MSK Flashcards

Question

A newborn is diagnosed with Congenital Hip Dysplasia (Developmental Dysplasia of the Hip). The parents ask the physical therapist when this condition typically develops. Which of the following is the MOST accurate developmental timeline? A. During the first trimester in utero due to genetic mutations. B. During the second trimester due to maternal drug exposure. C. During the last trimester in utero. D. Immediately during the birthing process due to mechanical trauma

Answer 1

C. During the last trimester in utero. ## Footnote Congenital Hip Dysplasia is characterized by malalignment of the femoral head within the acetabulum and typically develops during the last trimester in utero.

Answer 2

C. Stabilize the forearm and ulnarly deviate the wrist with the thumb tucked in a fist. ## Footnote The Finkelstein Test requires the thumb to be tucked in a fist followed by ulnar deviation of the wrist - (+) is indicated by pain over the Abductor Pollicis Longus and Extensor Pollicis Brevis tendons at the wrist and may be indicative of Tenosynovitis in the thumb (DeQuervain’s Disease)

Answer 3

A. Positive Posterior Sag Sign ## Footnote The Posterior Sag Sign is an observational finding where the tibia sags back on the femur due to PCL injury

Answer 4

A. Rotator cuff strengthening and scapular stability exercises ## Footnote The treatment protocol states that once the initial phase is tolerated, treatment should include rotator cuff strengthening and scapular stability exercises - Long term prevention includes continued strengthening of the rotator cuff and scapular stabilizers, along with improved biomechanics related to sport-specific or relevant work activities

Answer 5

C. Degeneration of the femoral head due to a disturbance in blood supply. ## Footnote Legg-Calve-Perthes Disease is characterized by degeneration of the femoral head due to a disturbance in the blood supply (avascular necrosis).

Answer 6

C. Ankle pumps and quadriceps sets to prevent thromboembolism and minimize atrophy. ## Footnote Initial treatment (Phase 1) focuses on decreasing inflammation, adhering to precautions, and minimizing muscle atrophy. Ankle pumps are specifically used to prevent DVT, while quad sets address the "quad lag" or atrophy often seen after the joint is opened

Answer 7

D. Tenderness at the medial tubercle of the calcaneus and pain that is worse after periods of inactivity ## Footnote The S/S for Plantar Fasciitis include tenderness at the insertion (medial tubercle), pain worse in the morning or after prolonged inactivity, and pain when walking in bare feet

Answer 8

D. Avoidance of isolated hamstring exercises for a minimum of 6 weeks. ## Footnote With a PCL sprain: - Intially RICE, NSAIDs, and analgescis are used as needed - PT treatment includes LE strengthening exercises and functional progression

Answer 9

B. Forearm supination and lateral rotation. ## Footnote Yergason’s Test requires the patient to actively supinate and laterally rotate against the therapist's resistance while the humerus is stabilized against the thorax

Answer 10

A. The outer one-third of the meniscus. ## Footnote The Medial Meniscus is more commonly injured than the lateral because it is less mobile due to its attachment to the joint capsule, however, The outer one-third is well-vascularized, giving it the best potential for healing or surgical repair compared to the avascular inner portions.

Answer 11

B. Glenoid labrum tear ## Footnote This procedure describes the Glenoid Labrum Tear (Clunk) Test. A clunk or grinding sound is a positive finding

Answer 12

D. Modalities to reduce inflammation followed by strengthening and functional progression ## Footnote Treatment for meniscal tears typically begins with conservative measures (RICE, NSAIDs, Palliative modalities and strengthening exercises). Post-surgically, the focus is on decreasing swelling and progressing through strengthening and functional drills

Answer 13

A. Hyaluronic acid; to improve lubrication of the joint. ## Footnote Pharmacological management may include acetaminophen, NSAIDs, and Corticosteroids. Some pts benefit from viscosupplementation, which is administered through a series of injections of hyaluronic acid into the knee. The goal is to improve lubrication of the knee, reduce pain, and improve ROM

Answer 14

B. A 50-year-old female with insidious onset of night pain and a capsular pattern of restriction. ## Footnote Adhesive Capsulitis etiology notes peak incidence in females between 40-60 years old. Signs include insidious onset, night pain, and restricted ROM in a capsular pattern

Answer 15

C. Apply a posterior glide to the humeral head. ## Footnote The initial procedure describes the Apprehension Test for anterior shoulder dislocation. This test is often paired with a Relocation Test, where a posterior glide is applied to the shoulder to see if the apprehension or pain subsides.

Answer 16

B. Using a raised toilet seat or portable commode. ## Footnote Discharge guidelines explicitly require a raised toilet seat or commode to prevent hip flexion beyond 90° Refutation: - A: is for fall prevention - C is wrong (should be uninvolved side). - D is wrong (avoid soft furniture).

Answer 17

B. Prone, knee 90°, compress tibia and rotate; (+) if pain or clicking occurs. ## Footnote Apley’s Compression Test is done in prone at 90° of knee flexion with a compressive force and rotation. A positive result is pain or clicking, indicative of a meniscal lesion

Answer 18

A. Mechanical loading via a heavy-load, slow-speed exercise program. ## Footnote The CPG for Achilles Tendonitis states that clinicians SHOULD use mechanical loading (eccentric or heavy-load, slow-speed concentric/eccentric). It also recommends Iontophoresis with Dexamethasone

Answer 19

D. Hip flexion beyond 90°, adduction, and internal rotation ## Footnote The Posterolateral Approach is the most common but has a higher dislocation rate. Precautions for this approach include avoiding flexion beyond 90°, adduction, and internal rotation. Refutation: - A: Avoided in Anterolateral and Direct Lateral approaches - B: Avoided in Anterolateral and Direct Lateral approaches - C: Only specific to the Direct Lateral approach if the gluteus medius was repaired

Answer 20

A. Joint line tenderness and a positive McMurray test. ## Footnote Common signs and symptoms of a meniscal tear include joint line pain, swelling, catching or locking sensations, and positive special tests like the McMurray test, Apley's compression test, Bounce home Test, and Thessalys Test

Answer 21

B. Ulnar Collateral Ligament (UCL)

Answer 22

A. Acromioclavicular Joint ## Footnote The Acromioclavicular Crossover Test involves 90° flexion and full horizontal adduction. Pain over the AC joint is positive for injury

Answer 23

C. Extensor carpi radialis brevis (ECRB). ## Footnote Lateral Epicondylitis is caused by eccentric loading of the wrist extensors, usually the extensor carpi radialis brevis, resulting in microtrauma

Answer 24

C. Progressive weight bearing and the use of bracing or taping. ## Footnote For Acute Lateral Ankle Sprains, the CPG states clinicians SHOULD use progressive weight bearing, bracing/taping, and therapeutic exercises (AROM, stretching, balance, neurmuscular training and posture re-ed).

