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- A 20 year old college basketball player reports of pain, stiffness and feeling of weakness in his left knee which aggravates after playing. On examination, there is no crepitus, no popping or locking of the joint movement. Palpating the lower pole of patella and quadriceps tendon reproduces pain. What is the MOST likely diagnosis? A. Jumpers knee B. Meniscal tear C. Osteochondritis dissecans D. Osgood Schlatter syndrome: The correct answer is A: Jumpers knee. Rationale- Patellar tendonitis or Jumpers knee is an overuse injury of the quadriceps tendon. Pain at the lower pole of patella and stiffness after activity are main presentations. Meniscal tear (Option B) presents with popping and locking on movement. Osteochondritis dissecans (Option C) may have pain at base of patella due to traction apophysitis of the tibial tubercle but it is seen in a younger age group who are not skeletal mature. Similarly, Osgood Schlatter (Option D) is seen in younger children aged 12-14. Reference: David J Magee; Orthopedic physical examination edition 6. Page: 770
- A PT is evaluating a 24-year-old female basketball player with a vague diagnosis of right knee pain. The patient is performing a jump landing as shown in the picture below. The PT treatment should MOST likely focus on: A. Strengthening of the right gluteus medius B. Strengthening of the right adductor magnus C. Strengthening of the right vastus medialis D. Strengthening of the right tibialis anterior: The correct answer is A: Strengthening of the right gluteus medius.
Rationale- The picture shows the right knee in a valgus position and strengthening of hip abductors muscles will help with proximal stability. Stretching of hip adductors, not strengthening (Option B) will most likely help with knee valgus. Recent evidence suggests strengthening of the right vastus medialis (Option C) does not have any significant effect on knee valgus. Tibialis anterior (Option D) is one joint dorsiflexor and invertor and doesn't cross the knee joint. Reference- Nordin M. Basic Biomechanics of Musculosketelal system, page 148- 149
- On examining a patient with a decreased trunk side bending to the left, the physical therapist finds a closing restriction between L2-L3 vertebrae. What is the MOST appropriate intervention to improve the restriction? A. Apply PA glide on L2 transverse process on the right side B. Apply PA glide on L3 transverse process on the right side C. Apply PA glide on L3 transverse process on the left side D. Apply PA glide on L4 transverse process on the left side: The correct answer is C. Apply PA glide on L3 transverse process on the left side. Rationale- Applying a Posterior- Inferior glide will move the L3 vertebrae superiorly and closer to the L2, and help improve the closing restriction. Applying PA glide on L2 transverse process on the right side (Option A) will open the L2-L3 on right side and indirectly close the left side but it is not the best option. Applying PA glide on L3 transverse process on the right side (Option B) will close the L2-L3 on the right side, and applying PA glide on L4 transverse process on the left side (Option D) will close L3-L4 on the left side. Reference: Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 501, 502
- A 33 year old physical therapy student presents to an outpatient clinic with history of low back pain. The patient walks home each night from the library carrying a heavy bag of NPTE books in his right hand. On examination, the PT notes right hip pain and 3+/5 strength of the right hip abductors. Which of the following is the MOST appropriate suggestion to help alleviate patients symptoms?
