2020 Scholars in Action

Assessment of Ball Skill in Elementary Students

Researched and presented by: Lino Azul, Hunter Bowers, and Fabian Correia, Class of 2021
Sponsored by: John Liu, Professor of Physical Education
Department: Physical Education and Health Education
Questions: lazul@springfield.edu

Abstract

The present study was designed to examine ball skill in male and female students of homeschooled elementary school students. The participants included 32 male and 17 female students with ages ranging from 5-11 in the Springfield area. All participants in the study have no previous training of this ball-skill assessment and volunteered to participate through the Springfield College Homeschool Program. 

The task of the study involved performing 3 trials each of kicking and catching assessments on the outside of the track in the field house. Participants were pulled from their homeschool classes to the area to participate, and were given no demonstration or warmup activity before attempting the assessments. Each participant performed the shooting skill individually and did not receive any feedback throughout his/her performance. A 3-point scoring rubric was used to evaluate the performer’s kicking and catching performance accuracy. 

An independent samples t-test was conducted to examine the difference in mean ball skill performance accuracy between the male and female students. Descriptive statistics were also used to illustrate performance characteristics of the two performers on the skill performance. All statistical analyses were performed using the current version of SPSS. The results of the study revealed that the male participants (M-22.59 SD-2.66) did not have significantly higher scores than their female counterparts (M-22.53 SD-3.1). The current finding suggests that both male and female students demonstrate a similar level of ball skill.  Future studies need to investigate gender difference in ball skill performance across all age groups.    

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Compound Ankle Fracture and Dislocation in a 20-Year-Old Female Gymnast: A Case Study

Researched and presented by: Ben Batoosingh and Jack Bixler, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: jbixler@springfield.edu

Background:

Women's gymnastics highlights the human body’s incredible ability to leap and twist through the air in an elegant fashion, which often involves high-impact landings. Early specialization coupled with the high-impact nature of the sport place collegiate female gymnasts at an increased risk for injury (Kerr, Hayden, Barr, Klossner, & Dompier, 2015). Over 70% of injuries in the sport occur during competition, with floor exercises and vault accounting for the largest number (Marshall, Covassin, Dick, Nasser, Agel, 2007). 

While uncommon, the high-impacts gymnasts endure can cause fracture and dislocation, and in even rarer instances, a combination of the two (Marshall et al., 2007, Kerr et al., 2015). Ankle position and force direction upon landing can cause traumatic injury to the ankle (Haraguchi & Armiger, 2009). Case Presentation: A 20-year-old female collegiate gymnast was performing a vault routine and landed on her right ankle pronated, resulting in a compound tibial dislocation. The fracture lacerated the skin exposing approximately an inch and a half of the distal tibia. Normal circulation, motor function, and sensation was present distal to the injury site. The patient was placed in a vacuum splint and transported via ambulance to a nearby hospital for surgery. The patient presented with an oblique distal fibula and medial malleolar fracture and dislocation of the tibiotalar and talofibular joints with a disruption of the tibiofibular syndesmosis (Priyanka, 2020). 

Conclusions:

Trans-syndesmotic ankle fracture-dislocations are usually the result of high-energy trauma (Deng et al., 2018). The Lauge-Hansen classification system is used to classify ankle fracture patterns by analyzing whether the foot was pronated or supinated during the application of abduction, adduction, or external rotation forces (Haraguchi & Armiger, 2009). 

A mechanism of ankle pronation with applied external rotation forces upon landing primarily caused the oblique fibular, medial malleolus fracture, and the associated dislocation (Haraguchi & Armiger, 2009). Under the Orthopedic Trauma Association (OTA) Fracture and Dislocation Classification Compendium the fracture is designated a 44C1.2u fracture (Meinberg, Agel, Roberts, Kellam, & Karam, 2018). The designation describes a supra-syndesmotic simple diaphyseal fibular fracture at the malleolar segment with a medial malleolar fracture and an unstable syndesmosis (Meinberg et al., 2018). While Lauge-Hansen classifications are widely used and accepted to classify ankle fractures, OTA classifications are more comprehensive and based off long bone fracture patterns (Tartaglione, Rosenbaum, Abousayed, & DiPreta, 2015). Disruption of the distal tibiofibular syndesmosis is commonly associated with ankle fracture-dislocations (Wang et al., 2017). In women’s gymnastics, the vault is the cause of over 25% of injuries in the sport, with the highest instance of injury occurring on the dismount and landing (Marshall et al., 2007). 

Similar mechanisms of high energy injuries can result in other types of ankle fractures. High-energy axial or rotational forces transmitted to the ankle complex could result in a “log-splitter” injury, where the talus wedges between the tibia and fibula or distal tibiofibular joint with possible tibial and fibular fractures (Wang et al., 2017). Tibial pilon fractures occur when the talus is driven into the distal tibia, exploding the articular surface of the distal tibia caused by high-energy trauma from falls from a height or motor-vehicle-related accidents (Jacob et al., 2015). 

Clinical Bottom Line:

Trans-syndesmotic ankle fracture-dislocations are extremely rare and require high-energy trauma to occur (Deng et al., 2018). However, when torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injuries (Zamboni et al., 2016). A high-energy external rotation force on a pronated ankle in a gymnastics vault landing can produce enough energy to result in ankle fracture-dislocation. Better understanding of the mechanism of ankle fracture-dislocations can increase understanding of such injuries.  Word Count: 595.

References 

Deng, Y., Dong, C., Yang, X., Liu, R., Hou, F., Li, S., & Tang, K. (2018). High-Energy Transsyndesmotic Ankle Fracture Dislocation: A Case Report and Systematic Literature Review. Case Reports in Orthopedics, 2018, 1–8. 

Haraguchi, N. & Armigr, R. S. (2009). A new interpretation of the mechanism of ankle fracture. The Journal of Bone and Joint Surgery, 91(82), 1-9. 

Jacob, N. Amin, A., Giotakis, N., Narayan, B., Nayagam, S., & Trompeter, A. J. (2015). Management of high-energy tibial pilon fractures. Strategies in Trauma and Limb Reconstruction, 10(3), 137-147.

Kerr, Z. Y., Hayden, R., Barr, M., Klossner, D. A., & Dompier, T. P. (2015). Epidemiology of national collegiate athletics association women’s gymnastics injuries, 2009-2010 through 2013-2014. Journal of Athletic Training, 50(8), 870-878. 