Answer 25

C. Exercises that gradually become more aggressive as functional activities are introduced. ## Footnote - Conservative treatment includes decreasing inflammation, protecting the knee joint and ligament, ROM, and strengthening exercises as tolerated - **Strengthening exercises gradually become more aggressive and functional activities are introduced**

Answer 26

A. Stand on one leg with 20° of knee flexion and rotate the femur on the tibia medially/laterally. ## Footnote The Thessaly Test involves standing on one leg (first at 5° then at 20° of flexion) and rotating the femur on the tibia three times

Answer 27

B. Prevention of adhesive capsulitis via PROM; return to overhead activities in 9-12 months. ## Footnote The primary focus of therapy is to prevent adhesive capsulitis and strengthen the UE. For a large tear (6 cm), immobilization lasts 4-6 weeks. PT begins with PROM and gradully become more functional with ADLs and progress to more strengthening activities, and return to dynamic overhead motion takes 9-12 months Refutation: - A: Strengthening is not the focus at 2 weeks post-op for a large tear. - C: AROM is not initiated until after PROM and AAROM stages - D: Aggressive mobilization is not mentioned as the primary goal; preventing stiffness with PROM is the standard

Answer 28

D. Posterior Meniscus ## Footnote The McMurray Test is specifically used to identify a posterior meniscal lesion. While the rotation direction (medial vs. lateral) targets different sides, the overall test as indicative of the posterior meniscus

Answer 29

D. Serial casting using the Ponseti method to restore proper positioning

Answer 30

B. Positive Hawkins-Kennedy, positive Painful Arc Sign, and weakness with the Infraspinatus Test.

Answer 31

B. Posterior Drawer Test ## Footnote The Posterior Drawer Test is the PCL equivalent of the anterior drawer, using a posterior force at 90° of flexion

Answer 32

A. LCL, PCL, Arcuate Complex, and Posterolateral Capsule ## Footnote A positive Varus Stress Test in full extension indicates a much more severe injury involving the LCL, PCL, Arcuate Complex, and Posterolateral Capsule

Answer 33

C. Patient A's injury is due to extrinsic factors, while Patient B's involves intrinsic factors like impaired blood supply. ## Footnote Etiology is split into intrinsic (impaired blood supply/degeneration) and extrinsic (trauma/microtrauma). Older patients (50+) are particularly susceptible to degenerative (intrinsic) pathology, while athletes often face traumatic/microtraumatic (extrinsic) forces Refutation: - A: Intrinsic factors (blood supply) are more specific to degenerative cases (Patient B), does not apply to patient A. - B: This swaps the etiologies; trauma is extrinsic

Answer 34

C. A counter-force strap placed 2 to 3 inches distal to the elbow joint. ## Footnote The treatment for Lateral Epicondylitis includes the use of a strap placed 2 to 3 inches distal to the elbow joint to diminish or eliminate symptoms - PT treatment should attempt to increase strength, flexibility, and endurance of the wrist extensors.

Answer 35

A. Adduction of the forefoot, varus of the hindfoot, and equinus at the ankle. ## Footnote Talipes Equinovarus (Clubfoot) is defined by three primary structural deviations: forefoot adduction, hindfoot varus, and ankle equinus (heel pointing downward). Refutation: - B & D: "Calcaneus" refers to a heel-up/dorsiflexed position, which is the opposite of equinus. - C: Hindfoot valgus is the opposite of the varus position seen in clubfoot.

Answer 36

C. Disease-modifying anti-rheumatic drugs (DMARDs); therapy should focus on joint protection and energy conservation. ## Footnote DMARDs are specifically noted for their ability to slow the progression of joint destruction. PT interventions include A/PROM, heating/cooling agents, education, joint protection techniques, energy conservation, and splinting - The goal is to reduce inflammation and pain, promote joint function, and prevent joint destruction and deformity Refutation: - A: NSAIDs reduce inflammation but do not slow disease progression; aggressive exercise is contraindicated during flare-ups - B: Acetaminophen is for pain/fever and doesn't address the autoimmune progression - D: Corticosteroids manage symptoms but do not "cure" the condition

Answer 37

C. Cryotherapy. ## Footnote According to the CPG, clinicians MAY use cryotherapy for Acute Lateral Ankle Sprains

Answer 38

C. Positive Allen’s Test ## Footnote Allen’s Test (for TOS) is defined by rotating the head away from the test shoulder while in the "90/90" position

Answer 39

A. Sacral Thrust Test ## Footnote The Sacral Thrust Test is performed in prone with a direct pressure on the sacrum to provoke SIJ pain

Answer 40

A. Continued strength of stabilizers and improved biomechanics of relevant work activities. ## Footnote long-term prevention includes continued strengthening of the rotator cuff and scapular stabilizers, along with improved biomechanics related to sport-specific or relevant work activities

Answer 41

B. Increased femoral anteversion ## Footnote Normal Anteversion in an adult is 8-15°. A measurement of 22° is higher than the normal range, indicating increased anteversion - Retroversion would be a measurement significantly lower than 8°.

Answer 42

A. Marked limitation in shoulder flexion and abduction with compensatory upper trapezius recruitment. ## Footnote S/S of a Rotator Cuff Tear include the arm positioned in IR and ADD, point tenderness at the greater tubercle/acromion, marked limitation in flexion/ABD, and evident upper trapezius recruitment (shrugging) to compensate for loss of rotator cuff function Refutation: B: The arm will be held in IR and ADD C: Tenderness is at the greater tubercle/acromion D: There is typically increased tone in the anterior structures

Answer 43

B. Infraspinatus and/or Supraspinatus ## Footnote The Lateral Rotation Lag Sign is positive if the patient cannot hold the position and the shoulder moves into medial rotation. This indicates infraspinatus and/or supraspinatus pathology.

Answer 44

C. Meniscal Lesion ## Footnote The Bounce Home Test is used for meniscal lesions; a positive result is incomplete extension or a rubbery end-feel.

Answer 45

A. Use of a patellofemoral brace for patellofemoral joint involvement. ## Footnote According to the CPG for Knee Osteoarthritis, therapists should avoid patellofemoral braces for patellofemoral arthritis. Conversely, the CPG states that a therapist may use valgus unloading braces for medial joint arthritis and manual therapy. Land-based or aquatic exercises are recommended (should/may) to promote function.

Answer 46

B. Advanced arthritis of the knee that has not responded to conservative management. ## Footnote The procedure is described as the most commonly performed surgery for advanced knee arthritis. It involves removing the proximal and distal joint surfaces and replacing them with an implant when conservative options no longer provide relief.

Answer 47

B. Painful Arc Sign, Drop Arm Test, and Infraspinatus Test.

Answer 48

D. Ultrasound ## Footnote The CPG for Acute Lateral Ankle Sprains explicitly states that clinicians should AVOID the use of ultrasound

Answer 49

C. Piriformis Test ## Footnote Piriformis Test is performed in sidelying with 60° of hip flexion; a positive result is pain or reproduction of sciatic symptoms due to the piriformis compressing the nerve

Answer 50

A. Manual therapy, including joint and soft tissue mobilizations. ## Footnote The Hip OA CPG (Card 68) classifies manual therapy (joint/soft tissue mobes) as something the therapist MAY perform - B & C: These are "SHOULD" recommendations (stronger evidence/requirement). - D: The CPG states to AVOID TENS or electrical stimulation for Hip OA.