postural strategies most accurately correlates with the observed foot position? A. Metatarsus abductus, internal tibial torsion, increased femoral retrover- sion B. Metatarsus adductus, internal tibial torsion, increased femoral antever- sion C. Metatarsal adductus, external tibial torsion, increased femoral retrover- sion D- Metatarsal abductus, external tibial torsion, increased femoral anteversion: The correct answer is B: Metatarsus adductus, internal tibial torsion, increased femoral anteversion. Rationale- The position of toe-in would correlate with metatarsus adductus (forefoot adducted), internal tibial torsion (position of pronation), and increased femoral anteversion. Reference- Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 715, 897
- During an outpatient evaluation the PT checks the active and passive ankle range of motion. The patient lacks 8 degree of passive ankle dorsiflexion. The same limitation in range of motion is present whether the knee is extended or flexed. The muscle MOST likely contributing to the restriction in passive range of motion is? A. Tibialis Anterior B. Hamstrings C. Gastrocnemius D. Soleus: The correct answer is D: Soleus. Rationale- Soleus and Gastroc will be stretched during passive ankle dorsiflexion. As Soleus is a one joint muscle which doesn't cross the knee joint, the position of knee shouldn't affect the passive range of motion at the ankle. Good job everyone! Reference- Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 1006
- A physical therapist is evaluating a 34-year-old female patient with a vague diagnosis of low back pain. The patient displays a positive Thomas test during initial evaluation as shown in the picture below. Which phase of the gait cycle will MOST likely show limitation in the hip range of motion? A. Loading response B. Mid stance C. Terminal stance D. Terminal swing: The correct answer is C: Terminal stance. Rational-A positive thomas test indicates tightness of the hip flexors. If the hip flexors are tight, it will result in limitation in range of motion of the anatgonistic motion (hip extension). Given the hip is in extension during terminal stance, tightness of hip flexors will cause limitation in hip extension range of motion. All other options (loading response, mid stance and terminal swing) don't require end range hip extension during a typical gait cycle. Great job everyone! Reference Pg 13 Gait Analysis- Normal and Abnormal by Jacquelin Perry (2nd edition
- A 24-year-old PT graduate student was using a phone with broken screen and recently upgraded to a new phone. The student is constantly on the new phone and is having difficulty swiping upwards with their thumb as shown in the picture below. What is the BEST mobilization to improve the thumb range of motion so that the student can swipe happily thereafter! A. Inferior glide at the CMC joint B. Superior glide at the CMC joint C. Ulnar glide at the CMC joint D. Radial glide at the CMC joint: The correct answer is D: Radial glide at the CMC joint. Rationale- A radial glide is used to improve thumb extension to help swipe upwards. At the CMC joint, the trapezium is convex and the proximal metacarpal is concave for flexion and extension. Flexion and Extension are frontal plane
which crosses the knee. Option C and D would be more appropriate options for active range of motion limitation. Reference- O'Sullivan SB; Physical Rehabilitation, 6th edition Page: 90
- A physical therapist is performing a manual muscle test on a patient with good muscle strength. The physical therapist positions the patient as shown in the picture, and applies force down and inward toward the patient's opposite hip. Which muscle is being tested? A. Pectoralis major clavicular head B. Latissimus dorsi C. Pectoralis major sternal head D. Pectoralis minor: Correct answer is C. Pectoralis major sternal head Rationale- MMT of Pectoralis major sternal head - the motion begins at 120° of shoulder abduction and moves diagonally down and in toward the patient's opposite hip. Reference- Daniels & Worthingham's muscle testing, 8th edition, Page: 105
- A physical therapist is examining a 44 year old patient walking at 3. miles/hour. The PT diagnoses a right pelvic drop during left stance phase. Which of the following is a potential cause of right pelvic drop? A. Weak hip abductors on right side B. Hip abductor contracture on right side C. Weak hip adductors on left side D. Hip abductors contracture on left side: The correct answer is B: Hip abductor contracture on right side. Rational-- Hip abductor contracture on right or weak left hip abductor causes right pelvis drop. Weak right hip abductors (Option A), or left weak hip adductors (option C) or left hip abductor contracture (option D) causes pelvic drop on the left side. Reference- J. Perry Gait textbook 2nd edition Pg 271 Figure 14.
