Hi Everyone! Happy Holidays! It’s officially winter break and this week I had my first job back since maternity leave. It felt great to go back to work, but a little sad to be away from my little-one for so long! It’s crazy to think that 5.5 hours is the longest period I’d been without the baby in 2 months. Crazy! Anyways, I digress… I assessed a serious injury on my first job back this week and I thought I should blog about it.
In the first quarter of a high school varsity basketball game, Melissa (name changed) a 17 y/o guard was injured boxing out after a rebound. She said that just before she swished a beautiful three pointer, she was kicked hard in the calf. When she came down from the shot she was limping and hopping toward our bench with tears in her eyes. Melissa said the pain in her calf was horrible. And it felt like she “couldn’t feel the floor” also she “couldn’t feel her leg.” Also, she said it feels like “I’m stepping into a hole, or like the floor should be higher than it is on this foot!” We didn't have a treatment table in the gym so our only options for evaluating were the bleachers between her bench and the scorers table. (Talk about feeling like you’re in a fish bowl!) Melissa had no prior history of a leg or ankle injury and did not hear or feel any pops or snaps. I began my assessment with palpation. I first determined that she COULD in fact feel her leg and foot. She also felt the ice bag that was quickly given to her. She had no pain over her tibia or fibula anteriorly, medially, or laterally, but had pain posteriorly over the belly and distal portion of her gastrocs by the proximal Achilles. She also had mild pain over her posterior deltoid ligament, but nothing on the lateral side. She had painful range of motion. Her most pain and limitations were with plantar-flexion. Special tests produced pain with compression and bump tests. Also her Thompson test (sitting in the benches is not good for this test) wasn’t great, but I did get some movement. She c/o numbness in her foot, but she had a steady pulse and good blood return. Initial assessment: bad calf contusion. Plan: We’d ice and elevate until the half (about 5 more minutes) and then see if she could weight bear and go from there.
Please note: This section was originally written with medical abbreviations. I went back had took them out for our non-medical readers. (You’re welcome, Mom!)
Half time comes and Melissa’s dad comes over and I fill him in. I have her stand up and tell her to just shift her weight from side to side. She can do it, but “it doesn’t feel right.” Again she says it feels like the floor is lower than it should be. At this point, I have her lay prone (on the bleachers) and perform a proper Thompson test. I compare bi-laterally and the difference is crystal clear. This poor 17 y/o girl has torn her Achilles! (If you have already figured this out by now…. You get an A!) Melissa was splinted and given crutches and sent to the ER.
The head coach was intense and focused on his team during the second half, but he stopped in front of where I was sitting and said, “I bet she didn’t get kicked! That’s what it feels like when you tear your Achilles!” I nodded in agreement and thought to myself, “Oh Duh, Mara! You should have thought of that instead of trying to figure out how a kick to the calf could cause that injury! Duh.” I was taught that a torn Achilles felt like being shot in the calf. I guess my brain took that too literally.
I spoke to Melissa’s mom the next morning. The ER diagnosed her with a “severe Achilles injury”. (nice) They casted her with a splint and ace and she had an appointment with her primary yesterday and will see the orthopedic doctor on Monday. Also, they watched the video and were surprised to see that she was never actually kicked after all. Her mother and I commiserated about how this was “her” year. She didn’t get much playing time in the past but worked very hard over the summer and majorly improved. A senior, a starter and a team leader she is the kid who the other team was yelling “SHOOTER!” for every time she got the ball. Also, she is just a cool kid and I was sad to have to send her to the ER. I felt awful for her and her family who were so excited to watch her this season.
Well, that’s my story. One thing that sucks about being a per diem AT is that you really don’t get the follow up with these kids. They have their own AT who will get to hang with her and help her through this. Many days, I’m really glad to just walk out of the gym and move onto the next gig, but on this day I was sad to leave.
Anyways, now that I’ve got you all down... Cheer up! It’s Christmas Eve and the last DAY of Hanukkah. Hope you all have/had a wonderful holiday. If you can… please help your fellow ATs, and if you have ever had an interesting injury that presents with something really odd, like “It feels like I’m stepping in a hole in the floor” please share in the comments section. Happy New Year! - Mara