Answer 51

C. Immediately anterior or distal to the lateral epicondyle. ## Footnote In Lateral Epicondylitis, pain is typically present immediately anterior or distal to the lateral epicondyle of the humerus

Answer 52

C. Early ambulation and functional training to improve mobility and reduce complications. ## Footnote The CPG for TKA emphasizes early ambulation and functional training as a "SHOULD." This is critical for preventing DVT and promoting functional independence Refutations: - A: CPM is in the "AVOID" section of the CPG. - B: This is in the "MAY" section, not "SHOULD" section of the CPG

Answer 53

B. Spina Bifida and Arthrogryposis. ## Footnote According to the etiology of Talipes Equinovarus, the condition often accompanies neuromuscular abnormalities such as spina bifida and arthrogryposis, potentially resulting from a lack of movement in utero. Refutation: - A: Osteogenesis Imperfecta is a collagen/bone disorder, not specifically linked to clubfoot in the deck - C: JRA is an autoimmune joint disease - D: These are associated with neuromuscular scoliosis

Answer 54

C. The patient is under the age of 65 and is considered highly active. ## Footnote Primary indication for cementless fixation is a young, active individual, typically defined as being less than 65 years old. Refutation: - A: Osteomyelitis is a condition associated with the need for THA, but not a specific indicator for cementless fixation - B: Older, less active patients are better candidates for cemented fixation to allow immediate weight-bearing, not cementless as stated in this question. D: Poor bone density might make cementless fixation (which relies on bone growth) difficult.

Answer 55

B. 35-70°

Answer 56

C. 70 - 120 degrees of abduction ## Footnote a classic finding for impingement is a painful arc of motion between 70 and 120 degrees of abduction

Answer 57

A. Swan neck deformity. ## Footnote Refutation: - B: Boutonniere deformity is DIP extension and PIP flexion - C/D: These are associated with Osteoarthritis

Answer 58

B. Abnormal or irritated Plica ## Footnote Hughston’s Plica Test specifically looks for that popping sound over the medial femoral condyle, indicating plica irritation.

Answer 59

B. Lateral Pivot Shift Test ## Footnote The Lateral Pivot Shift Test identifies anterolateral rotatory instability; the clunk is the reduction of the tibia on the femur.

Answer 60

B. Using bracing or taping as a stand-alone treatment. ## Footnote The CPG for Chronic Ankle Instability specifically lists that clinicians should AVOID using bracing or taping as a stand-alone treatment

Answer 61

A. Morning stiffness and thickening in the tendon area. ## Footnote Signs and symptoms of Achilles Tendonitis include aching/burning in the posterior heel, tenderness of the tendon, pain with increased activity, swelling/thickening of the tendon, and morning stiffness

Answer 62

A. Fibrosis and scarring between the capsule, rotator cuff, and subacromial bursa. ## Footnote Adhesive Capsulitis results in loss of AROM and PROM due to soft tissue contracture caused by adhesive fibrosis and scarring between the capsule, rotator cuff, subacromial bursa, and deltoid

Answer 63

A. Achilles tendon rupture ## Footnote This is the Thompson Test. The absence of plantar flexion during the calf squeeze is indicative of a ruptured Achilles tendon

Answer 64

C. Calcaneofibular (CF) Ligament ## Footnote The Talar Tilt Test specifically assesses the CF ligament when performed into inversion

Answer 65

B. Weakness of the right Gluteus Medius ## Footnote In the Trendelenburg Test, a drop of the pelvis on the unsupported side indicates weakness of the glute medius on the supported (stance) side.

Answer 66

C. Severe pain with weight-bearing and failure of previous non-operative management. ## Footnote Candidates for THA typically exhibit severe pain with WB, loss of mobility, and failure of conservative management. Refutation: - A: describes minor bursitis. - B: describes scoliosis - D: describes RA, which is a cause for THA, but the pain/failure of care is the clinical indication for surgery

Answer 67

C. Anterior Interosseous Nerve ## Footnote Inability to perform a tip-to-tip pinch (pad-to-pad instead) is a positive Pinch Grip Test, indicating anterior interosseous nerve pathology

Answer 68

B. Apply a varus force to the elbow in 20-30° of flexion.

Answer 69

B. A positive Trendelenburg sign and antalgic gait. ## Footnote Common signs and symptoms of Legg-Calve-Perthes include pain, decreased ROM, antalgic gait, and a positive Trendelenburg sign.

Answer 70

B. Pain that is most severe during the final miles of a long-distance run. ## Footnote The hallmark pain pattern for Plantar Fasciitis is that it is worse in the morning or after prolonged inactivity, rather than pain that builds up only at the end of long-duration activity

Answer 71

B. Isometric strengthening followed by PREs for internal and external rotators. | PRE= Progressive Resistive Exercise ## Footnote Treatment following immobilization includes ROM and isometric strengthening, followed by PREs emphasizing the internal/external rotators and large scapular muscles

Answer 72

A. When walking, turn toward the uninvolved side to avoid pivoting on the involved side. ## Footnote The discharge guidelines for THA explicitly state that when walking, the patient should turn to the uninvolved side to avoid pivoting on the involved limb Refutation: B: Patients must avoid low and soft furniture and limit forward bending C: Pivoting on the involved limb is contraindicated D: The nightstand should be placed on the uninvolved side of the bed

Answer 73

B. Infraspinatus strain or tear. ## Footnote This describes the Infraspinatus Test. Pain or weakness during this resisted lateral rotation maneuver indicates an infraspinatus strain or tear

Answer 74

D. Strengthening and flexibility exercises alongside functional and balance training.

Answer 75

A. Progressive destruction of articular cartilage and formation of osteophytes. ## Footnote This is a chronic condition that causes degeneration of articular cartilage, primarily in weight bearing joints. Subsequent deformity and thickening of subchondral bone occur resulting in imparied functional status

Answer 76

C. A softening of the articular cartilage of the patella due to increased joint forces. ## Footnote Patellofemoral Syndrome is a repetitive overuse disorder often termed chondromalacia patella, which specifically refers to the softening of the articular cartilage of the patella. - A: This describes bursitis, not Patellofemoral Syndrome. - B: This describes Osgood-Schlatter Disease (Card 60). - D: This describes an acute ligamentous injury or Sinding-Larsen-Johansson syndrome, not the degenerative softening described in the deck.

Answer 77

B. Intrinsic muscle tightness. ## Footnote In the Bunnel-Littler Test, if PIP flexion improves when the MCP is flexed, the restriction was caused by tight intrinsic muscles being stretched over the MCP joint

Answer 78

B. A positive Jerk Test. ## Footnote The combination of axial compression and horizontal adduction leading to a clunk is the definition of the Jerk Test. This may indicate a posterior labral lesion.

