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1.  EVALUATION AND TREATMENT OF MUSCULOSKELETAL CHEST WALL PAIN IN A MILITARY ATHLETE 
Background and Purpose:
Athletes reporting chest pain are challenging to diagnose and equally challenging to treat. The majority of chest pain is musculoskeletal in origin, yet differentiating these from other more serious conditions should be the initial primary focus. The ability to reproduce the patient's symptoms aids in the differential diagnostic process. The purpose of this case report is to illustrate the use of dry needling (DN) to aid in the diagnosis and treatment of focal chest wall pain.
Case Descriptions:
A 22 year-old male military athlete with anterior chest pain, refractory to traditional physical therapy, was evaluated and treated with dry needling.
Outcomes:
Favorable results were achieved as demonstrated by clinically meaningful improvements in the Patient Specific Functional Scale, the Global Rating of Change score, and his physical performance which allowed this athlete to return to competition and military training.
Conclusion:
Dry needling in the hands of properly trained providers may aid in diagnosis and treatment of focal chest wall syndromes.
Level of Evidence:
Therapy, Level 4
PMCID: PMC3362990  PMID: 22666647
chest pain; costochondritis; dry needling; military athlete; physical therapy
2.  DIAGNOSIS OF AN ISOLATED POSTERIOR MALLEOLAR FRACTURE IN A YOUNG FEMALE MILITARY CADET: A RESIDENT CASE REPORT 
Background and Purpose:
The ankle is the most commonly injured joint during athletic activity. While ankle sprains are certainly the most common injury, ankle fractures can occur frequently. One type of ankle fracture with a reportedly low incidence is the isolated posterior malleolar fracture. Because of the low incidence, isolated posterior malleolar fractures can present a diagnostic challenge. The purpose of this case report is to describe the diagnostic process used for this rare injury that occurred in a physically active college-aged female who injured her ankle when landing from a fall during performance on a military obstacle course.
Case Description:
A 19 year old female United States Military Academy cadet presented to a direct access physical therapy clinic. She was limping, not using any assistive device, and was wearing an ace bandage around her right ankle/foot. Two days earlier she fell from a “10 foot high” structure while performing the military obstacle course. She did not recall details of impact, but she was told by several bystanders that it appeared that she landed on her right foot followed immediately by a transition to her buttocks and then to her back.
Outcomes:
Ottawa Ankle Rules and ligamentous testing were negative; however, she was tender to palpation just anterior to the achilles tendon and lateral to the posterior edge of the medial malleolus. Based on mechanism of injury and tenderness of the posterior ankle, a potential posterior ankle fracture was suspected and subsequently confirmed by radiographic studies of the ankle including standard radiographs and computerized tomography.
Discussion:
While the Ottawa Ankle Rules are generally effective in detecting many types of ankle fractures, clinicians should not rely solely on such prediction rules. This case highlights the importance of completing a thorough history and performing a thorough physical examination. This case report focuses on differential diagnosis. It is important to consider all aspects of the patient evaluation process collectively instead of examination pieces individually.
PMCID: PMC3325632  PMID: 22530191
Direct access; Ottawa Ankle Rules; posterior malleolus fracture
3.  EXPLORATION OF THE Y-BALANCE TEST FOR ASSESSMENT OF UPPER QUARTER CLOSED KINETIC CHAIN PERFORMANCE 
Background:
Although upper extremity (UE) closed kinetic chain (CKC) exercises have become commonplace in most rehabilitation programs, a clinically meaningful UE CKC functional test of unilateral ability has continued to be elusive.
Objectives:
To examine reliability of the Upper Quarter Y-Balance Test (UQYBT), evaluate the effects of arm dominance on UQYBT performance, and to determine how the UQYBT is related to specific components of the test (trunk rotation, core stability and UE function and performance) in a college-aged population.
Methods:
A sample of healthy college students performed the UQYBT and a series of 6 additional dynamic tests designed to assess trunk rotation, core stability, and UE performance. The relationship of these tests compared to the UQYBT was assessed. The effect of upper limb dominance for the UQYBT was also explored. Finally, test re-test reliability was established for the UQYBT.
Results:
Thirty subjects (24 males, 6 females, mean ages 19.5 6 1.2 and 18.8 6 0.8 years) were assessed during the study. The test re-test reliability was excellent for UQYBT measurements (intraclass correlation coefficient > 0.9). A significant (p <0.05) fair to moderate association was observed between the UQYBT and several core stability and UE functional tests. There was no significant difference in UQYBT performance between dominant and non-dominant limbs.
Discussion:
The UQYBT is a reliable UE CKC test that can be used to assess unilateral UE function in a closed chain manner. The UQYBT appears to be most related to dynamic tests involving core stability and UE performance. Similarity on the UQYBT between dominant and non-dominant limbs indicates that performance on this test using a non-injured UE may serve as a reasonable measure for “normal” when testing an injured UE. Future research is needed to determine the clinical applicability of the UQYBT.
Level of Evidence:
2b
PMCID: PMC3325634  PMID: 22530188
upper extremity functional testing; Upper quarter Y-Balance test

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