CPR

Question 1

Lumbar Manipulation

Answer 1

1. Pain less than 16 days
2. No symptoms distal to the knee
3. FABQ(work) less than 19
4. PROMHip IR greater than 35 deg (either hip)
5. +Lumbar Spring Test (hypomobile + pain)

Child’s study - pretest 44%·
Less than 4 of 5 = + LR 13.2 à posttest prob success 95%
Greater than 3 of 5 = - LR 0.10 à posttest prob success 7%

Question 2

Cervical Myelopathy

Answer 2

1. Gait deviation
2. Hoffman’sTest
3. Inverted supinator sign
4. Babinski sign
5. Age less than 45

Pre-test prob 35%
Less than 1 - LR.18 = Posttest prob 43%
Greater than 3 + LR 30.9 = post test Prob 94%

Question 3

Cervical Radiculopathy

Answer 3

1. • ULTTA
2. Cervica lRotation (involved) less than 60 deg
3. Spurling’s
4. Distraction(up to 30#)

Pretest prob 53%
3 0f 4 = 85% post test
4 of 4 = 90% posttest

Question 4

Secondary Shoulder Impingement

Answer 4

1. Hawkins-Kennedy
2. Painful Arc Sign
3. Infraspinatus Muscle Test

• Pretest Prob 65%
• 3 of 3 → + LR 10.56 → Post test Prob 95%
• 2 of 3 → + LR 5.03 → Post test Prob 90%

Question 5

Rotator Cuff Tears

Answer 5

Best confirmed with MR-arthrogram
`1. Drop Arm
2. Painful arc sign
3. Infraspinatus Muscle test

• Pretest Prob 39%
• 3 of 3 → + LR 15.57 → posttest prob 91%
• 2 of 3 → + LR 3.57 → posttest prob 69%

Question 6

Lateral Epicondylagia Tx with MWM (mobilization with movement)

Answer 6

1. Age less 49 → + LR 2.6 → 91% success
2. Affected UE pain free grip greater 25# → + LR 2.3 →90% success
3. Unaffected UE PF grip greater 75.5# → + LR 2.1 → 89% success

Pretest Prob 79%
3 of 3 → + LR ∞ → 100% success
2 of 3 → + LR 3.7 → 93% success
1 of 3 → + LR 1.8 → 87% success

Question 7

Carpal Tunnel Syndrome Diagnosis

Answer 7

• Age Greater than 45
• Reports shaking hands relieves symptoms
• Wrist Ratio index > .76 (AP / ML wrist measure)
• Reduced Median sensory field first digit
• Symptom Severity Scale Score > 1.9

• Pretest Prob 34%
# + Sen -LR Spec + LR Post %
>2 .98 .14 .14 1.1
>3 .98 . 04 .54 2.1
>4 .77 .28 .83 4.6 70%
5 .18 .83 .99 18.3 90%

Question 8

CANADIAN CERVICAL SPINE RULES

Answer 8

High Risk Factors Present?

1. Age > 65
2. Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
3. Paresthesias in extremities

Low Risk Factors that allow safe assessment of range of motion?

1. Simple rear-end motor accident
2. Normal sitting posture in emergency department
3. Ambulatory at any time since injury
4. Delayed onset of neck pain and absence of midline tenderness

Is the patient able to actively rotate the neck > 45 degrees to the right and the left?

If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated.

Question 9

DVT (wells Criteria)

Answer 9

1. Active Cancer (treatment ongoing or within previous 6 months): + 1 Point
2. Paralysis, paresis or recent plaster immobilization of the LE: + 1 Point
3. Recently bedridden for 3 days or more, or major surgery within the previous 12 weeks requiring anesthesia: + 1 Point
4. Localized tenderness along the distribution of the deep venous system: + 1 Point
5. Entire leg swelling: + 1 Point
6. Calf Swelling at least 3cm larger than asymptomatic leg (measured 10cm below tibial tub): + 1 Point
7. Pitting Edema confined in symptomatic leg: + 1 Point
8. Collateral superficial veins (nonvaricose): + 1 Point
9. Previous DVT: + 1 Point
10. Alternative diagnosis at least as likely as a DVT: – 2 Points

> 3: High Probability
1-2: Moderate Probability
0: Low Probability

Question 10

Scaphoid Fx

Answer 10

-	Axial Load of Thumb
o	Sn .89 / - LR .02
o	Sp .98 / + LR 49
-	Scaphoid Shift/ Watson’s test
o	Sn .69 / - LR .47
o	Sp .66 / + LR 2.0

Question 11

Lumbar Stabilization

Answer 11

1. • PITS Test - Prone instability test
2. Aberant motions present
3. Mean SLR Greater than 91
4. Age Less than 40

• Pretest prob 33%
• Greater 3 → + LR 4.0 Posttest Prob 67%
•

Question 12

LBP Tx with Pilates-based Exercises

Answer 12

1. Total Trunk Flexion Greater 70 deg
   2, Duration of symptoms Less 6 month
2. No symptoms in legs for greater 1 week
3. BMI Greater 25
4. Mean hip rotation > 25 deg (either hip)

