Evaluation and Diagnosis
History and hypothesis-driven exam
The sports PT evaluation is a structured process: history (mechanism, onset, aggravating/easing factors, prior injury, training change), observation, and then targeted special tests chosen to confirm or refute hypotheses. Questions reward efficient, hypothesis-driven testing over shotgun batteries. Understand sensitivity (rules out when negative) and likelihood ratios (LR+ >10 and LR- <0.1 meaningfully shift probability).
Region-specific knowledge
Know high-yield special tests and their limits: anterior drawer and Lachman for ACL (Lachman most sensitive), McMurray and Thessaly for meniscal pathology, apprehension/relocation for shoulder instability, and cluster rules for hip and lumbar differential diagnosis. Recognize that many tests have modest accuracy and should be combined.
Differential diagnosis
Be able to distinguish referred pain sources: hip pathology presenting as knee pain, lumbar radiculopathy mimicking hamstring strain, and vascular or neurogenic claudication. Red flags (night pain, unexplained weight loss, neurological progression, cauda equina signs) mandate referral.
Traps
Questions often present a positive test as diagnostic when it is only supportive. Do not confuse provocative tests (reproduce symptoms) with structural tests. Also beware of choosing imaging as the first step when a clinical exam would guide care.
Worked example
A runner with lateral knee pain and a positive Thessaly test but no locking: meniscal tear is possible, but combine with history and consider iliotibial band or lateral meniscal sources; a single positive test does not confirm diagnosis.