Answer 79

A. Step up with the Left leg; step down with the Right leg. ## Footnote The discharge guidelines specify: "Up with the Good (Uninvolved), Down with the Bad (Involved)." Right is involved, Left is uninvolved.

Answer 80

C. Median nerve compression

Answer 81

C. Education on body weight management and land-based exercise ## Footnote According to the CPG for Knee Osteoarthritis (OA), the therapist SHOULD provide education on body weight management and implement land-based exercises (hip/knee strengthening). Refuting the other choices: TENS and electrical stimulation should be AVOIDED for Hip OA; for Knee OA, lateral wedge insoles and patellofemoral braces are specifically listed under the AVOID category.

Answer 82

B. ACL; prevents anterior displacement of the tibia in relation to the femur.

Answer 83

B. Maudsley’s Test.

Answer 84

A. Absence of movement in the bicep tendon. ## Footnote This procedure is the Ludington’s Test. A positive test, indicating a rupture of the long head of the biceps, is the absence of movement in the bicep tendon during contraction Refutation: - B: Pain in the bicipital groove is the positive finding for Speed's Test or Yergason's Test

Answer 85

A. Supraspinatus tendon ## Footnote This describes the Neer Impingement Test. a positive result (pain/grimace) is indicative of impingement involving the supraspinatus tendon

Answer 86

B. Sprain of the Posterior SI Ligaments.

Answer 87

A. Paraffin, ultrasound, and warm water. ## Footnote PT management includes passive and active ROM, positioning, splinting, strengthening, endurance training, weight bearing activities, postural training and functional mobility - Pain management includes the use of modalities such as Paraffin, ultrasound, warm water, and cryotherapy

Answer 88

A. Positive for hamstring tightness ## Footnote In the 90-90 Straight Leg Raise Test, a positive result is documented if the knee remains in 20° or more of flexion. 35° exceeds this threshold, indicating hamstring tightness.

Answer 89

A. Hip flexion contracture ## Footnote This is the Thomas Test. If the straight leg rises from the table, it indicates a hip flexion contracture

Answer 90

A. Both have a similar risk for the current mild curve, but the sister has a significantly higher risk of the curve progressing beyond 30°. ## Footnote Idiopathic scoliosis is most commonly diagnosed between 10-13 years. While boys and girls have a similar risk for mild curves (10° or less), girls have a significantly greater risk of acquiring a curve greater than 30° Refutation: - B: This contradicts the data; girls are at higher risk for progression. - C: Etiology is typically idiopathic, not neuromuscular or functional by default. - D: Progression is not guaranteed; treatment is based on the magnitude and degree of progression

Answer 91

A. Anterior Drawer Test ## Footnote The Anterior Drawer Test is performed at 90° of knee flexion with an anterior directed force.

Answer 92

A. Iliopsoas, Sacroiliac joint, or Hip joint ## Footnote The Patrick’s (FABER) Test is positive if the leg fails to abduct below the opposite leg, pointing to iliopsoas, SIJ, or hip joint abnormalities

Answer 93

B. Positive for Thoracic Outlet Syndrome.

Answer 94

C. Arcuate Complex ## Footnote a positive valgus stress test in full extension indicates damage to the MCL, PCL, Posterior Oblique Ligament, and Posteromedial Capsule - (+) test is indicated by excessive valgus movement and may be indicative of a MCL sprain

Answer 95

D. Pain is not typically caused by the curve itself, but by abnormal forces placed on other tissues. ## Footnote Signs and symptoms include asymmetry and rib humps. Crucially, pain is not typically associated with the spinal curvature itself; rather, it results from abnormal forces on other tissues Refutation: - A: Pain is not the primary symptom; asymmetry is. - B: While bone demineralization can facilitate degenerative scoliosis, it is not the standard cause of pain in most idiopathic cases. - C: This is false; the curve itself is usually asymptomatic regarding direct pain.

Answer 96

C. Rectus femoris contracture ## Footnote The procedure described is Ely’s Test. Spontaneous hip flexion occurring simultaneously with passive knee flexion is a positive result, indicative of a rectus femoris contracture.

Answer 97

B. Positive Ortolani’s Test ## Footnote Ortolani’s Test uses abduction and pressure on the greater trochanters to reduce a dislocation

Answer 98

B. Anterior Labral Tear ## Footnote The Anterior Labral Tear Test moves the hip through a specific arc (flex/ER/abd to ext/IR/add). A positive result is pain or a click, though it may also be indicative of Iliopsoas Tendonitis or Anterior-Superior Impingement

Answer 99

A. CMC Degenerative Joint Disease ## Footnote The Grind Test (compression/rotation of the metacarpal) indicates DJD in the CMC joint

Answer 100

C. Passively pronate the forearm, flex the wrist, and extend the elbow.

Answer 101

C. Lachman Test

Answer 102

C. Patellar Apprehension Test ## Footnote The Patellar Apprehension Test is positive when the patient fears dislocation during a lateral force and contracts the quads for protection

Answer 103

D. Open reduction with a hip spica cast, followed by PT after cast removal. ## Footnote The treatment protocol mentions that if initial repositioning (harness/bracing) is insufficient, open reduction with subsequent application of a hip spica cast may be indicated. PT follows cast removal for stretching and strengthening - But if open reduction is not indicated, the focus of treatment is dependent on age, severity, and initial attempts to reposition the femoral head within the acetabulum through constant use of a harness, bracing, splinting or traction

Answer 104

A. Asymmetrical hip abduction and apparent femoral shortening.

Answer 105

C. Stretching exercises combined with corticosteroid injections. ## Footnote The Adhesive Capsulitis CPG states that clinicians SHOULD use stretching exercises, which are most effective when combined with corticosteroid injections

Answer 106

B. Foraminal Compression Test (Spurling's); Cervical nerve root compression. ## Footnote The Foraminal Compression Test (Spurling's) involves lateral flexion and downward pressure. A positive result (radiating pain) is indicative of nerve root compression

Answer 107

D. Barlow’s Test ## Footnote Barlow’s Test involves adducting the hip and applying posterior pressure to see if the hip can be dislocated (the clunk).

Answer 108

B. Lift Off Sign ## Footnote Lift Off Sign (also known as the Medial Rotation Lag Sign), where inability to move the hand away from the back indicates a subscapularis lesion.

Answer 109

B. Prescription and training in the use of a wheelchair. ## Footnote - If pt is able to ambulate, PT will focus on AROM emphasizing symmetrical movements, positioning, functional mobility, Fx managemet, and the use of orthotics.

