Chapter 32 | Musculoskeletal Trauma

Question 1

Fill in the blank:

Skeletal muscle is [VOLUNTARY/INVOLUNTARY] muscle.

Answer 1

Skeletal muslce is voluntary muscle.

same thing as striated muscle

Question 2

Fill in the blank:

Striated muscle is [VOLUNTARY/INVOLUNTARY] muscle.

Answer 2

Striated muscle is voluntary muscle.

same thing as skeletal muscle

Question 3

Fill in the blank:

Smooth muscle is [VOLUNTARY/INVOLUNTARY] muscle.

Answer 3

Smooth muscle is involuntary muscle.

Question 4

Fill in the blank:

Bones are formed of [BLANK].

Answer 4

Bones are formed of dense connective tissue.

protein, collagen, and minerals like calcium

Question 5

True or false:

Bones are not vascular and usually would not bleed on injury.

Answer 5

false

vascular and suceptible to bleeding

Question 6

True or false:

Bones are vascular and susceptible to bleeding on injury.

Answer 6

true

Question 7

List:

shapes of bones

4 points

Answer 7

• long
• short
• flat
• irregular

Question 8

Explain:

how bones heal themselves

3 points

Answer 8

break causes soft tissue swelling and a blood clot in the fracture area

interruption of blood supply causes death of bone section

cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone

Question 9

List:

mechanisms of musculoskeletal injury

3 points (kinds of forces)

Answer 9

• direct force
• indirect force
• twisting/rotational force

Question 10

Define:

bone fracture

Answer 10

any break in a bone

(open or closed)

Question 11

Define:

comminuted bone fracture

Answer 11

bone broken in several places

Question 12

Define:

greenstick bone fracture

Answer 12

incomplete break in a bone

Question 13

Define:

angulated bone fracture

Answer 13

injury to bone caused by bending at abnormal angle

Question 14

Define:

dislocation

(musculoskeletal trauma)

Answer 14

“coming apart” of a joint

Question 15

Fill in the blank:

The majority of femur fractures occur at [BLANK].

(where on the bone?)

Answer 15

The majority of femur fractures occur at the femoral neck.

Question 16

True or false:

All injuries can be confirmed as a fracture in the field.

Answer 16

false

not all fractures can be identified in field

Question 17

True or false:

Not all injuries can be confirmed as a fracture in the field.

Answer 17

true

Question 18

Define:

sprain

(musculoskeletal trauma)

Answer 18

stretching and tearing of ligaments

Question 19

Define:

strain

(musculoskeletal trauma)

Answer 19

overstretching of muscle

Question 20

Fill in the blank:

Splinting an extremity with a suspected fracture helps prevent [BLANK].

Answer 20

Splinting an extremity with a suspected fracture helps prevent blood loss from bone tissues.

Question 21

List:

the 6 P’s

(and what it’s used for)

Answer 21

• pain/tenderness
• pallor
• parasthesia
• pulse quality
• paralysis
• pressure

(assessing musculoskeletal injuries)

Question 22

Define:

parasthesia

Answer 22

pins and needles sensation

Question 23

Define:

pallor

Answer 23

pale skin

Question 24

Fill in the blank:

The 6 P’s is a memorization device used for [BLANK].

Answer 24

The 6 P’s is a memorization device used for assessing musculoskeletal injuries.

Question 25

Fill in the blank:

[BLANK] is a memorization device used for assessing musculoskeletal injuries.

Answer 25

The 6 P’s is a memorization device used for assessing musculoskeletal injuries.

Question 26

List:

advantages of splinting

5 points

Answer 26

• minimizes movement of disrupted joints and broken bones
• prevents additional injury to soft tissues
• decreases pain
• minimizes blood loss
• prevents a closed fracture from becoming open fracture

Question 27

Fill in the blank:

When splinting a patient’s limb, [DO/DON’T] push protruding bones back into place.

Answer 27

When splinting a patient’s limb, do not push protruding bones back into place.

Question 28

Fill in the blank:

If splinting is necessary, you should apply a splint [BEFORE/AFTER] moving the patient to stretcher.

Answer 28

If splinting is necessary, you should apply a splint before moving the patient to stretcher.

Question 29

True or false,

For a patient with a deformed extremity, you should realign the limb back in place.