Marshall, S. W., Covassin, T., Dick, R., Nassar, L. G., & Agel, J. (2007). Descriptive epidemiology of women’s gymnastics injuries: National collegiate athletics association injury surveillance system, 1988-1989 through 2003-2004. Journal of Athletic Training, 42(2), 324-240. 

Meinberg, E. G., Agel, J., Roberts, C. S., Kellam, J. F., & Karam, M. D. (2018). Fracture and dislocation classification compendium. Journal of Orthopedic Trauma, 32(1), 1-170. 

Priyanka, D. (2020). Radiology report findings (Report No. 999). Springfield, MA: Baystate Medical Center. 

Tartaglione, J. P., Rosenbaum, A. J., Abousayed, M., & DiPreta, J. A. (2015). Classifications in brief: Lauge-Hansen classification of ankle fractures. Clinical Orthopedics and Related Research, 473(10), 3323-3328. 

Wang, Z., Tang, X., Li, S., Wang, X., Gong, L., Zhong, T., & Wang, K. (2017). Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation—the “Logsplitter” injury . Journal of Orthopedic Surgery and Research, 12(3), 1–10.

Zamboni, C., Campos, F. A. G., Foi, N. O., Souza, R. C., Christian, R. W., & Mercadante, M. T. (2016). Tibial shaft fracture and ankle injury: A case report. Brazillian Society of Orthopedics and Traumatology, 51(5), 597-600."

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Superventricular Tachycardia in a 20-year old Female Volleyball Athlete: A Case Study

Researched and presented by: Hannah Dargie and Meghan Glynn, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: hdargie@springfield.edu

Background:

Atrioventricular nodal reentrant tachycardia (AVNRT) is a common form of supraventricular tachycardia (SVT).  AVNRT is most prevalent in the adult population accounting for 50 to 60 percent of the diagnosis (Colucci, Silver, & Shubrook, 2010). The group most affected is young, healthy women (Colucci et al., 2010).  AVNRT is caused by atypical or typical nodal pathways.  An atypical nodal pathway reacts fast then slow while a typical pathway reacts slow then fast (Colucci et al., 2010). Supraventricular tachycardias represent a range of tachyarrhythmias originating from a circuit or focus involving the atria or the atrioventricular node (Bibas, Levi, & Essebag, 2016).  Supraventricular tachycardias are common (Bibas et al., 2016). The prevalence of SVT in the general population is 2.25 per 1,000 population and the incidence 35 per 100,000 person-years (Bibas et al., 2016)

Case Presentation: 

A 20-year-old female volleyball player complained of strong heart palpitations once, during a game and once at practice. During the palpitation episodes the patient experienced cold sweats with an increased blood pressure and a heart rate greater than 230 beats per minute (bpm). Ventricular rates in SVT may vary from 150 to 250 bpm (Bibas et al., 2016).  After wearing a heart monitor for 30 days, undergoing multiple electrocardiograms, an echocardiogram, blood work, and stress tests, the patient was diagnosed with AVNRT. The results of each test presented an arrhythmia that went from fast to slow instead of slow to fast indicating a tachycardia abnormality.  This atypical tract, fast to slow, is only present in 10% of the population whereas the slow to fast tract is present in 90% of the population (Colucci et al., 2010). The patient was then scheduled for an ablation procedure to remove the abnormality.  

The patient fasted for 12 hours before the procedure and was put under heavy sedation for the surgery. Three incisions were placed in the groin region and a catheter was inserted through the main artery to the heart. Once the catheter was inserted, the electrical circuit of the heart was mapped to find the exact location of the SVT. A typical electrophysiology study is a programmed stimulation from the right ventricle, followed by programmed stimulation from the proximal coronary sinus (Jan, Zizek, Rupar, Mazic, Kuhelji, Lakie, & Gersak, 2016). To induce a tachycardia episode, the heart rate of the patient was increased to 230 bpm through medication to locate the abnormality. The abnormality was found in the coronary sinus (CS) almost midway through the activation of the right ventricle and left ventricle lateral wall (V-V interval). The abnormality was then ablated and the patient was then given isoproterenol to induce a second episode. 

A tachycardia episode could not be produced, indicating a successful procedure. 

Conclusions: 

All patients with symptomatic SVT should be referred to a cardiologist for assessment and management (Bibas, Levi, & Essebag, 2016).  Due to the location of the abnormality, the ablation was very close to the electrical circuit of the heart, causing the procedure to be completely precise. The assessment of blood pressure, heart rate, and breathing rate warranted further referral by the athletic trainer to gain a final diagnosis of atrioventricular nodal reentrant tachycardia (Colucci et al., 2010).

Clinical Bottom Line: 

For an athletic trainer, recognition of a tachycardia episode and proper treatment is key to prevent the use of emergency medical response (Casa et al., 2012).  Rapid recognition of the underlying rhythm is essential to correct management in the acute setting, including identifying patients who may benefit from definitive treatment with catheter ablation (Bibas et al., 2016). 

Word Count: 586"

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A Male Basketball Player with Chronic Plantar Fasciitis Treated with PRP Injection

Researched and presented by: Sean Foster, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: sfoster3@springfield.edu

Background: 

A male basketball player with chronic plantar fasciitis received a platelet-rich plasma (PRP) injection. The PRP injection was prescribed due to multiple modes of unsuccessful treatment in reducing pain. The PRP is extracted from the blood of the patient and put through a centrifuge. A PRP injection is an injection of the patient’s blood plasma into the site of the injury to bring nutrients for the purpose of healing. (Tiwari & Bhargava, 2013). 

Case Presentation:

 21-year-old male basketball player with chronic plantar fasciitis received a platelet-rich plasma (PRP) injection. The patient received PRP treatment following six weeks of conservative treatment consisting of immobilization in a walking boot for two weeks and a plantar fasciitis rehabilitation protocol. Multiple treatment options were ineffective in resolving the patient’s symptoms. 

Patient underwent iontophoresis with dexamethasone treatments for two weeks, which also proved ineffective. After being immobilized for two weeks, the patient’s treatment consisted of hot whirlpool therapy, thermal ultrasound, arch strengthening, ankle range of motion (ROM) and lower leg strengthening. Following six weeks of treatment, the pain did not subside, and the patient was prescribed a PRP injection as recommended by the team physician. The patient was immobilized in a walking boot for two weeks post-injection and was transitioned out of a walking boot over the course of three days. Light ankle ROM and arch strengthening was added after being immobilized. 