Answer 110

B. Minimizing muscle atrophy and decreasing inflammation. ## Footnote Initial treatment focuses on decreasing inflammation, adhering to precautions, minimizing atrophy, and regaining Full PROM Refutation: A/C/D represent late-stage or inappropriate goals for the first 3 days

Answer 111

A. Use of icing, flexibility exercises, and eliminating activities that place strain on the patellar tendon. ## Footnote Conservative treatment focuses on education, icing, flexibility exercises and eliminating activities that place strain on the patella tendon such as squatting, running or jumping

Answer 112

A. Extension and External Rotation. ## Footnote The Anterolateral Approach involves dislocating the hip anteriorly; therefore, **Extension, ER, and Adduction are the prohibited motions**. Refutations: - B/D are posterolateral precautions - C is not a standard precaution for this approach

Answer 113

B. Kleiger Test ## Footnote The Lateral Rotation Stress Test (Kleiger Test) is positive for a high ankle sprain (syndesmosis injury) if pain is produced over the tibiofibular ligaments during lateral rotation of the foot.

Answer 114

A. Pain localized specifically to the bicipital groove. ## Footnote The procedure described is Speed's Test, a positive test is indicated specifically by pain or tenderness in the bicipital groove region indicative of bicipital tendonitis

Answer 115

D. The use of soft-soled footwear during training ## Footnote Etiology of Achilles Tendonitis includes repetitive overload (increased intensity), limited flexibility/strength of the gastroc/soleus, and pronated or cavus feet. Appropriate soft-soled footwear is actually a prevention strategy, not an etiological risk factor

Answer 116

C. Posterior Sag Sign ## Footnote The signs and symptoms of a PCL sprain include the sensation of the femur sliding off the tibia and often an asymptomatic presentation. The specific tests identified in the deck for PCL are the Posterior Drawer and the Posterior Sag Sign.

Answer 117

C. The forefoot is deviated laterally away from the midline. ## Footnote Signs and symptoms of clubfoot include adduction (medial deviation) of the forefoot. Lateral deviation (abduction) would be the opposite of the clinical presentation

Answer 118

B. Manual therapy for joint/soft tissue and stretching of the gastroc-soleus complex. ## Footnote Under the "SHOULD" category for Plantar Fasciitis, the CPG includes: Stretching of the plantar fascia and gastroc/soleus, joint and soft tissue mobilizations, rigid taping, foot orthoses, and night splints Refutation: - A: Iontophoresis and Rocker bottom shoes are categorized as "MAY" - C: Phonophoresis and strengthening for pronation control are categorized as "MAY" - D: While night splints are a "SHOULD," elastic taping is specifically listed as a "MAY". Rigid taping is the "SHOULD" recommendation.

Answer 119

B. Positive Apprehension Test and capsular tenderness. ## Footnote For subluxation, signs include the feeling of the shoulder "popping" out/back, "dead" arm sensation, Positive Apprehension Test, and capsular tenderness. (Option A and D describe a full dislocation).

Answer 120

C. It achieves maximum fixation in approximately 15 minutes, allowing immediate weight-bearing. ## Footnote Cemented fixation reaches maximum strength in ~15 minutes, allowing for immediate WBAT, which is ideal for older patients with fragile bone Refutation: - A/B describe benefits of cementless - D is false; precautions apply regardless of fixation

Answer 121

A. Have the patient extend their neck and see if pain decreases.

Answer 122

D. Chronic tension creates microtears at the proximal insertion on the medial calcaneal tubercle ## Footnote Plantar Fasciitis involves inflammation and microtears at the proximal insertion on the medial tubercle of the calcaneus. - A: The plantar fascia is a broad structure comprised of connective tissue, not contractile muscle tissue. - B: It is most common between 40 and 60 years of age (Card 80). - C: The pain and tears occur at the proximal insertion (calcaneus), not the distal metatarsal heads.

Answer 123

B. Application of a spinal orthosis (bracing) and flexibility exercises. ## Footnote Treatment for scoliosis is determined by the magnitude of the curve. A spinal orthosis is warranted for curves between 25° and 40°. PT also includes strengthening, flexibility exercises, and shoe lifts Refutation: - A: Surgery is typically reserved for curves **greater than 40°**. - C: "No formal action" is only for **non-progressing** or very mild curves. - D: Shoe lifts are for functional scoliosis (leg length), but this patient has a structural curve of 32°.

Answer 124

D. Mild swelling and a requirement for a knee immobilizer to assist with a "quad lag." ## Footnote Post-operative TKA signs include swelling and decreased range of motion. A knee immobilizer is often used specifically if the patient cannot actively "lock" the knee (quad lag). Refutation: A: Signs of DVT, a serious complication B: Signs of Pulmonary Embolism (PE), a medical emergency C: Signs of infection, a major complication

Answer 125

D. A tear that extends through the entire substance of the tendon, measuring more than 5 cm. ## Footnote Rotator cuff tears are classified by thickness and size. A "full-thickness" tear extends through the entire tendon. Size-wise, "small" is 1 cm or less, and "large" is defined as more than 5 cm Refutation: - A: Describes a partial-thickness tear - B: Describes a small tear - C: While a full-thickness tear, it does not meet the "large" (>5 cm) criteria

Answer 126

B. ACL or Medial Meniscus. ## Footnote MCL sprain often involves injury to other knee structures, specifically the ACL or Medial Meniscus.

Answer 127

A. Anterolateral instability ## Footnote The Slocum Test uses 30° of medial foot rotation to specifically assess for anterolateral instability

Answer 128

B. MAY use rigid taping; AVOID elastic taping. ## Footnote According to the Achilles Tendonitis CPG, a therapist MAY use rigid taping to decrease strain. However, they should AVOID elastic taping, complete rest, and night splints

Answer 129

A. Sprain of the Anterior SI Ligaments. ## Footnote The SIJ Distraction (Gapping) Test puts tension on the Anterior SI Ligaments

Answer 130

D. Glenoid labrum tear ## Footnote Empty Can Test indicates a supraspinatus tear, impingement, or suprascapular nerve involvement. It does not list a glenoid labrum tear as a primary indication for this specific test.

Answer 131

B. 30° of flexion ## Footnote In the Noble Compression Test for IT Band Friction Syndrome, a positive result is characterized by pain over the lateral femoral epicondyle at approximately 30° of knee flexion

Answer 132

B. Supraspinatus tendon ## Footnote This describes the Hawkins-Kennedy Impingement Test. A positive test (pain) may be indicative of shoulder impingement involving the supraspinatus tendon.

Answer 133

D. Drop Arm Test ## Footnote The Drop Arm Test is specifically used to identify a rotator cuff tear. A positive result is the inability to slowly lower the arm or the presence of severe pain during the descent

Answer 134

A. Implementation of posterolateral hip strengthening exercises. ## Footnote PT's SHOULD implement hip strengthening, specifically targeting the posterolateral hip muscles, and that this is often emphasized in early treatment. As well as Knee strengthening, Prefabricated foot orthoses to correct overpronation. - B: The CPG states to AVOID knee orthoses, braces, and straps. - C: The CPG states to AVOID biophysical agents like ultrasound. - D: The CPG states to AVOID visual feedback for correcting leg alignment.