- A physical therapy examination reveals posterior superior iliac spine (PSIS) is low on the left; anterior superior iliac spine (ASIS) is high on the left. Interventions should MOST likely include unilateral isometric contraction of the left hip: A. Gluteus maximus B. Iliopsoas C. Gluteus medius D. Adductor Magnus: The correct answer is B: Iliopsoas. Rationale- In posterior innominate rotation, PSIS is lower and the ASIS is higher on the involved side (left in this case). It can be caused by tightening of hip extensors. Isometric contraction of iliopsoas (hip flexor) and stretching of hip extensors are interventions to treat posterior innominate rotation. Contraction of gluteus maximus will further increase the posterior innominate rotation. Reference- Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 471, 472
- During testing of the patient's grip strength, the physical therapist notices that the patient's lateral two fingers are unable to fully grip the hand held dynamometer. The physical therapist can likely conclude which of the following structures has been damaged? A. Median nerve B. Radial nerve C. Antebrachial nerve D. Ulnar nerve: The correct answer is A: Median nerve. Rationale- Median nerve injury at the forearm or elbow results in the "hand of benediction". The index and middle finger do not flex at the IP joints due to damage to median nerve that supplies the flexor digitorum profundus and superficialis. Reference- Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 379, Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 415
1 8. A physical therapist notices that a patient is experiencing early toe-off during terminal stance in gait. Which of the following identifies a likely cause, AND an appropriate intervention to address that cause? A. Hip flexor contracture, prolonged stretching B. Hip extensor weakness, progressive strengthening C. Soleus tightness, prolonged stretching D. Great toe flexion weakness, progressive strengthening: The correct answer is A: Hip flexor contracture, prolonged stretching. Rationale: Hip flexion contracture will lead to lack of hip extension in terminal stance and will result in early toe off. An appropriate intervention to address this is to provide prolonged stretching to the hip flexor musculature to improve ROM. Soleus is a plantarflexor and its tightness will not cause an early toe off. Reference- Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 1002
- A physical therapist is teaching self-stretching of levator scapulae muscle to the patient. Which one of the following is the correct technique to stretch the right levator scapulae muscle? A. Sitting with the head bent and rotated towards the right side, place the right hand on the head in an oblique direction and use the left hand to hold onto the seat of the chair. B. Standing with the head bent and rotated towards the left side, place the right hand behind the head, bend the right elbow against a wall and slide the elbow up. C. Sitting with head bent and rotated towards the left side, place the right hand on the head in an oblique direction and use the left hand to hold onto the seat of the chair. D. Standing with the head bent and rotated towards the right side, place right hand behind the head and bent the right elbow against wall and slide the elbow up.: Correct Answer is "B" Self- Stretch of the Levator Scapulae Muscle Standing with the head side bend and rotated away from the tight side, place the ipsilateral hand behind the head and the bent elbow against a wall. The other hand can be placed across the forehead to stabilize the rotated head. Instruct the patient
to slide the elbow up the wall as he or she takes in a breath, then hold the position while exhaling. Reference-Therapeutic Exercises by Kisner & Colby, 6th edition - Page 595)
- During testing of the patient's grip strength, the physical therapist notices that the patient's lateral two fingers are unable to fully grip the hand held dynamometer. The physical therapist can likely conclude which of the following structures has been damaged? A. Median nerve B. Radial nerve C. Antebrachial nerve D. Ulnar nerve: The correct answer is A: Median nerve. Rationale- Median nerve injury at the forearm or elbow results in the "hand of benediction". The index and middle finger do not flex at the IP joints due to damage to median nerve that supplies the flexor digitorum profundus and superficialis. Reference- Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 379, Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 415
- The physical therapist is testing trunk movements of a 23-year-old healthy male client. The patient is lying supine and lifts his shoulders off the table to bring his right elbow towards his left knee. Which of the following muscles are being tested? A. Right internal oblique and left external oblique B. Pectoralis minor and major C. Right external oblique and left internal oblique D. Right and left Rectus abdominus: The correct answer is C: Right external oblique and left internal oblique. Rational--The same side (left) internal obliques, and opposite side (right) external obliques will work during the exercise. Option A is for the opposite side muscles. Reference Kisner and Colby pg 366
A. Clunk test B. Jobe's test C. Hawkins Kennedy test D. Neer's Impingement test: The correct answer is B: Jobe's test. Rationale: The MRI image shows a full thickness supraspinatus tear http://www.mri.melbourne/mri/mri-shoulder/ Jobe's test is a special test used for supraspinatus tears. Clunk test (Option A) is used for labral tears. Neer's and Hawkins Kennedy tests are used for supraspinatus impingement.