Answer 29

true

assists in restoring circulation to extremity and to fit into splint

Question 30

Fill in the blank:

For a patient with a deformed extremity, you should [BLANK] before splinting it.

Answer 30

For a patient with a deformed extremity, you should realign the limb back in place before splinting it.

splint may be ineffective (painful and harmful) if not realigned

Question 31

True or false:

For a patient with a deformed extremity, you should not realign the limb back in place.

Answer 31

false

assists in restoring circulation to extremity and to fit into splint

Question 32

True or false:

The increased pain from realigning a deformed extremity is only temporary.

Answer 32

true

Question 33

True or false:

The increased pain from realigning a deformed extremity lasts after the procedure.

Answer 33

false

pain should only be temporary

Question 34

Define:

“splinting patient to death”

Answer 34

splinting before treating life-threatening conditions

Question 35

Describe:

hazard of splinting too tight

Answer 35

compression of soft tissue

Question 36

Describe:

hazard of splinting too loose

Answer 36

allowing too much movement

Question 37

Describe:

hazards of splinting in deformed position

3 points

Answer 37

• increased pain
• further injury
• compromise of nerves or vasculature

Question 38

Answer:

When splinting a long bone, how should you determine the appropriate size for the splint?

Answer 38

measure size on patient’s other (uninjured) extremity

Question 39

Describe:

primary treatment for shoulder girdle injury

Answer 39

use sling/swathe to immobilize patient’s shoulder and arm

Question 40

Describe:

primary treatments for humerus, elbow, or radius/ulna injury

2 points

Answer 40

splint fracture and use sling/swathe to immobile patient’s arm

Question 41

Describe:

primary treatments for forearm, wrist, or hand injury

2 points

Answer 41

splint fracture and use sling/swathe to immobile patient’s arm

Question 42

Describe:

primary treatments for pelvic injury

2 points

Answer 42

minimize hip movement and stabilize lower limbs

Question 43

Describe:

primary treatments for hip dislocation/fracture

2 points

Answer 43

immobilize limb with pillows/blankets and secure patient to spine board

Question 44

Describe:

primary treatment for femoral shaft fracture

Answer 44

apply traction splint

Question 45

Describe:

primary treatment for knee injury

Answer 45

immobilize knee in current position

Question 46

Describe:

primary treatment for tibia/fibia injury

Answer 46

splint the leg

(air-inflated is viable alternative)

Question 47

Describe:

primary treatment for ankle/foot injury

Answer 47

elevate and stabilize limb with pollow tied around ankle

(also apply ice pack as needed)

Question 48

Choose:

Most injuries to the upper extremities are caused by:

A. assault or abuse.

B. athletic injuries.

C. forces applied to an outstretched arm.

D. penetrating trauma.

Answer 48

C

Question 49

Choose:

You are summoned to the aid of a​ 45-year-old male who was hunting and fell from a tree stand. When you​ arrive, he is experiencing severe pain in his lower right thigh. On​ examination, you find that an area about three inches above his right knee has an open wound about one inch in diameter that is bleeding minimally. There are no exposed​ bones, but you palpate crepitus and see swelling that makes you suspect bone fracture.

You would you classify this as a(n):

A. open extremity injury.

B. sprain.

C. closed extremity injury.

D. dislocation.

Answer 49

A

This would be classified as an open extremity​ injury, which is an extremity injury in which the skin has been broken or torn through from the inside by an injured bone or from the outside by something that has caused a penetrating wound with associated injury to the bone.

Question 50

Choose:

Your patient fractured her right wrist in a motor vehicle collision. You notice swelling, redness, and tenderness distal to the site. The patient is wearing a ring and a bracelet. The ring slides off her finger easily but the bracelet is tight against the swelling.

You should:

A. slide off the ring and cut off the bracelet.

B. leave both the ring and bracelet in place.

C. cut off the bracelet but leave the ring in place.

D. slide off the ring but leave the bracelet in place.

Answer 50

A

jewelry can easily constrict and injure underlying tissue

Question 51

Choose:

Why should you not let a grotesque but relatively minor extremity injury sidetrack you or the patient when assessing a patient with musculoskeletal injuries?

A. The pain or terrible appearance of an extremity injury may distract the patient and you from awareness of other injuries or symptoms.

