter 2 – Injury Nomenclature 1/19/06 Lab Anatomy and Palpation of the Foot and Toes 3 1/23/06 Lecture Chapter 4 – The Foot and Toes 1/24/06 Lab History, Inspection, and Observation of the Foot and Toes 3

1/25/06 Lecture Chapter 4 – The Foot and Toes ROM, Neurologic Tests, Special Tests for the Foot 1/26/06 Lab and Toes 1/30/06 Lecture Chapter 4 – The Foot and Toes Evaluation of the Foot and Toes 1/31/06 Lab Hand-in SOAP note 4 2/1/06 Lecture Chapter 4 – The Foot and Toes Anatomy and Palpation of the Ankle and Lower 2/2/06 Lab Leg 2/6/06 Lecture Chapter 5 – The Ankle and Lower Leg History, Inspection, and Observation of the Ankle 2/7/06 Lab and Lower Leg 5 2/8/06 Lecture Chapter 5 – The Ankle and Lower Leg ROM, Neurologic Tests, Special Tests for the 2/9/06 Lab Ankle and Lower Leg 2/13/06 Lecture Chapter 5 – The Ankle and Lower Leg Evaluation of the Ankle and Lower Leg 2/14/06 Lab 6 Hand-in SOAP note 2/15/06 Lecture Chapter 5/Review 2/16/06 Lab Review 2/20/06 Lecture Exam # 1 (Chapters 1, 2, 4, and 5) 2/21/06 Lab Proficiency Demonstration # 1 7 2/22/06 Lecture Chapter 6 – The Knee 2/23/06 Lab Anatomy and Palpation of the Knee 2/27/06 Lecture Chapter 6 – The Knee 2/28/06 Lab History, Inspection, and Observation of the Knee 8 3/1/06 Lecture Chapter 6 – The Knee ROM, Neurologic Tests, Special Tests for the 3/2/06 Lab Knee Chapters 6 and 7 – The Patellofemoral 3/6/06 Lecture Articulation 3/7/06 Lab Special Tests for the Knee 9 3/8/06 Lecture Chapter 7 – The Patellofemoral Articulation Evaluation of the Knee 3/9/06 Lab Hand-in SOAP note 3/13/06 Lecture Chapter 7/Review 3/14/06 Lab Review 10 3/15/06 Lecture Exam #2 (Chapters 6 and 7) 3/16/06 Lab Proficiency Demonstration #2 3/20/06 Lecture 3/21/06 Lab 11 NO CLASSES – SPRING BREAK 3/22/06 Lecture 3/23/06 Lab 12 3/27/06 Lecture Chapter 8 – The Pelvis and Thigh 3/28/06 Lab Anatomy and Palpation of the Pelvis and Thigh 3/29/06 Lecture Chapter 8 – The Pelvis and Thigh 4

History, Inspection, and Observation of the Pelvis 3/30/06 Lab and Thigh 4/3/06 Lecture Chapter 8 – The Pelvis and Thigh ROM, Neurologic Tests, Special Tests for the 4/4/06 Lab Pelvis and Thigh 13 4/5/06 Lecture Chapter 9 – Evaluation of Gait Evaluation of the Pelvis and Thigh 4/6/06 Lab Hand-in SOAP note 4/10/06 Lecture Chapter 9 – Evaluation of Gait 4/11/06 Lab Evaluation of Gait 14 4/12/06 Lecture Chapter 3 – Assessment of Posture 4/13/06 Lab Assessment of Posture 4/17/06 Lecture Chapter 3 – Assessment of Posture 4/18/06 Lab Review 15 4/19/06 Lecture Last Day of Class/ Review for Final 4/20/06 Lab Clinical Proficiency Demonstration #3 16 TBA Final Exam (Chapters 1-9)