- A 20 year old volleyball player suffered a meniscus injury and underwent meniscal repair surgery 6 weeks ago. The patient presents to an outpatient clinic and the PT is designing a gym exercise program. Which of the following is MOST appropriate exercise? A. Leg press machine to strengthen quadriceps B. Squatting with hip and knee flexion to 90 degrees C. Stationary cycling against light resistance D. Balance training on wobble board: The correct answer is C: Stationary cycling against light resistance. Rationale: The patient is in the moderate protection phase after meniscal repair surgery. Quadriceps strengthening with leg press should start at 8 weeks (A incorrect). Similarly squat at 90 degree depth is contraindicated before 8 weeks (B incorrect). Stationary bike will not only provide light resistance but also help with range of motion within limits (C correct). Although balance and proprioception are treatment goals, wobble board can cause additional stress and will come after 8 - 10 weeks in the treatment plan (D incorrect)
- An 18-year-old female volleyball player complains of right forearm and hand pain during overhead activities. Upon examination, the physical therapist finds the following range of motion values: Right elbow flexion 10 - 100, forearm supination 0-75, forearm pronation 0-45, wrist extension 0- 75 and wrist radial deviation 0-20 degrees. What is the MOST appropriate intervention to help increase range of motion on the right side? A. Posterior glide of the radius at the proximal radio-ulnar joint
B. Dorsal glide of ulna at the distal radio-ulnar joint. C. Volar glide of radius at the distal radio-ulnar joint. D. Medial glide of the radius at the radio-carpal joint.: The correct answer is A. Posterior glide of the radius at the proximal radio-ulnar joint. Rationale: The patient presents with limitation in pronation and elbow range of motion. As convex radius moves on concave ulna the roll and slide is in the opposite direction. Posterior glide at Proximal radio-ulnar joint can be used to increase Pronation (3P's). Volar glide of radius at the distal radio-ulnar joint can also increase pronation but the range of motion limitation is more marked at the elbow
- A physical therapist performs lower lumbar spinal joint mobilization on an 28-year-old pregnant female patient who is in her first trimester. The patient calls the next day and complains of a dull ache in the lower back that has lasted for 2 hours. The MOST appropriate physical therapist response would be: A. Ask the patient to have an MRI done to rule out any disc problems B. Immediately refer the patient to a physician as joint mobilization is an absolute contraindication in pregnancy C. Explain to the patient that this response is common and continue with original plan of care D. Ask the patient to come back the next day and add strengthening exercises to the exercise program: The correct answer is C: Explain to the patient that this response is common and continue with original plan of care. Rationale: Dull ache is a normal response to joint mobilization and the PT should encourage the patient to continue with the plan of care. Mobilization is a relative (not absolute) contraindication in pregnancy (especially first trimester) which makes B incorrect.
- A 40 - year-old male patient presents to an outpatient clinic with complains of low back pain. The physical therapist is reviewing the MRI
B. Spinous processes of thoracic spine rotated to the right C. High right shoulder and a left hip that protrudes D. Posteriorly protruding right scapulae with no gap between right arm and trunk: The correct answer is B: Spinous processes of thoracic spine rotated to the right. Rationale: The patient has a left thoracic scoliosis indicating left convex curve. The body of the vertebrae will rotate to the convex side (left) and the spinous processes will rotate to the concave side (right side). So the correct option is B. The shoulder will be elevated on the convex (left) side and scapula will also become prominent on the convex side (left side) along with the left arm closer to the body making C and D options incorrect.
- A 48-year-old female lawyer presents to an outpatient clinic with history of low back pain. The patient walks home each night carrying a heavy bag of files in her right hand. On examination, the physical therapist notes right hip pain and weakness of right hip abductors. Which of the following is the MOST appropriate suggestion to help alleviate her symptoms? A. Start carrying the same bag on the left side B. Get a bag with wheels, and push it with her right hand C. Get a bag with wheels, and push it with her left hand D. Start driving to work, as walking causes increased pain: The correct answer is C: Get a bag with wheels, and push it with her left hand. Rationale: Having the bag with wheels on the opposite (left) side will create a counter-clockwise torque on the right hip which will help reduce the stress (and pain) on the right hip. Holding the bag without wheels on the left side will increase the stress on the right hip making A incorrect.
- A 66-year-old male patient with a right transfemoral amputation is referred to an outpatient physical therapy clinic. During gait analysis, the physical therapist observes right medial heel whip during right toe off phase of the prosthetic limb. Which of the following is the MOST likely cause of this deviation? A. The foot is too far medially inset.