The patient remained pain-free following the PRP injection. Six weeks post-injection, the patient returned to intense treatment and rehabilitation which included ultrasound, dynamic fascial decompression, ankle ROM, eccentric foot exercises, arch strengthening, balance, and various forms of soft tissue mobilization. The patient moved into sport-specific motions 12 weeks post-injection. Conclusions: Tiawari & Bhargava (2013) define plantar fasciitis as chronic degenerative tendinopathy with inflammation of the thick fibrous band of tissue which originates at the calcaneus and inserts on the metatarsal heads. Micro-tears occur within the fascia at the insertion near the calcaneus (Tiawari & Bhargava, 2013). Efficacy of PRP injection in chronic plantar fasciitis has exhibited a long-term decrease in pain.

Patients who have received PRP injections have a decrease in pain within the first-month post-injection. Full healing properties of PRP take effect after the three-month period (Vahdatpour, Kianimehr, Moradi & Haghighat, 2016). PRP was the better treatment option compared to corticosteroids as a long-term treatment pain control and healing of the plantar fascia. Corticosteroids have an increased likelihood of reducing pain in the short term but do not promote the healing effects that PRP does (Vahdatpour et al., 2016). PRP has shown to decrease pain after one, three, and six months compared to corticosteroids which are associated with an increase in pain until the six-month mark (Tiawari & Bhargava, 2013). PRP can be beneficial in the recruitment of growth factors like cytokines, and anti-inflammatory markers begin the healing process and remove any degenerated tissue in the process (Yang et al., 2017). 

Clinical Bottom Line:

PRP is an effective treatment for the athletic population if conservative treatment does not produce relief of symptoms in plantar fasciitis. Treatment after PRP injection is vital for decreasing pain and increasing the ability to target foot strengthening for return to play in a timely manner. The rehabilitation protocol did not change before or after injection, the PRP aided in the decrease of pain and the ability to progress in rehabilitation. 

Word count: 555

References:

Tiawari, M. & Bhargava, R. (2013). Platelet-rich plasma therapy: A comparative effective therapy with promising results in plantar fasciitis. Journal of Clinical Orthopedics and Trauma, 4(1), 31-35.

Vahdatpur, B., Kianimehr, L., Moradi, A. & Haghighat, S. (2016). Beneficial effects of platelet-rich plasma on improvement of pain severity and physical disability in patients with plantar fasciitis: A randomized trial. Advanced Biomedical Research, 5(1), 179-194.

Yang, W., Han, Y., Cao, X., Pan, J., Zeng, L., Lin, J. & Liu, J. (2017). Platelet-rich plasma as a treatment for plantar fasciitis: A meta-analysis of randomized control trials. Wolters Kluwer Health, 96(44), 1-8.

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A microdiscectomy of L5-S1 in a 20-year-old male offensive lineman: A Case Study

Researched and presented by: Sophie Grant, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: sgrant4@springfield.edu

Background:

A microdiscectomy also known as micro-decompression is a minimally invasive surgical procedure performed on patients with herniated lumbar discs (Hermantin, Peters, Quartararo & Kambin, 1999). The main goal of a microdiscectomy is to reduce pressure on spinal cord and spinal nerve roots (Hermantin et al., 1999). A microdiscectomy uses an interlaminar approach to remove herniated disc material and to resect other damaged tissues (Barth, Weiss & Thomé, 2008). Surgeons use a microscope to view the disc and nerves (Barth, Weiss & Thomé, 2008).  The larger views allow the surgeon to use a smaller incision, resulting in less damage to the surrounding tissue (Barth, Weiss & Thomé, 2008).  Throughout the years, the procedure has been modified to a more minimalist approach with minimal removal of bony and ligamentous structures while keeping the herniated disc as intact as possible (Barth et al., 2008). Often patients who present with a herniated disc receive a lumbar fusion. Though a lumbar fusion presents with the same recovery time as a microdiscectomy, lumbar fusion often has more restrictions in return to activity (Barth et al., 2008). Due to the patient being a Division I offensive linemen, a microdiscectomy was used.

Case Presentation:

The patient is male, NCAA Division I offensive linemen, complaining of lower back pain effecting his hamstring and hip flexor. 

During summer football session (2019), the patient was benching when the disc herniation took place, similar to pain the patient has felt in the previous summer session. Immediately the patient started to feel radicular pain and weakness in the back and left leg, also the patient also had decreased reflex in the left Achilles. The patient was removed from sport and referred to the team physician to undergo a Magnetic Resonance Imagining (MRI). The MRI revealed a lumbar disc herniation of L5-S1 on the left side. The patient was recommended for a microdiscectomy. The surgery to place on August 2019. The patient immediately was able to feel his left leg without having any radicular symptoms. 

After surgery, the patient was restricted from any sport activities for eight weeks. The patient had a follow-up with the surgeon who stated the patient should keep following a protocol. The patient has yet engaged in position-specific drills but is instructed to begin running and participating in drills in March 2020. Conclusions: Due to the patient having a microdiscectomy, the patient was able to begin rehabilitation, and everyday activities with less to no restrictions. After having a microdiscectomy, the patient should immediately become pain-free and should be able to resume activity within 4 to 6 months of surgery (Barth et al., 2008). The patient is able to return to lift (with caution of axial loading), start engaging in return to play activities, started running drills, and is said to return fully to play in the fall 2020 session.  

Clinical Bottom Line:

By choosing a microdiscectomy, the patient will be able to return to sport with no restrictions. Microdiscectomy allows for faster return to play then lumbar fusion. The success rate of a microdiscectomy is very high indicating a good overall quality of life.   

Word Count: 544

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Retrolisthesis of the Fifth Lumbar and First Sacral Vertebra in a 17 Year Old High School Football Athlete: A Case Study

Researched and presented by: Katherine Holliday, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: kholliday@springfield.edu

Background:

Retrolisthesis is a condition of the spine in which the vertebral body is displaced posteriorly (Zaidi, Nuhmani, & Jalwan, 2015).  Spondylolisthesis, an anterior slippage of the vertebral body, is a  similar condition and more common injury than Retrolisthesis (Spinasanta, 2020).   Overall, retrolisthesis at the level of L5-S1 has an incidence of 23.2% (Shen, Razi, Lurie, Hanscom, & Weinstein, 2007).   