7. Course Outcomes At the end of this course, the student will be able to:

Cognitive Domain  Demonstrate knowledge of the normal anatomical structures of the human body systems and their physiological functions, including the musculoskeletal (including articulations) and nervous (central and peripheral) systems.  List and define directional terms and cardinal planes used to describe the body and the relationship of its parts.  Define the principles and concepts of body movement including functional classification of joints, joint biomechanics, and normal ranges of joint motion, joint action terminology, muscular structures responsible for joint actions (prime movers, synergists), skeletal muscle contraction, and kinesthesis/proprioception.  Differentiate injury recognition, assessment, and diagnosis.  Describe commonly accepted techniques and procedures for evaluation of the common injuries and illnesses that are incurred by athletes and others involved in physical activity. These techniques and procedures include the following: (a) taking a history, (b) inspection or observation, (c) palpation, (d) functional testing (range of motion, ligamentous or capsular stress, manual muscle, sensory, motor, reflex neurological), (e) special evaluation techniques (e.g., orthopedic tests, auscultation, percussion)  Explain the relationship of injury assessment to the systematic observation of the person as a whole.  Demonstrate knowledge of a systematic process that uses the medical or nursing model to obtain a history of an injury or illness that includes, but is not limited to, the mechanism of injury, chief complaint, and previous relevant injuries or illnesses.  Describe the use of myotomes, dermatomes, and reflexes (deep tendon, superficial) including manual muscle-testing, range-of-motion testing, and distinguishes between primary, cortical, and discriminatory forms of sensation. 5

 Define the measurement and grading of dermatomes, myotomes, and reflexes and their relationships in a neurological examination.  Describe active, passive, and resisted range-of-motion testing and differentiates the significance of the findings of each test.  Explain the role of special tests, testing joint play, and postural examination in injury assessment.  Explain how to measure resistive range of motion (or strength) of major muscles using manual muscle testing or break tests.  Differentiate the use of diagnostic tests (x-rays, arthrograms, MRI, CAT scan, bone scan, ultrasound, myelogram) based on their applicability in the assessment of an injury or illness when prescribed by a physician.  Describe the use of basic somatotyping to quantify objective physical characteristics.  Describe the etiological factors, signs, symptoms, and management procedures for injuries of the toes, foot, ankle, lower leg, knee, thigh, and hip.  Use the terminology necessary to communicate the results of an athletic training assessment to physicians and other health professionals.  Describe components of medical documentation (e.g., subjective, objective, assessment, plan [SOAP] and history, inspection, palpation, special tests [HIPS]).

Psychomotor Domain  Administers static and dynamic postural evaluation procedures, including tests for muscle shortening.  Construct and phrase appropriate questions to obtain a medical history of an injured or ill individual that includes a previous history and a history of the present injury or illness.  Visually identify clinical signs associated with common injuries and illnesses, such as the integrity of the skin and mucous membranes, structural deformities, edema, and discoloration.  Demonstrate active, passive, and resisted range-of-motion testing of the toes, foot, ankle, knee, hip, shoulder, elbow, wrist, hand, thumb, fingers, and spine.  Measure active and passive joint range of motion with a goniometer.  Perform appropriate manual muscle-testing techniques and/or break tests, including application of the principles of muscle/muscle group isolation, segmental stabilization resistance/pressure, and grading, to evaluate injuries incurred by athletes and others engaged in physical activity.  Apply appropriate stress tests for ligamentous or capsular instability based on the principles of joint positioning, segmental stabilization, and force.  Measure the grade of ligamentous laxity during a joint stress test and notes the quality and quantity of the end point.  Apply appropriate and commonly used special tests to evaluate athletic injuries to various anatomical areas.  Palpate bony and soft tissue structures to determine normal or pathological tissue(s).  Perform and interpret appropriate palpation techniques and special tests of the abdomen, chest, cranium, and musculoskeletal system.  Assess the neurological function of spinal nerves, and peripheral nerves and assesses the level of spinal cord involvement following injury, including the function of dermatomes, myotomes, and reflexes (e.g., deep tendon, superficial). 6

 Perform appropriate examination of injuries to lower extremities prior to an individual's return to activity.  Use appropriate terminology in the communication and documentation of injuries and illnesses.

Affective Domain  Appreciate the importance of a systematic assessment process in the management of injuries and illness.  Appreciate the importance of documentation of assessment findings and results.  Accept the role of the certified athletic trainer as a primary provider of assessment to the injuries and illnesses of athletes and others involved in physical activity.  Recognize the initial clinical evaluation by the certified athletic trainer as an assessment and screening procedure, rather than as a diagnostic procedure.  Appreciate the practical importance of thoroughness in a clinical evaluation.  Accept the professional, ethical, and legal parameters that define the proper role of the certified athletic trainer in the evaluation and appropriate medical referral of injuries and illnesses of athletes and others involved in physical activity.  Value the skills and knowledge necessary to competently assess the injuries and illnesses of athletes and others involved in physical activity.