B. Inadequate medial rotation of the knee joint. C. Excessive lateral rotation of the knee joint. D. The socket is in excessive abduction.: The correct answer is C: Excessive lateral rotation of the knee joint. Rationale: If the knee axis of prosthesis is in excessive external rotation, the heel will move closer to the mid-line of the body at toe off and a medial heel whip will occur.
- A patient presents to an outpatient clinic with complains of pain and numbness in the right arm extending to the thumb. The physical therapist performs the special test as shown in the picture below. If the test is positive, which of the following would be the MOST appropriate physical therapy intervention? A. Strengthen the right levator scapulae and sternocleidomastoid muscles. B. Perform (Posterior-Anterior) PA glide of the C6 vertebrae with right side bending and rotation. C. Stretch the right pectoralis minor and sternocleidomastoid muscles. D. Perform grade 3 manipulation of the first and second ribs.: The correct answer is C. Stretch the right pectoralis minor and sternocleidomastoid muscles. Rationale: The special test shown in the picture is Costoclavicular Syndrome test. A positive test is indicated by an absence of the pulse and implies possible thoracic outlet syndrome. The most appropriate intervention would be to stretch the pectoralis muscles, SCM and scalenes. Mobilizing can also be used to decrease muscle guarding and pain but Grade V (not grade III) manipulation of the first rib (not 2nd) will be the appropriate intervention. Reference--https://books.google.com/books?id=cxu0BQAAQBAJ&pg=PA345...
- A 28-year-old software engineer reporting difficulty at work is referred to an outpatient physical therapy clinic. The patient complains of pain, numbness and tingling sensation in her left forearm, elbow and hand. The PT suspects a median nerve injury but Phalen's test is negative. To confirm
and appears to get longer in sitting. Based on the examination what is the MOST appropriate treatment: A. Stretch the Right Hip Extensors B. Stretch the Right Hip Flexors C. Strengthen the Right Hip Flexors D. Strengthen the Right Hip Extensors: The correct answer is A. The patient presents with right posterior innominate rotation which can be caused by weak hip flexors or tight hip extensors on the same side. The most appropriate treatment would be to stretch the right hip extensors. Here are couple of Mnemonics to help remember anterior and posterior innominate rotations When in long sitting: SPLASH (Sitting Posterior Longer Anterior Shorter) ASS (anterior short in sitting) ALL (anterior long in laying)
- 28 year-old female, 8 months pregnant, is working out in an outpatient clinic. The plan of care includes strengthening the core muscles by using the therapeutic ball. Which of following is the BEST intervention to train her lower abdominal muscles while sitting on the ball? A. Displace the ball anteriorly. B. Displace the ball posteriorly. C. Sit on the ball and flex both knees. D. Training on ball is not recommended.: The correct answer is A: Displace the ball anteriorly. Rationale: Moving the ball anteriorly will promote posterior pelvic tilt and help strengthen the lower abdominal muscles. Option D is incorrect as exercise ball is allowed and often encouraged during pregnancy (even at 8 months).
- The physical therapist is testing trunk movements of a 23-year-old healthy male client. The patient is lying supine and lifts his shoulders off the table to bring his right elbow towards his left knee. Which of the following muscles are being tested?
A. Right internal oblique and left external oblique B. Pectoralis minor and major C. Right external oblique and left internal oblique D. Right and left Rectus abdominus: The correct answer is C: Right external oblique and left internal oblique. Rationale: The same side (left) internal obliques, and opposite side (right) external obliques will work during the exercise. Option A is for the opposite side muscles. Reference: Kisner and Colby pg 366
- A patient presents to an outpatient clinic with pain at the ankle. According to the patient, the pain is worse while walking or running on uneven surfaces. Based on the MRI image shown below, the physical therapist should suspect: A. Plantar fasciitis and perform calf stretching B. Anterior talofibular ligament injury and provide an ankle brace C. Achilles tendinosis and prescribe ice therapy and rest D. Heel spur and prescribe orthotic shoes: The correct answer is C- Achilles tendinosis and prescribe ice therapy and rest. Rationale: The image http://www.mri.melbourne/mri/mri-series-achilles-tendon/ shows thickening of Achilles tendon and tendinosis. No tear is seen. Pain is usually present during running and weight bearing activities. The treatment would include ice therapy and activity modification. Eccentric exercises can also be given for strengthening.