Retrolisthesis can be caused by congenital laxity or by a gradual elongation of the vertebral ligaments (Zaidi, Nuhmani, & Jalwan, 2015).   The symptomatic presentation of retrolisthesis varies but is typically caused by nerve root compression and mechanical pressure on the joint depending on the degree of displacement (Zaidi, Nuhmani, & Jalwan, 2015).   Retrolisthesis is linked to disc degeneration, decreased lordosis of the lumbar spine, and a decrease in the angle of the vertebral endplate (Shen, Razi, Lurie, Hanscom, & Weinstein, 2007).   The most common intervention for retrolisthesis is non-surgical (Zaidi, Nuhmani, & Jalwan, 2015). In significant cases of retrolisthesis, surgery is possible (Zaidi, Nuhmani, & Jalwan, 2015).   

Nonsurgical treatment includes the use of therapeutic exercise to strengthen the muscles of the low back and core focusing on stabilization and extension exercises (Zaidi, Nuhmani, & Jalwan, 2015).   Surgical correction of retrolisthesis is typically completed with a displacement of two millimeters or more (Zaidi, Nuhmani, & Jalwan, 2015).   Case Presentation: A  seventeen year old, male, high school football and track athlete reported the gradual onset of increasing pain over the course of three years.   The patient complained of increased pain while laying in the prone position, with side lying, and increased pain when running. The patient reported a sharp pain which prevented normal movement when standing.   

The original diagnosis after referral to a physician was “growing pain”.   The patient returned to the physician after three years of increasing pain.   The physician ordered diagnostic imaging in the form of X-ray and Magnetic resonance imaging (MRI).   The MRI did not show any soft tissue abnormalities.   The X-ray revealed retrolisthesis of L5 and S1. The patient was treated conservatively with non-surgical intervention. Treatment included physical therapy three times weekly and restriction from weight lifting for three months during the summer.   The patient has reported a decrease in duration, frequency, and intensity of pain after the start of a therapeutic exercise program.   The patient was cleared for full contact in September, 2019.   Since returning to sport specific activity the patient has responded well to treatment with heat and soft tissue mobilization in addition to therapeutic exercises.  

Conclusion:

Retrolisthesis is more rare compared to spondylolisthesis but may result in similar pain and dysfunction.   Retrolisthesis is identified with X-Ray imaging.   The non surgical route of treatment allows the patient to gain strength, stability, and normal function without the risk and cost of spinal surgery.   

Clinical Bottom Line:

Retrolisthesis is a condition wherein the vertebrae of the spine slip posteriorly.   Chronic low back pain in young athletes should not be looked at as merely “growing pains” as it was in this case, because the possibility for injury is too great when dealing with the spine.   Radiographs are the gold standard in identifying retrolisthesis.   

Correct diagnosis of retrolisthesis is needed for proper therapeutic exercise and healing.  

Word count: 520"

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Associations Between Male Gender and Autism Spectrum Disorder

Researched and presented by: Alyssa Karpicki, Class of 2020
Sponsored by: Pamela Higgins, Associate Professor of Health Science
Department: Health Science
Questions: akarpicki@springfield.edu

Abstract

Autism Spectrum Disorder (ASD) is categorized as a developmental disability that affects the brain in areas such as social interaction, communication, and cognitive functioning. ASD is one of the fastest-growing developmental disorders in which research is critical to conduct and understand. In 2018, the CDC established that 1 in 37 males are diagnosed with ASD, while 1 in 151 females are diagnosed with ASD.

The high rates of gender variance have been reported; however, very little is understood about ASD and the underlying factors of the discrepancies between gender and prevalence because symptoms vary across each individual. The available literature was sorted by the most recent investigations since 2014. Of the eleven analytic studies distinguishing male prevalence of ASD from females four recent investigations were considered that involved the following criteria: investigations were conducted in the past five years, included adolescents (ages 1.5 to 19 years of age), included a relatively even male to female ratio of participants, included ASD diagnostic criteria conducted by a trained clinician and were not confusing in the English language.

 Therefore, the purpose of this investigation was to assess the relationship between the male gender, specifically in adolescents, and the diagnosis of ASD.  Based on the literature available, there is weak evidence to support the association of why males have a higher prevalence of ASD. Further investigations using larger sample sizes and that specifically describe gender differences in ASD adolescents’ brains and behavior are necessary to distinguish the association of ASD and male gender.

Young Adults' Expectation for Dating Relationships

Researched and presented by: Christina Forde and Sara King, Class of 2020
Sponsored by: Elizabeth Morgan, Associate Professor of Psychology
Department: Psychology
Questions: emorgan2@springfield.edu

Abstract

This study examined expectations that young adults' in the United States perceived to receive from other sources about dating and sexual experiences. Participants included 494 young adults between the ages of 18-30 who completed open-ended questions via an online platform. 

Recruitment included a purposeful data sampling from Qualtrics panels to achieve roughly the same number of male and female participants who were currently in relationships with same-sex and other-sex partners. Analysis included thematic coding of responses, with adequate reliability between two independent coders. 

Results suggested that participants recognized: expectations for heterosexuality; expectations for certain timelines to occur (e.g., when to date, when to have sex, when to get married, and when to have kids); expectations for having a quality relationship (including trust, fidelity, and care for each other); and less so for following traditional gender roles and religious principles. Some gender differences emerged with regard to how expectations were articulated. Overall, the young adults were able to recognize patterns of expectations that follow traditional social norms, and discuss how they did and did not fit into these expectations in their own dating histories and current relationships.

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Left Unlar Collateral Ligament Sprain in a 19- Year - Old Female Gymnast: A Case Study

Researched and presented by: Emily LaPlante, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: elaplante@springfield.edu

Background: 

The ulnar collateral ligament (UCL) is the primary medial stabilizer of the elbow and resists valgus stresses applied to the elbow joint (Zaremski et al., 2017). Injuries to the UCL are common among participants in overhead throwing sports (Zaremski et al., 2017).  Research focuseson the male population and showed good outcomes for patients who undergo surgical repair and/ or reconstruction of the UCL (Ramos & Limpisvasti, 2019).  