Answer 135

D. Anterior dislocation; detachment of the glenoid labrum (Bankhart lesion). ## Footnote Anterior dislocation is the most common and is usually associated with shoulder abduction and lateral rotation. Approximately 85% of dislocations result in a Bankhart lesion (detachment of the glenoid labrum).

Answer 136

B. Above the medial femoral epicondyle to the medial aspect of the tibial shaft. ## Footnote An MCL sprain often involves injury to other knee structures such as the ACL or Medial Meniscus

Answer 137

A. A limb that has developed to a specific level, beyond which no skeletal elements exist. ## Footnote A transverse limb deficiency as a limb that has developed to a particular level beyond which no skeletal element exists. (Option B describes a longitudinal deficiency).

Answer 138

D. Positive Jeanne’s Sign ## Footnote While the flexion of the distal phalanx is Froment's sign, the specific addition of hyperextension of the thumb MCP joint is termed Jeanne's Sign.

Answer 139

A. The MCL has a high level of vascularity, allowing it to heal well conservatively. ## Footnote Surgery is rarely required for an MCL sprain because the ligament is well vascularized

Answer 140

D. Wright Test ## Footnote The Wright Test (Hyperextension Test) involves moving the arm overhead in the frontal plane to check for a diminished radial pulse.

Answer 141

C. Brush Test ## Footnote The Brush Test (or Bulge test) identifies minor knee effusion by moving fluid from the medial side into the suprapatellar pouch and back.

Answer 142

A. 20° ## Footnote 90° of flexion is needed for general ADLs (like sitting), 105° of flexion is required to rise comfortably from sitting or climb stairs. 105 - 85 = 20.

Answer 143

D. Direct Lateral Approach ## Footnote The Direct Lateral Approach leaves the posterior capsule intact, which minimizes the probability of dislocation, making it ideal for non-compliant patients. **Although it still has precautions: Avoid 90° flexion, hip ext, ER, and ADD.** Refutation: - A: has the highest dislocation rate - B: still requires strict avoidance of extension/ER

Answer 144

B. In the avascular zone 2 to 6 cm above the insertion level. ## Footnote Achilles Tendonitis is an overuse disorder where the tendon is most often impacted in an avascular zone located 2 to 6 cm above the insertion level

Answer 145

C. Gaenslen’s Test ## Footnote Gaenslen’s Test involves the "scissors" position (one hip flexed, one extended) to stress the SIJ. A positive result is pain in the SIJ.

Answer 146

A. Gamekeeper’s Thumb ## Footnote The UCL Instability Test of the thumb (valgus force at MCP) is used to diagnose Gamekeeper’s or Skier’s Thumb

Answer 147

B. Froment’s Sign and Jeanne’s Sign ## Footnote A (+) is indicated by the pt flexing the distal phalanx of the thumb due to adductor pollicis muscle paralysis/Ulnar nerve lesion - If at the same time, the pt hyperextends the MCP joint of the thumb, it is termed Jeanne’s Sign. Both objective findings may be indicative of ulnar nerve compromise or paralysis

Answer 148

B. 1.0 cm ## Footnote a variation of greater than 1.0 cm constitutes a positive True Leg Length Discrepancy Test

Answer 149

C. Positive Tripod Test ## Footnote The Tripod Test is positive when passive knee extension results in either hamstring tightness or trunk extension to compensate for the short hamstrings

Answer 150

A. Clarke’s Test ## Footnote Clarke’s Test is positive if the patient cannot contract the quads without pain while the PT provides distal patellar pressure.

Answer 151

B. Cubital Tunnel Tinel’s Test ## Footnote Tapping between the olecranon and medial epicondyle targets the ulnar nerve at the elbow (Cubital Tunnel Tinel's).

Answer 152

B. Positive Sulcus Sign, Grade 2+ ## Footnote Sulcus Sign is graded by the vertical length of the depression. A 1.5 cm depression falls into the 2+ grade (1–2 cm). Refutation: - A: Grade 1+ is for a depression < 1 cm. - C: Grade 3+ is for a depression > 2 cm. - D: Ludington’s Test involves bicep contraction to check for a tendon rupture

Answer 153

D. To reduce pain, promote joint function, and protect the joint

Answer 154

C. Costoclavicular Syndrome Test.

Answer 155

A. In the morning, typically lasting less than 30 minutes.

Answer 156

C. Positive Cross Body Adduction, AC Resisted Extenion, and Active Compression Test (O'Brien's Test).

Answer 157

B. Anterior talofibular ligament (ATFL) ## Footnote The Anterior Drawer Test (Ankle) is specific to the ATFL.

Answer 158

C. Dysfunction at the Atlantoaxial (AA) joint. ## Footnote The procedure described is the Cervical Flexion Rotation Test. The spine is fully flexed to isolate the AA joint. A positive test (limited rotation) indicates dysfunction specifically at the Atlantoaxial (AA) Joint

Answer 159

A. Systemic, Polyarticular, and Oligoarticular

Answer 160

A. The humeral head migrates proximally and impinges on the undersurface of the acromion. ## Footnote Impingement syndrome is caused by the humeral head and rotator cuff migrating proximally and becoming impinged on the undersurface of the acromion and coracoacromial ligament

Answer 161

C. Measurement via the Cobb Method; classified as structural scoliosis. ## Footnote Scoliosis is quantified using the Cobb Method with a standing radiograph. If the curve is inflexible and does not reduce with lateral bending, it is classified as structural (which includes neuromuscular and degenerative types). Refutation: A: The Risser Scale (bone maturity) is not the measurement for the curve itself; functional curves are flexible. B: Non-structural (functional) curves are flexible and do reduce with bending. D: Plum-line is a posture tool, not the standard for quantification (Cobb Method).

Answer 162

B. TFL or Iliotibial band contracture ## Footnote This describes Ober’s Test. A positive test is indicated by the inability of the test leg to adduct and touch the table, suggesting ITB or TFL contracture

Answer 163

C. Positive Supine Impingement Test. ## Footnote The procedure of moving into full flexion, lateral rotation, and adduction followed by medial rotation is the specific protocol for the Supine Impingement Test - The test is (+) if the pt experiences a significant increase in pain with medial rotation

Answer 164

B. Immediately return the head to a neutral position and notify the physician. ## Footnote The findings of dizziness and nystagmus during the Vertebral Artery Test indicate potential vascular compression. This is a medical red flag that contraindicates further cervical manipulation/mobilization and requires physician notification

Answer 165

D. A 50-year-old female ## Footnote The etiology of RA is unknown, but it most commonly affects women (3x more than men) with an onset typically between 40 and 60 years of age. Refutation: - A: Describes the profile for JRA or Osgood-Schlatter - B: Describes the risk factors for Osteoarthritis - C: Describes Osteogenesis Imperfecta

Answer 166

B. Periods of exacerbation with symmetrical involvement of joints and the presence of blood rheumatoid factor. ## Footnote Rheumatoid Arthritis (RA) is defined as a systemic autoimmune disorder with chronic inflammation of synovial tissues, resulting in cartilage erosion. Key identifiers include periods of exacerbation, symmetrical joint involvement, and the presence of rheumatoid factor Refutation: - A: Describes Patellofemoral Syndrome - C: Describes Osteoarthritis - D: Describes Adhesive Capsulitis

Answer 167

A. Idiopathic cause; lateral flexion to the same side and rotation to the opposite side. ## Footnote The signs are lateral cervical flexion to the same side as the contracture and rotation toward the opposite side, as well as facial asymmetries

Answer 168

A. Valgus force with external tibial rotation; laxity with Valgus Stress Test.

Answer 169

C. Three ## Footnote The SIJ Cluster (Laslett) requires 3 out of 5 positive tests to significantly increase the probability of SIJ-mediated pain.