Clinical Proficiencies  The student will recognize the following postural deviations and predisposing conditions: o tibial torsion o genu valgum, varum, and recurvatum o rearfoot valgus and varus o forefoot valgus and varus o pes cavus and planus o foot and toe posture  The student will perform a postural assessment of the following: o hip  The student will perform a postural assessment of the following: o knee  The student will perform a postural assessment of the following: o ankle, foot, and toes  The student will o use standardized record keeping methods (e.g., SOAP, HIPS, HOPS) o select and use injury, rehabilitation, referral, and insurance documentation o use progress notes  The student will obtain the medical history of an ill or injured athlete or other physically active individual for hip pathology.  The student will observe and identify the clinical signs and symptoms associated with common injuries, illnesses, and predisposing conditions: o leg length discrepancies o hip retroversion o hip anteversion 7

o Legg-Calve-Perthes disease o apophysitis o slipped capital femoral epiphysis o dislocation or subluxation o fracture o stress fracture o bursitis o piriformis syndrome o iliotibial band syndrome o contusion o sprain o strain o tendonitis  The student will administer active and passive range-of-motion tests using standard goniometric techniques and/or a tape measure for the hip.  The student will use manual muscle-testing techniques for the hip.  The student will administer appropriate sensory, neurological, and circulatory tests for the hip.  The student will administer functional tests and activity-specific tests for the hip.  The student will identify, palpate, and interpret the integrity of bony landmarks of the hip.  The student will identify, palpate, and interpret the integrity of soft tissue of the hip.  The student will administer commonly used special tests to make a differential assessment of the following: o neuropathy (e.g., femoral nerve traction test) o neuromuscular pathology (e.g., Trendelenburg's test, Thomas' test, rectus femoris contracture test, Ober's test, Noble's test, piriformis test)  The student will obtain the medical history of an ill or injured athlete or other physically active individual suffering from knee pathology.  The student will observe and identify the clinical signs and symptoms associated with common injuries, illnesses, and predisposing conditions: o bursitis o chondromalacia patella o dislocation and subluxation o fat pad contusion o fracture o leg length o meniscal tear o Osgood-Schlatter disease o osteochondritis dissecans o patellar alignment (e.g., patella alta, patella baja, squinting patella, Q angle) o tibial torsion o tibiofemoral alignment (e.g., ...) o patellar tendon rupture o peroneal nerve contusion or palsy 8

o popliteal cyst o sprain o strain o tendonitis  The student will administer active and passive range-of-motion tests using standard goniometric techniques for the knee.  The student will use manual muscle-testing techniques for the knee.  The student will administer appropriate sensory, neurological, and circulatory tests for the knee.  The student will administer functional tests and activity-specific tests for the knee.  The student will identify, palpate, and interpret the integrity of bony landmarks of the knee.  The student will identify, palpate, and interpret the integrity of soft tissue of the knee.  The student will administer commonly used special tests to make a differential assessment of the following: o uniplanar stress tests (e.g., valgus stress test, varus stress test, Lachman test, anterior drawer test, posterior drawer test, posterior sag sign) o multiplanar (rotational) stress tests (e.g., Slocum test, Hughston's test, lateral pivot shift maneuver) o meniscal tears (e.g., McMurray's test, Apley's test) o patellofemoral dysfunction (e.g., grind test, apprehension test) o intra/extracapsular swelling (e.g., sweep test, ballottable patella)  The student will obtain the medical history of an ill or injured athlete or other physically active individual suffering from foot, ankle, or leg pathology.  The student will observe and identify the clinical signs and symptoms associated with the following common injuries, illnesses, and predisposing conditions: o overuse injures o Achilles tendon rupture o compartment syndromes o apophysitis o dislocation or subluxation o foot type/structure o fracture o deep vein thrombosis o neuroma o osteochondritis dissecans o sprain o strain o toe structure/alignment o weight-bearing versus non-weight-bearing alignment o gait  The student will administer active and passive range-of-motion tests using standard goniometric techniques for the foot, ankle, and lower leg.  The student will use manual muscle-testing techniques for the foot, ankle, and lower leg. 9

 The student will administer appropriate sensory, neurological, and circulatory tests for the foot, ankle, and lower leg.  The student will administer functional tests and activity-specific tests for the foot, ankle, and lower leg.  The student will identify, palpate, and interpret the integrity of bony landmarks for the foot, ankle, and lower leg.  The student will identify, palpate, and interpret the integrity of soft tissue of the foot, ankle, and lower leg.  The student will administer the following commonly used special tests to make a differential assessment: o compression test o percussion test o anterior drawer test o Kleiger's test o talar tilt test o Thompson test o Tinel's sign o Homans' sign