Injury to the UCL in non-throwing athletes involves an acute traumatic incident and the prevalence of UCL injuries in gymnasts is not known (Nicolette & Gravlee, 2018).  Gymnasts have repetitive upper extremity axial loading, performed with the elbow near full extension (Nicolette & Gravlee, 2018).  Considering sport and position, the load placed on the UCL can determine nonsurgical or surgical treatment (Nicolette & Gravlee, 2018).  A large magnitude of forces is present on the body in all gymnastics events however, the specific forces may vary depending on the event (Nicolette & Gravlee, 2018).  Case Presentation:  A 19-year-old female gymnast sustained a sprain of the left elbow UCL when performing an overshoot on the uneven bars.  The patient was tender to palpate over the anterior and posterior aspects of the UCL.  

Positive tests were found with a valgus stress test and moving valgus stress test between 70 and 120 degrees. The patient was given a two week home rehabilitation program during the winter break.  Upon return to participation the patient was unable to complete sport based activities without pain. The patient was removed from practice after no change in symptoms or ability.  Rehabilitation of the elbow included forearm flexor strengthening and external rotation exercises.  Strengthening exercises are performed initially in pain free midrange of motion with overpressure at the end ranges of motion (Prentice, 2015).  

Laser treatment was implemented before the exercise program.  Nonoperative treatments with structured rehabilitation have demonstrated high rates of return to play following UCL injury in non-throwing sports (Nicolette & Gravlee, 2018).  Gymnasts who have sustained partial tears of the elbow UCL have been returned to sport between two and six weeks with nonoperative treatment (Nicolette & Gravlee, 2018).  The patient began the return to play process in five weeks, and was competition ready in six.   Conclusions:  The patient underwent a nonoperative treatment.  Majority of UCL injuries can be managed conservatively and are beneficial for the non-throwing athlete due to the limited time spent in an externally rotated position (Zaremski et al., 2017). 

Conservative treatments of the UCL begin once symptoms reside and focus on strengthening the forearm muscles (Prentice, 2015).  A high magnitude of forces is present on the upper body during the uneven bars event in gymnastics (Nicolette & Gravlee, 2018). The sport and event of the patient likely played a large role in injury severity and return to play.   Clinical Bottom Line:   Elbow UCL injuries are common in adolescents playing throwing sports (Zaremski et al., 2017).  

The incidence of nonsurgical UCL injury patterns and management in populations of non-throwing athletes is unknown (Zaremski et al., 2017).  Few studies have been published on the incidence of injury and return to play recommendations in gymnastics (Nicolette & Gravlee, 2018).  Rehabilitation programs which focus on strengthening the flexor muscles can help the patient return to play without the need for surgical intervention (Prentice, 2015). 

Word Count: 562

References

Prentice, W. E. (2015). Rehabilitation Techniques for Sports Medicine and Athletic Training (6th  ed.). Thorofare, NJ: SLACK Incorporated.

Nicolette, G. W., & Gravlee, J. R. (2018). Ulnar collateral ligament injuries of the elbow in female division I collegiate gymnasts: a report of five cases. Journal of Sports Medicine, (9), 183-189.

Ramos, N., & Limpisvasti, O. (2019). UCL injury in the non-throwing athlete. Current Reviews in Musculoskeletal Medicine, 12, 527-533.

Zaremski, J. L., & McClelland, J., Vincent, H. K., & Horodyski, M. (2017). Trends in sports-related elbow ulnar collateral ligament injuries. The Orthopaedic Journal of Sports Medicine, 5(10), 1-7."

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Atypical Rhabdomyolysis in a 16-year-old Male Water Polo Player: A Case Study

Researched and presented by: Dani Donnelly and Miranda Lee, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: mlee8@springfield.edu

Background:

Exertional rhabdomyolysis (ER) is a condition when a breakdown and necrosis of skeletal muscle occur after the engagement in physical activity (Tietze & Borchers, 2014).  

Rhabdomyolysis typically evolves from strenuous eccentric exercise at an intensity unaccustomed to an individual participating in a physically demanding task (Cleary et al., 2011).  The increase in intracellular ionized calcium to a level much higher than normal in the cytoplasm and mitochondria causes the cell damage death in skeletal muscle (Tietze & Borchers, 2014).  Individuals with ER typically complain of delay-onset muscle soreness (DOMS), localized edema, and decreased muscle pain (Furnman, 2015).  Exertional rhabdomyolysis is relatively uncommon but the growing popularity of endurance events with more aggressive training is leading to several more reported cases of exertional rhabdomyolysis in both trained and untrained athletes (Furman, 2015).  

Case Presentation:

A 17-year-old boys’ water polo player was in practice when the athlete complained of having chest pain in addition to painful soreness throughout entire body. The athletic trainer responded to the incident and started taking vital signs before the EMTs arrived and found the heart rate abnormally high.  The patient was immediately sent to the hospital and was diagnosed with an atypical rhabdomyolysis. 

The athlete was held in the hospital and was treated with intravenous hydration and tracking of creatine kinase levels. The athlete was also diagnosed with Wolf Parkinson White Syndrome after an electrocardiograph was performed due to experiencing palpitations. The athlete was allowed to leave the hospital after no recurrent symptoms appeared after 48 to 72 hours from the time of injury. The athlete was instructed to limit physical activity and to drink at least 3 liters of water per day. The athlete underwent an intracardiac electrophysiology study after 2 weeks and was noted to have low to moderate risk for sudden cardiac arrest and an ablation procedure of the pathway was performed. The athlete returned to play after a slow progression cardio program with no recurrent symptoms.

Conclusions:

In this unique case of rhabdomyolysis, the athlete did not present common signs of exertional rhabdomyolysis involving DOMS, myoglobinuria, or localized edema (Furnman, 2015). The patient in the unique case study presented symptoms of chest pain, shortness of breath, and muscle soreness. In the case reported by Cleary et al. (2011) the athlete was participating in a preseason wrestling camp where the athlete was participating in strenuous exercise.  After the third day of training, the athlete started noticing dark brown urine and sever bilateral leg pain in the quadriceps (Cleary et al., 2011).  The wrestler presented with DOMS and dark colored urine where as in the unique case the water polo player presented with chest pain, shortness of breath and muscle fatigue (Cleary et al., 2011). 

Clinical Bottom Line: When a patient complains of severe muscle cramping and is experiencing symptoms such as dark colored urine after intense physical activity, clinicans should always suspect the possibility of ER no matter what level of exertion the patient reports (Furnman, 2015).  During the diagnosis of rhabdomyolysis, the possibility of multiple different signs and symptoms may occur.  Clinicians must be careful and aware of what to look for in an athlete who may be susceptible to getting rhabdomyolysis (Furnman, 2015). Rhabdomyolysis can be prevented but potentially life-threatening if not caught or recognized in time (Cleary et al., 2011).