B. It’s important to remember where you are in the assessment process to make sure you follow the steps correctly.

C. You will treat any musculoskeletal injury the same way, and so it’s wrong to assign importance to injuries based on appearance.

D. The more apparently gruesome an injury is, the less likely it is to actually be serious.

Answer 51

A

In cases of severe extremity​ trauma, injuries can be very obvious.​ However, when treating trauma​ patients, your priority must be to rapidly identify and treat​ life-threatening conditions first. Do not let a grotesque but relatively minor extremity injury sidetrack you or the patient. The pain or terrible appearance of an extremity injury may distract the patient from awareness of other injuries or​ symptoms, such as abdominal pain from internal bleeding. Be sure to assess the patient fully and ask appropriate questions to avoid missing other injuries.

Question 52

Choose:

As you care for a patient with a possible lower leg injury, you should assess the distal pulse, motor function, and sensation:

A. only before applying a splint to the leg.

B. both before and after applying a splint to the leg.

C. every 5 minutes until arrival at the hospital.

D. only after the application of a splint to the leg.

Answer 52

B

It is important for the EMT to check the patient’s distal pulses, motor function, and sensation both before and after splinting bone and joint injuries. Document your findings in the prehospital care report.

Question 53

Choose:

You are treating a 17-year-old female who fell while playing basketball. Her right thigh is painful, swollen, and deformed. She is in considerable pain.

The most appropriate device for splinting her injury would be a:

A. inflatable splint.

B. pneumatic anti-shock garment.

C. traction splint.

D. pair of long board splints.

Answer 53

C

When a patient has a suspected isolated femoral shaft fracture (painful, swollen, and deformed thigh, and a leg that is flexed and will not straighten), the most appropriate splint is the traction splint.

Question 54

Choose:

If a commercial pelvic splint is not available, the next best alternative is:

A. backboard straps and a long wooden splint.

B. a pelvic wrap improvised from a sheet.

C. a sling and swathe.

D. cot straps and a backboard.

Answer 54

B

Question 55

Choose:

For a high-priority, unstable patient with musculoskeletal injuries, you should:

A. apply a cervical collar and then splint specific injuries before transport.

B. splint specific injuries before transport.

C. position the patient on the less injured side and then “load and go.”

D. immobilize the whole body on a long spine board and “load and go.”

Answer 55

D

Question 56

Choose:

What is the primary concern about a splint that is applied too loosely?

A. It could cause pressure sores to develop from skin rubbing against the splint.

B. It could allow the bone fragments to move, which could cause further damage.

C. The splint will cut off distal circulation.

D. The patient will lose motor function in that extremity.

Answer 56

B

Question 56

Choose:

The first step in the progression of compartment syndrome is that:

A. cellular damage occurs and causes additional swelling.

B. pressure and swelling caused by bleeding within a muscle compartment become so great that the body can no longer perfuse the tissues against the pressure.

C. a fracture or crush injury causes bleeding or swelling in an extremity.

D. blood flow to the area is lost, and the limb itself may be lost if the pressure is not relieved.

Answer 56

C

Question 56

Choose:

A 22-year-old female patient slipped running down stairs, and has injured her right tibia and fibula. You have used an air splint to splint the injury.

To test an air splint, you can:

A. drum your fingers briefly on the side of the splint.

B. gently brush the length of the split with your fingertips.

C. see if you can cause a slight dent in the plastic with fingertip pressure.

D. ask the patient if the splint is tight enough without being painful.

Answer 56

C

Question 57

Choose:

The first effects of a bone injury are swelling of soft tissue and:

A. tearing of cartilage connected to the bone.

B. strain of muscles and sprain of ligaments associated with the bone.

C. referred pain from the injury to associated muscle and bone groups.

D. the formation of a blood clot in the area of the fracture.

Answer 57

D

bone healing process:

1. break causes soft tissue swelling and a blood clot in the fracture area
2. interruption of blood supply causes death of bone section
3. cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone

Question 58

Choose:

If you see angulation when assessing a patient, then:

A. the patient is bending the knees or arms.

B. a bone or bones are out of anatomical position.

C. the patient’s distal pulse must be reassessed.

D. splinting is unlikely to be of assistance.

Answer 58

B

Question 59

Choose:

When treating a patient with an open musculoskeletal injury to the thigh, how would you best treat the open wound?