• Pretest prob 54%
• 3 of 5 → + LR 10.64 → posttest prob 93%

Question 13

SI Joint Pain

Answer 13

1. SI Distraction
2. SI compression
3. Thigh Trust
4. Gaenslen’s
5. Sacral thrust
6. FABER

• Pretest prob 32%
• 3 pos → + LR 7 → posttest 59%
• 3 of 6 → Sn 94%, Sp 78%

Question 14

Cervical Pain

Mobilization / Manipulation of T Spine

Answer 14

1. Symptoms less 30 days
2. No symptoms distal to shoulder
3. Looking up does not aggravate symptoms
4. FABQ(PA) less 12
5. Diminished upper thoracic spine kyphosis
6. Cervical extension ROM less 30 deg

• Pretest prob 54%
• 3 of 6→ 86%
• 4 of 6 → 93%

Question 15

HVLA to Cervical Spine

Answer 15

1. Symptoms less 38 days
2. • expectation of HVLA with help (pt believes)
3. AROM rotation side/side differs greater 10 degrees
   4 . Pain with PA mid cervical spine

• Pretest prob 39%
• 3 of 4 → + LR 13.5 → posttest prob 90%

Question 16

Cervical Traction

Answer 16

1. Peripheralization with c4-c7 mobility testing
2. Age greater 55
3. (+) Shoulder abduction test
4. (+) ULTT A
5. (+) cervical distraction test

• Pretest prob 44%
• 3 of 5 → + LR 4.81 → Posttest 79%
• 4+ of 5 → + LR 23 → Posttest 94.8%

Question 17

Hip OA

Answer 17

• Self-reported “squat” as an aggravating factor
• AROM hip extension causes pain
• AROM hip flexion causes lateral hip pain
• Scour test with Adduction causes lateral hip and or groin pain
• PROM hip IR

Question 18

Hip OA (Clusters)

Answer 18

1 - (Sn 86%, SP 75%)

• Hip Pain
• IR Greater 15 deg
• Pain with IR
• Morning stiffness

Question 19

Knee OA Clusters

Answer 19

2

Sen 89%, Spec 88% (all groups)
#1
– knee pain & crepitus with active motion
- Morning stiffness 38

– knee pain & crepitus with active motion
- Morning stiffness greater 30 min
- Boney enlargement

– knee pain
- Boney Enlargement

Question 20

Manual therapy – HVLA SIJ mob for Patellofemoral Pain

Answer 20

• Difference in hip IR >14 deg
• Ankle dorsiflesion >16 deg
• Navicular Drop Greater 3mm
• No stiffness with sitting >30 min
• Squatting is most painful activity
• Pre-test probability 45%
• 3/5 present → + LR 18.4 / - LR 0.33
• 4/5 present → 100% success

Question 21

Taping for Patellofemoral Pain

Answer 21

• • Patellar tilt (K=0.49)
• Tibial Varum Greater 5 degress (ICC = 0.66)
• Pre-test success – 52%
• 2/2 present → + LR 4.4 / - LR 0.53
• Post test success – 83%

Question 22

Orthotics for PFPS

Answer 22

Vicenzino, et al:

1. Age over 25 years
2. Height less than 165 cm
3. Worst pain less than 53.25 mm (100 mm visual analogue scale)
4. Mid-foot width difference greater than 10.96 mm

2+ +LR = 2.2 59%
3+ +LR = 8.8 85%

Question 23

Maitalnd Hip Mobilizatoins for Knee OA

Answer 23

• Hip/ groin pain or paresthesia
• Anterior Thigh pain
• Pain with hip distraction
• Knee flexion PROM

Question 24

Ankle Instability/Stabilization treatment

Answer 24

• Symptoms worse when standing
• Symptoms worse in the evening
• Navicular Drop > 5.0 mm
• Distal Tibiofibular Joint hypomobility
• Pre-test prob: 75%
• 3 of 4 → +LR 5.90 → post test 95%

Question 25

Ottawa Ankle Rules

Answer 25

Pain in malleolar or midfoot area and Either: 1. Inability to bear weight immediately after injury AND in the ED (taking 4 steps) OR 2. Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral malleolus 3. Bone tenderness at the navicular or proximal base of 5th metatarsal

Question 26

Ottawa Knee Rules

Answer 26

1. Age greater 55 2. Tenderness at the head of the fibula 3. Isolated tenderness of the patella during palpation 4. Inability to flex the knee to 90 degrees 5. Inability to bear weight immediately and upon ER evaluation

Question 27

Meniscus Pathology

Answer 27

1. History of catching or locking reported by the patient 2. Joint line tenderness 3. Pain with forced hyperextension (modified bounce home test) 4. Pain with maximal passive knee flexion 5. Pain or audible click with McMurray manuver 3+ + LR 3.14 4+ + LR 4.28 5+ + LR 11.20

Question 28

C/T Manipulation for Shoulder Pain

Answer 28

1. Less 90 days of symptoms 2. No meds for shoulder pain 3. (-) Neers 4. Pain free flexion Less 127 deg 5. IR Less 53 deg @ 90 deg GH abduction * Pretest Prob 61% * 3+ of 5 → + LR 5.3 → Posttest Prob 89%

Question 29

Cervical Radiculoptahy Predictors for Success

Answer 29

1. Age Less 54 years 2. Dominant UE not affected 3. Looking down does NOT increased Sx 4. Multimodal Tx (greater 50% of time = Manual therapy, Deep cervical flexor strengthening, cervical traction * Pretest 53% * 3 of 4 → posttest prob 85% * 4 of 4 → posttest prob 90%