Word Count: 578 words. 

References

Cleary, M. A., Sadowski, K. A., Lee, Y. S., Miller, G. L., & Nichols, A. W. (2011). Exertional rhabdomyolysis in an adolescent athlete during preseason conditioning: A perfect storm. Journal of Strength and Conditioning Research, 25(12), 3506-3513. 

Furnman, J. (2015). When exercise causes exertional rhabdomyolysis. Journal of the American Academy of Physician Assistants, 28(4), 38-43. 

Tietze, D. C. & Borchers, J. (2014). Exertional rhabdomyolysis in the athlete: A clinical review. Sports Health, 6(4), 336-339. 

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Acute Clavicular Fracture of an 18 yo Collegiate Wrestler Treated Nonoperatively without Signs of Healing: A Case Study

Researched and presented by: Alex Maring, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: amaring@springfield.edu

Background:

Clavicle fractures account for approximately 2.6% of total body fractures. Approximately, 69–81% of fractures to the clavicle occur in the middle one-third (Wang et al., 2015). Clavicle fractures comprise 35–45% of all shoulder girdle injuries in adults and are more prevalent in males (Virtanen et al., 2012). Clavicle fractures are traditionally treated nonoperatively due to concerns about infection, hardware prominence, and a potential increase in the risk of nonunion (Rabe & Oliver, 2011). Individuals who sustain displaced midshaft clavicular fractures are typically placed in a sling for immobilized as nonoperative conservative treatment compared to surgical intervention affecting the anatomical structure of the clavicle as well as the recovery time (Rabe & Oliver, 2011). 

Fractures of the clavicle are typically sustained as a result of direct trauma or a fall on the outstretched hand. Although falling on the outstretched hand is thought to be the most common mechanism of injury, research found in 94% of cases the mechanism of injury to be direct trauma (Daolagupu et al., 2013). Case Presentation: An eighteen-year old, first-year male wrestling athlete, with no prior history of fracture or major injury sustained a displaced mid-shaft clavicular fracture. The injury occurred from being slammed on the mat directly on the tip of the injured shoulder during competition on 1/5/20. Examination determined obvious deformity with brachial and radial pulses within normal limits. Upon initial x-rays, the patient was informed the clavicle was fractured and placed in a sling. Re-evaluation from a second doctor observed no sign of union upon second x-ray. Patient was placed in a posture brace and was instructed to report back to the clinician in two weeks. If no calcification is present, the patient will undergo operative treatment. Upon re-evaluation by the orthopedist, calcification was present at the fracture location; therefore, negating the need for surgical intervention. 

Conclusions:

Operative treatment is superior to nonoperative treatment for the management of displaced mid-shaft clavicle fractures; however, nonoperative treatment is also recommended for fractures with a displacement and shortening of less than 2 two centimetres (Waldmann et al., 2018; Wang et al., 2015). Considering these indications, more than 50% of all midshaft fractures of the clavicle in adults are suitable for nonoperative treatment with excellent functional outcome. (Waldmann et al., 2018). Primary operative fixation could effectively reduce the rates of nonunion, symptomatic malunion, neurological symptoms and overall complications (Wang et al., 2015). 

Clinical Bottom Line:

Conservative treatment may lead to significant deficits, whereas surgical management results in an earlier and more reliable return to full function with a low complication rate (Rabe & Oliver 2011).

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Traumatic Hyphema with an Irregular Presentation: A Case Study

Researched and presented by: Ben Paquette and Joseph Salatel, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: bpaquette@springfield.edu

Background:

Hyphema is a condition of blood accumulation in the anterior chamber of the eye (Stilger et al.,, 1999). A hyphema caused by blunt trauma is known as traumatic hyphema (Ghafari et al., 2013). Hyphema is classified into four categories  based on the amount of blood in the eye (Seyed et al.,, 2014). Treatment of a hyphema can reduce the occurrence of intraocular pressure, blood deposition in the cornea, cataracts, optic nerve damage, and a reduction of visual acuity (Ghafari, et al., 2013). Patients with traumatic hyphema are predominantly male with a mean age under 25. Two thirds of hyphemas result from traumatic incidents with the final one-third caused from penetrating trauma (Zafar et al.,, 2019). Hyphema can spontaneously occur in non-traumatic causes of rubeosis iridis, blood dyscrasias, and juvenile xanthogranuloma.  (Zafar, er al., 2019).  

Case Presentation:

A 23 year-old male soccer player was hit directly in the right orbital region with a soccer ball during practice. The anterior compartment began to fill with blood in an irregular triangular shape causing the individual to lose vision in the affected eye. In common hyphema cases the blood will begin to pool in the bottom portion of the anterior chamber. The blood pools in a fashion where there is continuity across the eye rather than an irregular shape. 

The patient was sent to urgent care where the individual was redirected to the hospital in order to be seen by an opthamologist . The athlete was admitted for five days in order to allow the blood to absorb by sitting upright in the semirecumbent position. The individual had to be admitted in order to reduce the chances of the membrane of the eye from rupturing again and causing permanent vision loss.  Conclusions: The goal of treatment is to minimize secondary injury, decrease the chance of further loss of eyesight and to regain eyesight back. One method of treatment calls for bedrest with bilateral patching while another method includes moderate activity with no significant differences. The most common and conservative form of treatment consists of a patient lying supine with the head elevated to 45 degrees. 

A 45 degree angle allows for grading and assists in clearing visual axis (Stilger, Alt, & Robinson, 1999). Patients are urged to report a suspected hyphema quickly and seek appropriate medical attention from an opthamologist.  Clinical Bottom Line: The mechanism of the injury presented is the most common form of hyphema, but the presentation of the blood in the anterior chamber was unique to the current case. The triangular blood pooling shape was not seen in any other literature upon review. Instantaneous loss of vision was an uncommon presentation to common presentations of hyphema.

Word Count: 464

References 

Ghafari, A., Siamian, H., Aligolbandi, K., & Vahedi, M. (2013). Hyphema caused by trauma. Medical Archives, 67(5), 357–359.

Seyed, H., Mohammad, R., & Mahmoud, M. (2014). Comparison between topical and oral tranexamic acid in management of traumatic hyphema. Iranian Journal of Medical Sciences, 39(2), 178-183. 