A. Cover the open wound with a sterile dressing, pack it with ice, and wrap it with self-adhesive bandages.

B. Cover the open wound with a sterile dressing, elevate the extremity, and apply a cold pack to the area to help reduce swelling.

C. Cover the wound with bulky dressings, keep the extremity level, and transport immediately.

D. Splint the wound, cover it with compression bandages, and transport as soon as possible.

Answer 59

B

Question 60

Choose:

A 14-year-old girl has fallen from her bicycle. She sustained injuries when she landed with her arm extended to catch her fall. According to the principles of indirect mechanisms of injury, which of the following bones is least likely to have been injured in this fall?

A. Ulna

B. Thoracic vertebra

C. Clavicle

D. Radius

Answer 60

B

Question 61

Choose:

To realign an extremity, an EMT grasps the distal extremity while a partner places one hand above and one hand below the injury site, and then:

A. the partner supports the site while the first EMT creates gentle manual traction in the direction of the long axis of the extremity.

B. each EMT pulls in a sudden sharp motion away from the site of injury along the long axis of the extremity.

C. each EMT exerts gentle manual traction on either side of the injured site until the limb snaps into place.

D. the partner immobilizes the site with a splint before the first EMT creates gentle manual traction in the direction of the long axis of the extremity.

Answer 61

A

Question 62

True or false:

A pelvis wrap can be used if the pelvis shows instability.

Answer 62

true

Question 63

True or false:

You can consider using a pelvic wrap based on mechanism of injury (MOI).

Answer 63

true

Question 64

True or false:

A pelvic wrap can be used if the pelvis shows deformity.

Answer 64

true

Question 65

True or false:

A pelvic wrap should not be used unless the patient shows signs of shock.

Answer 65

false

Question 66

True or false:

An angulated break is when the broken bone segments are at an angle to one another.

Answer 66

true

Question 67

True or false:

A comminuted break is when a bone is broken in only one place.

Answer 67

false

Question 68

True or false:

A greenstick break is an incomplete break in a bone.

Answer 68

true

Question 69

True or false:

A fracture is any break in a bone.

Answer 69

true

Question 70

Describe:

most common type of hip dislocation

Answer 70

posterior hip dislocation

Question 71

True or false:

An anterior hip dislocation would probably present with the entire lower limb rotated inward.

Answer 71

false

it would be outward

Question 72

True or false:

A posterior hip dislocation presents with a bent knee and the foot may hang loose.

Answer 72

true

Question 73

True or false:

With a hip fracture, there is often a lack of sensation in the limb.

Answer 73

true

Question 74

Choose:

The part of the skeleton that includes the skull and spinal column is called the:

A. appendicular skeleton.

B. axial skeleton.

C. boney skeleton.

D. torso.

Answer 74

B

Question 75

Choose:

Which of the following is appropriate in the examination of a painful, swollen extremity of a conscious patient?

A. Comparing the injured side to the uninjured side

B. Gently attempting to flex the mid-portion of the bone to check for angulation

C. Asking the patient to see if he can bear weight on the extremity

D. Seeing if you can elicit crepitus on palpation

Answer 75

A

Question 76

Choose:

One of the more serious conditions that EMTs are confronted with would occur as follows: A fracture or crush injury causes bleeding and swelling within the extremity. Pressure and swelling caused by the bleeding within the muscle compartment become so great that the body can no longer perfuse the tissues against the pressure. Cellular damage occurs and causes additional swelling. Blood flow to the area is lost. The limb itself may be lost if the pressure is not relieved.

What is this condition called?

A. Compartment syndrome

B. Crushing syndrome

C. Fracture syndrome

D. Perfusing syndrome

Answer 76

A

Question 77

Choose:

Your patient is a 28-year-old male who was ejected from his motorcycle after striking a parked vehicle. He has multiple deformities to his upper and lower extremities on both sides.

Which of the following would be the best way to immobilize this patient’s extremities prior to transport?

A. Immobilize the patient to a long backboard without splinting the extremities individually.

B. Use traction splints for the lower extremities and allow the upper extremities to be immobilized by the long backboard.

C. Use moldable splints for the upper and lower extremities, padding any voids to fully stabilize the fractures.

D. Use padded board splints for the upper extremities and a PASG for the lower extremities.

Answer 77

A

Question 78

Choose:

Which of the following hazards may arise from properly splinting an injured extremity?