Answer 170

D. Murphy Sign; Lunate dislocation ## Footnote The Murphy Sign is positive when the 3rd metacarpal does not project distally (remains level) when making a fist, which may indicate a dislocated lunate

Answer 171

A. Tight retinacular ligaments ## Footnote In the Tight Retinacular Ligament Test, if DIP flexion improves when the PIP is flexed, it indicates the retinacular ligaments were the limiting factor (tight).

Answer 172

C. Surgical release followed by physical therapy for ROM and alignment. ## Footnote Surgical management is indicated when conservative options fail and the child is over one year of age. The procedure involves a surgical release followed by PT - Initially, treatment is conservative with emphasis on stretching, AROM, positioning, and caregiver education

Answer 173

B. Positive Anterior Drawer test; surgery using a patellar tendon or hamstring tendon autograft. ## Footnote ACL signs include a "pop," buckling, and positive Anterior Drawer, Lachman, or Pivot Shift tests. Grade 3 often warrants surgery using the patellar, IT band, or hamstring tendon

Answer 174

B. A look of apprehension or facial grimace. ## Footnote The procedure described is the Apprehension Test for Posterior Shoulder Dislocation. A positive test is indicated by a look of apprehension or a facial grimace prior to reaching an end point.

Answer 175

B. Autosomal recessive inheritance and pathological fractures. ## Footnote Types 2 and 3 Osteogenesis Imperfecta are considered autosomal recessive traits, while Types 1 and 4 are dominant. Clinical signs include pathological fractures and osteoporosis (brittle bones).

Answer 176

A. Drop Arm Sign, Painful Arc Sign, and Infraspinatus Muscle Test.

Answer 177

B. Resistance exercise with a rapid concentric phase ## Footnote Resistance exercises with a rapid concentirc phase is commonly used method to address power in older adults. Studies have shown power training to be more effective than strength training to improve function in community dwelling older adults. The concentric phase of each exercise repetition should be performed as rapidly as possible, with the eccentric phase controlled over approximately 3 seconds. (PT365 - 10/09/25)

Answer 178

B. Talocrural ventral (anterior) glide using small-amplitude oscillations performed at the limit of the available motion and into tissue resistance ## Footnote Small amplitude oscillations performed at the limit of the available motion and into tissue resistance describes Grade IV joint mobs, which are appropriate to improve joint mobility. A ventral (anterior) glide is used to increase talocrural plantar flexion. (PT365 - 10/12/25)

Answer 179

D. Erector Spinae ## Footnote Extension exercises are often an important component of a comprehensive POC to assist patients with Ankylosing Spondylitis to maintain the normal curvature of the spine while at the same time limiting the forward bending nature of the disease process (PT365 - 10/30/2025)

Answer 180

C. Decrease the seat height and decrease the revolutions per minute ## Footnote Decreasing both the seat height and revolutions per minute would be the most appropriate of the presented options. A lower seat height enhances knee flexion, and a lower cycling cadence would make it easier to accommodate to the change in ROM demands and facilitates the quality of the stretch (PT365 - 10/31/2025)

Answer 181

C. Hydrocodone ## Footnote Hydrocodone is an opiod analgesic commonly used for pain management. Opiods are known to affect functional mobility and put patients at an increase risk for falling. If the patient reports they are taking this medication, the therapist should consider then at an increased risk for falling. - Aspirin and ibuprofen are not associated with increased fall risk at normal dosages - Although antidepressants are known to cause hyponatremia and may contibute to increased falls, Wellbutrin is an exception and is not associated with increased falls. (Pocket Prep.)

Answer 182

A. Utilize a vertical fold appoximately 2cm to the right to the umbilicus ## Footnote The abdominal skinfold site utilizes a vetical fold approximately 2cm to the right of the umbilicus (PT365 - 12/8/25)

Answer 183

B. 80° ## Footnote According to the American Academy of Orthopedic Surgeons and the American Medical Association normal forearm pronation is 0-80°/

Answer 184

A. Extensor Carpi Radialis Brevis ## Footnote The ECRB is most commonly affected by microscopic repetitive trauma. Other extensor musculature may also be affected with more severe or chronic cases, although typcially to a lesser extent than the ECRB. (PT365 - 12/12/25)

Answer 185

A. Plantar fasciitis ## Footnote Plantar fasciitis typically presents insidiously with pain originating in the heel. Symptoms are usually exaggerated with initial weight bearing after a period of rest and decreases with activity. Decreased ankle DF, pain with palpation over the medial calcaneal tubercle, and an antalgic gait are common examinations findings. (PT365 - 12/15/25)

Answer 186

C. Scaphoid fracture ## Footnote The scaphoid is the largest carpal bone in the proximal row and is commonly injured when falling on an outstretched hand (FOOSH). Localized tenderness in the anatomic snuffbox is the most typical presentation associated with this type of injury. Scaphoid fractures can be particularly problematic since disruption in the scaphoid's blood supply can result in avascular necrosis

Answer 187

B. Cadence ## Footnote Cadence is defined as the number of steps taken by a person per unit of time. Walking with increased cadence decreases the duration of double support time. A cadence of 110 steps per minute is typically in a male, while 116 steps per minuts is typical in a female (PT365 - 12/23/25)

Answer 188

C. Exaggerated Lordosis ## Footnote Pts with tight hip flexors frequenly exhibit increased lordosis. Shortness of the hip flexors is often observed in standing as lumbar lordosis or identified through special test such as the Thomas test. - Lordosis refers to an excessive curvature of th spine in an anterior direction, usually identified in the cervical or lumbar spine. Tight hip flexors are often associated with excessive lordosis (anterior pelvic tilt) due to the orgin and insertion of the hip flexors (PT365 - 1/4/26)

Answer 189

D. A scale ## Footnote A scale can be a valuable tool for a patient to use to better understand what a selected amount of weight bearing feels like since it offers immediate feedback in the form of pounds. (PT365 - 1/5/26)

Answer 190

C. Triquetrum ## Footnote The triquetrum is located on the medial side of the proximal row of carpals between the lunate and pisiform (PT365 - 1/22/26)