Stilger, V., Alt, M. J., & Robinson, W. T. (1999). Traumatic hyphema in an intercollegiate baseball player: A case report. Journal of Athletic Training, 34(1), 25-28. 

Zafar, S., Canner, J., Mir, T., Srikumaran, D., Channa, R., Goldberg, M., . . . Woreta, F. (2019). Epidemiology of hyphema-related emergency department visits in the united states between 2006 and 2015. Ophthalmic Epidemiology, 26(3), 208-215.

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Grade 3 Lisfranc Ligament Sprain Treated with Internal Fixation in a 21-year-old Male: A Case Study

Researched and presented by: Noah Rouleau, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: nrouleau@springfield.edu

Background:

A lisfranc joint sprain is a rare condition in which the lisfranc ligament complex becomes compromised due to axial loading while in a plantarflexed position (Nunley & Vertullo, 2002). The lisfranc joint acts as a stabilizer for the arch of the foot as well as transfers force from the gastrocnemius to the forefoot (Nunley & Vertullo, 2002). The ligament originates on the lateral surface of the medial cuneiform and inserts into the plantar and lateral surfaces of the first and second metatarsals (Nunley & Vertullo, 2002). Important findings to note when evaluating a patient with a suspected lisfranc ligament injury include tenderness to palpation at the tarsometatarsal joint and first and second metatarsals. Other findings include pain when weight-bearing and a decrease in the transverse arch of the foot (Nunley & Vertullo, 2002). 

In order to accurately diagnose this injury, a weight-bearing radiograph is needed to highlight a diastasis between the first and second metatarsal (Nunley & Vertullo, 2002). Case Presentation: A 21-year-old male NCAA male football offensive lineman endured a grade 3 rupture of the lisfranc joint. The initial injury occurred while participating in a game. The patient reported having the retrocalcaneal aspect of the foot rolled on during a play while in a plantarflexed position and immediately felt a sharp pain. Initial x-rays revealed no fracture or ligamentous rupture, a typical outcome observed in midfoot sprains. Weightbearing x-rays were ordered and revealed a 3-5 millimeter diastasis. The patient underwent fixation of a plate on the first metatarsal and utilized a “homerun” screw pinning the first cuneiform to the base of the second metatarsal. At the twelve-week checkup, x-rays exhibited the fixated screw had broken in two pieces. 

Surgeons plan on the removal of the fixated screw and treat the injury conservatively. Conservative treatment consists of the use of orthotics and the continued use of rehabilitative exercise. The study seeks to determine the effectiveness of the usage of a single fixed screw compared to normative surgical procedures on recovery time. Conclusions: Studies agree that in the case of a level 3 lisfranc sprain the mechanism, symptoms and surgical treatment were all in agreement (Nunley & Vertullo, 2002). Patients typically will experience a low-velocity impact in a plantar fixed position and experience a pop or crack followed immediately by pain (Nunley & Vertullo, 2002). Patients will have symptoms in the days following the initial mechanism; pain while weight-bearing, tender to palpate on the midfoot ecchymosis and edema on the midfoot and erythema (Nunley & Vertullo, 2002). 

Surgically, internal fixation is suggested in the research and was utilized in the case study as well.

Clinical Bottom Line:

The evidence of the case study suggests the use of a fixation screw in lisfranc joint sprains has the possibility to fail. Clinicians should caution in advocating for the use of this type of surgical intervention. Conservative rehabilitation is possible and should be considered in the clinical decision-making process.

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Compound Dislocation of the PIP joint of 5th Finger without Fracture of Avulsion of Flexor Tendons: A Case Study

Researched and presented by: Bella Thornton, Class of 2021
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: bthornton@springfield.edu

Background:

A male football player obtained a volar compound dislocation of the R 5th proximal interphalangeal (PIP) during a collision at football practice. No fracture of the proximal, intermediate, or distal phalanges were present, nor avulsion of flexor digitorum superficialis or flexor digitorum profundus tendons upon further evaluation at the hospital. Dislocations of the PIP are common, but volar dislocations without rupture of the central tendon or collateral ligament with the absence of a fracture is rare (Saitta & Wolf, 2018). Case Presentation: The patient is a 19-year-old male football player who received a traumatic injury to the fifth digit of the hand after the finger was caught in a jersey of a teammate during practice. The mechanism of injury resulted in a compound dislocation of the PIP joint. The wound was irrigated to remove debris from the site of injury, followed by immobilization and packing of the finger in ice before referring to Bay State Medical Center. 

The patient received an x-ray determining the absence of a fracture or avulsion of the flexor tendons and was given stitches after the dislocation was reduced. An orthoplast buddy strap splint was applied to protect the joint while the stitches healed. Other comparative splints, such as complete immobilizations and dorsal-blocking splints, may be implemented to treat a volar PIP dislocation (Joyce, Joyce, Conroy, Chan, Buckley, & Carroll, 2014). Using a figure-eight splint instead of an orthoplast buddy strap is more effective in regaining full range of motion (ROM) and having fewer doctor visits during recovery while reducing long-term pain, joint stiffness and instability of the PIP joint (Joyce et al., 2014). The preferred outcome to a volar dislocation is regaining full ROM without complications of joint stiffness, muscle weakness, or disruption in the gliding of tendons (Joyce et al., 2014). The patient progressed to running and aerobic workouts two weeks after injury, refraining from grasping items of at least 10 pounds in weight as well as lifting objects greater than 15 pounds with his right hand. 

The patient had to wear the orthoplast buddy strap brace for all activities. The patient has made a full recovery and is currently cleared for full participation splint-free, 14 weeks after the initial injury took place. Conclusions: Injuries to the PIP joint must be treated immediately due to the potential damage of ligaments or the volar plate (Freiberg, 2007). X-rays are valuable at the time of injury to determine the extent of dislocation or subluxation, as well as to identify the presence of any avulsion fractures requiring further rehabilitation (Freiberg, 2007). The patient was able to receive immediate treatment from the athletic training staff present at the time of injury and was sent for imaging immediately after the incident occurred, overall reducing the occurrence of secondary injury. 

Clinical Bottom Line:

Dislocations of the PIP joint of the fifth finger are not uncommon injuries of the hand, but a volar dislocation is the least common type of PIP dislocation, making the case presented unique (Saitta & Wolf, 2018). Volar dislocations often result in a central slip rupture or are accompanied by a rupture of the volar plate with at least one collateral ligament, but the patient had neither complication, also adding to the uniqueness of the case (Saitta & Wolf, 2018).