A. Converting a closed fracture to an open one

B. Ignoring life-threatening problems while focusing on an extremity injury

C. Compromising circulation to the extremity

D. All of the above

Answer 78

B

“splinting the patient to death”

Question 79

Choose:

A suspected musculoskeletal injury of the shoulder is best managed by which of the following techniques?

A. Placing the arm in a sling and using a triangular bandage to secure it to the body

B. Using a long-arm air splint

C. Placing two long padded board splints on either side of the extremity, extending from the shoulder to the wrist

D. Using an upper extremity traction splint

Answer 79

A

Question 80

Choose:

Which of the following is not a principle of splinting that must be considered by the EMT?

A. Immobilize the site of an extremity injury from the joint above it to the joint below it.

B. Check the distal neurovascular function before and after splinting.

C. Splint an isolated extremity injury before moving the patient to the stretcher.

D. Gently replace protruding bone ends back beneath the skin to prevent further contamination.

Answer 80

D

Question 81

True or false:

Another name for manual traction is tension.

Answer 81

true

Question 82

True or false:

A sprain is the stretching and tearing of ligaments.

Answer 82

true

Question 83

True or false:

Joints are places where bones articulate.

Answer 83

true

Question 84

Choose:

Your patient is a 20-year-old college student who has fallen from a third-level balcony onto a wooden deck below. The patient responds to verbal stimuli, is pale in color with moist skin, and has a very obvious deformity with protruding bone ends of his right forearm.

Which of the following is the best sequence of intervention for this patient?

A. Provide immediate manual in-line stabilization of the cervical spine; apply high-concentration oxygen by nonrebreather mask; perform a focused history and assessment; apply the cervical collar; apply a padded board splint, sling, and swathe to the forearm injury; and transport.

B. Provide manual in-line stabilization of the cervical spine along with assessment of breathing, pulse, and the presence of significant hemorrhage; apply high-concentration oxygen; perform a rapid trauma exam; immobilize to a long backboard; and check with medical control about the need to splint the forearm injury prior to transport.

C. Provide manual in-line stabilization of the cervical spine along with assessment of breathing, pulse, and the presence of significant hemorrhage; apply high-concentration oxygen; perform a rapid trauma exam; immobilize to a long backboard; transport; and splint the extremity en route if time and resources allow.

D. Open the airway; assess breathing; check the carotid pulse; splint the forearm injury; immobilize the patient to a long backboard; apply high-concentration oxygen; and transport.

Answer 84

C

Question 85

Choose:

A painter falls from his ladder and tells you he has dislocated his shoulder again. When you attempt to splint the shoulder, it “pops back into place.”

What should your next step be?

A. Check distal CSM, apply a sling and swathe, and transport the patient.

B. Contact medical control for input into the best treatment for this patient.

C. Check distal CSM, apply a traction splint, and transport the patient.

D. Report the popping sound to the receiving physician when you arrive at the hospital.

Answer 85

A

Question 86

Choose:

Your patient is a 37-year-old man who tripped while walking down a hill and now has a painful, deformed right leg. Your assessment reveals that the foot is cold and mottled in appearance. You cannot detect a pulse in the foot or ankle.

Which of the following is the best course of action?

A. Transport rapidly to the nearest trauma center.

B. Gently attempt to straighten the leg to regain a pulse before splinting.

C. Splint the leg in the position in which it was found and transport without delay.

D. Explain to the patient that, because you cannot detect circulation in his foot, his leg will most likely have to be amputated above the site of the injury.

Answer 86

B

Question 87

True or false:

Tendons are bands of connective tissue that bind the ligaments to muscles.

Answer 87

false

Question 88

True or false:

Muscles are the tissues or fibers that cause movement of body parts or organs.

Answer 88

true

Question 89

True or false:

Cartilage is connective tissue that covers the outside of the bone end and acts as a surface for articulation.

Answer 89

true

Question 90

True or false:

Ligaments are connective tissues that connect bone to bone.

Answer 90

True

Question 91

Choose:

There are general rules that apply to all types of splinting. Which of the following is not a general rule of splinting?

A. Align long-bone injuries to anatomical position.

B. In order to avoid loss of use of a limb, it is important to splint before moving, even if the patient is unstable.

C. Assess distal CSM.

D. Expose the injury.

Answer 91

B

treat life-threatening conditions first to avoid “splinting to death”

Question 92

Choose:

Which of the following best describes the compartment syndrome?