Word Count: 544

References:

Freiberg, A. (2007). Management of proximal interphalangeal joint injuries. Can J Plast Surg,15(4). 199-203.

Joyce, K. M., Joyce, C. W., Conroy, F., Chan, J., Buckley, E., & Carroll, S. M. (2014). Proximal interphalangeal joint dislocations and treatment: An evolutionary process. Archive of Plastic Surgery, 41. 394-397. 

Saitta, B. H., & Wolf, J. M. (2018). Treating proximal interphalangeal joint dislocations. Hand Clinic, 34. 139-148.

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Correlation between performance outcome and performance quality of fundamental movement skills

Researched and presented by: Nick Bratberg, Brendan Tassy, and Dereck Webb, Class of 2021
Sponsored by: Zhan Liu, Professor of Physical Education
Department: Physical Education and Health Education
Questions: dwebb@springfield.edu

The population of homeschool children in the United States is growing, but the correlation between their level of skill and performance level is unknown. Without access to physical education, homeschool children may engage in inadequate levels of skill development in relation to skill performance. The purpose of this study was to examine the relationship between the performance outcome and the performance quality of fundamental movement skills homeschool students participating in a Physical Education program. 

Forty-nine homeschool children (32 boys and 17 girls) participated in a once-weekly structured Physical Education program over a four-week period.  Separate Pearson Product Moment Correlation Coefficients were conducted to examine the relationship between the performance outcome and the performance quality scores.  Descriptive statistics were also examined.  

All statistical analyses were performed using the current version of SPSS.  The significance level was set at .05.  The results of the analyses revealed a significant correlation between locomotor skill performance outcome and movement quality scores, r=-.283, p=.048, and between horizontal jump outcome and jumping movement quality scores, r=.659, p=.0001.  The findings of the current study suggest that desirable performance outcome of fundamental locomotor skills is closely associated with good movement forms and mechanical quality of the skill performance in homeschool children.  It is recommended that future programs focus on increasing the time spent on skill development rather than performance outcome.

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Delayed onset bursitis in a male collegiate football player

Researched and presented by: Nicholas Critz and Cameron Gray
Sponsored by: Sue Guyer, Professor of Athletic Training
Department: Athletic Training
Questions: cgray4@springfield.edu

Background:

According to Prentice (2015), a bursa is a fluid filled sack which are found in areas of high friction throughout the body and allow for smooth, pain free motion. When a bursa becomes injured, the fluid from the bursa leaks out into the surrounding area and the inflammatory response of the body causes swelling to become present in the area of injury. The presentation of swelling due to bursitis, especially in traumatic injuries, usually occurs within the first few hours after trauma (Prentice, 2015). 

Clinical Presentation:

An 18-year-old football lineman with no history of knee injuries came into the athletic training room complaining of burning pain just proximal and medial to the left knee. After a full evaluation the athlete left the athletic training room, the athlete came back 30 minutes later with large levels of pitting edema (grade 4+/4+) in the medial aspect of the left knee. In the 30 minutes between visits the patient was sitting watching film, no strenuous activity occurred. The pain was sharp pain (6/10 without pressure and 9.5/10 with pressure) at the point of edema. Blunt trauma was reported in the area forty-eight hours prior to the onset of edema upon secondary evaluation. The patient was referred for both radiography and magnetic resonance imaging, both imaging techniques found no abnormalities. Initially, GameReady with elevation was utilized, and patient was sent home with ace wrap. Patient was also given instructions to sleep with the effected leg elevated and to continue to use ace wrap. GameReady would be administered for five days after initial injury. Five days after initial evaluation the patient began therapeutic exercise with isometrics and was advanced through and appropriate concentric and eccentric exercise progression to prevent atrophy.

Conclusion:

The case evaluated is highly unique as the presence of delayed onset bursitis is absent or inconclusive in the literature. Although the patient present with a mechanism of blunt trauma which is a common cause of bursitis, the delayed onset nature of the injury is not typical of an MCL bursitis. According to the case report submitted by Nar, Aytekin, and Gilgil (2018), the presence of MCL bursitis is a rare musculoskeletal condition which occurs in approximately 0.2 percent of the population who have sustained a medial knee injury. In addition, MCL bursitis presents as inflammation, pain, and pitting edema over the medial aspect of the knee. Furthermore, within the study the presence of MCL bursitis is rarely seen in younger patient populations (N= >50 years old) (Nar, Aytekin, & Gilgil, 2018). The patient being 20 years of age and reporting a mechanism which occurred two days prior to the presentation of swelling makes the case presented highly unique.

Clinical Bottom Line:

The recognition and diagnosis of bursitis is highly important in the clinical setting. According to Todd, Isaac, and Curtis (2018), bursitis presents as a rapid accumulation of edema in the area of a bursa after an acute traumatic injury or chronic overuse injury. Van Holsbeeck and Introcaso (2016) also describe bursitis as an acute injury with swelling occurring quickly after initial injury due to the dilation of capillaries, arterioles, and the liquid excreting from the bursa. While the presence of a delayed onset MCL bursitis is extremely rare, the pathology should be considered in any case which presents with knee inflammation consistent with bursitis.

Relevant Evidence:

Pangia and Rizvi (2019) found some instances of olecranon bursitis having a delayed onset of over a week from the initial trauma. However, the presence of MCL bursitis and delayed onset bursitis is inconclusive or absent in the current literature. 

Word Count: 598.

References

Nur, H., Aytekin, A., & Gilgil, E. (2018). Medial collateral ligament bursitis in patient with knee osteoarthritis, Journal of Back and Musculoskeletal Rehabilitation, 2018(31), pp. 589-591.

Prentice, W. E. (2015). Chapter 2: Understanding and managing the healing process through rehbilitation, Rehabilitation Techniques for Sports Medicine and Athletic Training (6th Edition, pp. 45-47). SLACK Incorporated. Thorofare, NJ.

Todd, D. J., Isaac, Z., & Curtis, M. R. (2018). Bursitis: An Overview of Clinical Manifestations, Diagnosis, and Management. Retrieved from https://www-uptodate-com.springfieldcollege.idm.oclc.org/contents/bursi… on 2/3/2020. 

Van Holsbeeck, M., & Introcaso, J. H. (1992). Musculoskeletal ultrasound. Jaypee Brothers Medical Publishers Ltd.

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