A. A life-threatening condition caused by trapping the blood flow by a fracture when the bone ends cut the blood vessels

B. A non-life-threatening condition caused by orthopedic injuries in which blood flow is stopped when the bone ends compress the blood vessels

C. A serious condition caused by the bleeding and swelling from a fracture or crush injury that becomes so strong that the body can no longer perfuse the tissues against that pressure

D. A serious condition caused by the amount of equipment that must be carried in the ambulance compartments

Answer 92

C

Question 93

Choose:

Which one of the following statements is not true concerning a knee injury?

A. Fractures can occur to the proximal tibia and fibula.

B. Fractures can occur to the patella.

C. There could be pain and tenderness.

D. Fractures can occur to the proximal femur.

Answer 93

D

Question 94

Choose:

Your patient is a 12-year-old female who fell onto her outstretched hands while rollerblading. She has a deformity of her forearm, about 2 inches proximal to her wrist.

This injury is a result of which of the following mechanisms?

A. Twisting motion

B. Sudden acceleration

C. Direct force

D. Indirect force

Answer 94

D

she probably landed on her hand — but the injury is to her forearm

injury occurring in place that did not make contact means its indirect

Question 95

Choose:

Your patient is a 60-year-old woman who stepped off a curb and injured her ankle. Your exam shows that her left ankle is swollen and painful.

Which of the following should you do?

A. Explain to the patient that you cannot tell if her ankle is sprained or fractured until she is X-rayed at the emergency department, then splint the ankle.

B. Explain to the patient that her ankle is fractured, and you must splint her ankle to prevent further injury and reduce pain.

C. Transport the patient immediately to a trauma center, applying high-concentration oxygen en route.

D. Explain to the patient that her ankle is sprained and transport her with her ankle elevated on a pillow and a cold pack applied to the injury.

Answer 95

A

Question 96

Choose:

You are treating a 16-year-old skateboarder who has fallen at the skate park. She has an angulated left forearm that she has in a guarded position.

When do you splint this injury?

A. During the primary exam

B. En route to the hospital

C. Immediately

D. During the secondary exam

Answer 96

D

Question 97

Choose:

A new EMT who is treating a suspected femur injury asks his partner, “How much traction should I pull?” The partner’s best reply is which of the following?

A. The amount of traction applied should be 15 pounds.

B. No traction splint applied in the field pulls true traction; they must pull 20 pounds of countertraction.

C. Pull enough traction to give the patient some relief from the pain.

D. The amount of traction applied should be roughly 10% of the patient’s body weight and not exceed 15 pounds.

Answer 97

D

Question 98

Choose:

Which of the following is the most definitive sign of a fractured extremity?

A. Pain upon palpation

B. Swelling and redness along the shaft

C. Mid-shaft angulation

D. Absent distal pulses

Answer 98

C

A mid-shaft angulation is the MOST definitive sign of a fractured extremity. Many things can cause the other 3. Nothing except a fracture could cause the actual bone to be angulated along the shaft.

Question 99

Choose:

A 34-year-old female ballerina is coming down from an aerial move and sustains a severe lateral ankle sprain. She needs to be carried off of the stage as she says she cannot walk on it and 911 is called. On evaluation, you note significant swelling and erythema around the lateral malleolus. There are the beginnings of a bruise at the base of the malleolus. She is squirming due to the pain and has trouble cooperating with even a simple musculoskeletal exam.

Which of the presenting signs is most suggestive of a significant underlying injury?

A. The presence of perimalleolar swelling

B. The bruise forming at the base of the lateral malleolus

C. Significant pain limiting cooperation with exam

D. The inability to ambulate

Answer 99

D

By far one of the most objectively concerning signs of significant ankle injury is the inability to ambulate. This sign is an indication for ankle X-rays to be taken. While this is not an emergency requiring transport, the patient should be evaluated in the emergency department as soon as reasonably possible. The other key sign of underlying injury would be significant tenderness to palpation at the head of the 5th metatarsal or the medial midfoot area. The most common acute injury in theatrical dance is the ankle sprain, usually involving the lateral ligamentous structures. Proper ballet positioning, while beautiful and artful, also destabilizes the ankle and foot support when landing from a jump.