Answer 191

B. 3 days per week ## Footnote Flexibility training should be performed minimally 2-3 days per week, although stretching should ideally occur 5-7 days per week. (PT365 - 2/7/26)

Answer 192

C. Anterior-posterior ## Footnote Motions in the frontal plane, such as abduction and adduction, occur around an anterior-posterior axis. The frontal plane divides the body into anterior and posterior sections. (PT365 - 2/8/26)

Answer 193

D. Active movement ## Footnote Active movement requires the patient to perform unassisted voluntary ROM. The activity provides the therapist with information on the patients willingness to use the affected body part, available ROM, strength, and coordination (PT365 - 2/12/26)

Answer 194

A. Walking program ## Footnote Moderate pain-free exercise on a regular basis is typically the most desirable activity for a patient with OA. Nourishment of articular cartilage is facilitated by the "milking" action of articular surface deformation during intermittent loading. A walking program at a comfortable pace and distance is an example of an activity meeting this criteria. (PT365 - 2/13/26)

Answer 195

A. Eccentric bench press with dumbbells ## Footnote DOMS is most commonly noted in pts who have engaged in high intensity, eccentric strengthening exercise, especially if the pt has recently begun a resistance training program. Since the pt is eccentrically strengthening the tricep muscles in this exercise, they are at the highest risk for developing DOMS (PT365 - 2/15/26)

Answer 196

B. Height ## Footnote A patient's height is the primary determinant when estimating stride length since height is positively correlated with limb length and a longer limb will result in a longer stride. (PT365 - 2/17/26)

Answer 197

B) Anterior bundle of the ulnar collateral ligament ## Footnote [The ulnar collateral ligament (UCL)](https://www.physio-pedia.com/Milking_Maneuver) is the primary stabilizer against valgus stress. The anterior bundle is the strongest component and provides the most significant restraint to valgus force when the elbow is flexed between 30° and 120

Answer 198

B) Elbow flexed to 90°, forearm supinated. ## Footnote According to the technique steps, the [standard maneuver](https://www.physio-pedia.com/Milking_Maneuver) requires the patient's forearm to be supinated and the elbow flexed to 90 degrees. Supination helps clear the bony anatomy to allow for a more direct valgus stress to the medial structures.

Answer 199

B) By grasping the thumb and pulling it laterally. ## Footnote The examiner pulls the patient's thumb laterally, which uses the forearm as a lever to create a valgus stress at the elbow. This "[milking](https://www.physio-pedia.com/Milking_Maneuver)" motion is what gives the test its name

Answer 200

C) Shoulder in adduction and external rotation; Elbow in 70° flexion. ## Footnote The [Modified Milking Maneuver](https://www.physio-pedia.com/Milking_Maneuver) is defined by positioning the elbow at 70 degrees of flexion and placing the shoulder in adduction and external rotation. This position is often used to capture the "painful arc" of instability more effectively than the 90-degree position.

Answer 201

C) Reproduction of pain, instability, or apprehension. ## Footnote A [positive](https://www.physio-pedia.com/Milking_Maneuver) test is characterized by the reproduction of the patient’s pain, a sensation of instability, or the patient exhibiting apprehension (fear of the joint "giving way").

Answer 202

D. Increased elevation of the right shoulder ## Footnote A patient with a R thoracic scoliotic curve would have the convexity of their curve facing to the R. S/S include level asymmetry with or without the presence of a rib hump. Pain is not typically associated with the spinal curve, rather it is a result of the abdominal forces placed on other tissues on the body due to the curvature (PT365 - 3/5/26)

Answer 203

C. Lumbar facet joint ## Footnote The standing lumbar quadrant test is a clincal assessment used by PTs to help identify potential sources of low back pain. - This test will compress the facet joint on the side of extension, lateral, bending, and rotation. Pain reproduced the maneuver may indicate facet joint involvement. Since the patient is reported pain localized to their lumbar spine, the facet joints are most likley the structures being loaded during this test (Pt365 - 3/11/26)

Answer 204

D. Scoliosis ## Footnote The described clinical presentation is consistent with a scoliotic curvature. A patient with a structural curvature will present with asymmetries of the shoulders, scapulae, pelvis, and skinfolds. The Cobb method is often used to determine the angle of curvature. Pts with scoliosis should be closely monitiored for progression of the curve (PT365 - 3/12/26)

Answer 205

D. Medication list ## Footnote Cipro (Ciprofloxacin) is a Fluoroquinolone antibiotic that is effective against a wide-range of gram-positive and gram-negative bacteria. This medication i used to treat UTI's and sexually transmitted diseases, among other things. This class of drug is known for increasing the risk of tendinopathies (e.g., lateral epicondylitis) and can ultimately lead to tendon rupture in some patients (PT365 - 3/18/26)

Answer 206

B. Implement a program of self-directed passive stretchng and progressive splinting ## Footnote [(Link for YT vid)](https://www.youtube.com/watch?v=MJzvmaldHFY) During the inflammatory phase (2-6 weeks), scar tissue is still soft and responsive. Self-passive stretching and dynamic or static progressive splinting are safe and effective strategies to recapture lost motion without increasing the risk of HO progression.

Answer 207

B. Hamstring/Quad strength ratio of 50% ## Footnote The hamstring/quad strength ratio should be greater that 70% prior to returning to high-demand competetive athletics, meaning that the hamstrings should possess a minimum of 70% of the strength of the quads. A hamstring/quad strength ratio of 50% is less than the recommended level and may result in the patient being susceptible to reinjury (PT365 - 3/25/26)

Answer 208

A. Reduce cell phone use ## Footnote A therapist should advise a patient with DeQuervain's Tenosynovitis to reduce their cell phone use to limit unnecessary stress to the affected structures. Cell phones use commonly involves repetitive use of the thumb, such as holding when typing or scrolling. Additionally, holding a cell phone can place a stress on the abductor pollicis longus and extensor pollicis brevis muscles (PT365 - 3/36/36)

Answer 209

C. ATP-PC (Phosphagen) System ## Footnote This is used for ATP production during high intensity, short duration exercise such as sprinting 100 meters. Refutation: A: The Aerobic System is used for low-intensity, long-duration exercise like marathons. B & D: Anaerobic Glycolysis (also known as the Lactic Acid system) is the major supplier for high-intensity activities lasting slightly longer, typically 30–90 seconds (like 400-800 meter sprints), rather than the immediate burst required for a 100-meter dash.

Answer 210

A. Phosphocreatine decomposes to release energy used to construct ATP. ## Footnote Phosphocreatine decomposes and release a large amount of energy to construct APT. There is two to three times more phosphocreatine in cells of muscles than ATP. - This process occurs almost instantaneously, allowing for ready and available energy needed by the muscles. - The system provides energy for muscle contraction for up to 15 seconds Refutation: B: Lactic acid formation is a characteristic of the Anaerobic Glycolysis system, not the ATP-PC system. C: Oxidation of food (fatty acids/amino acids) is the mechanism for the Aerobic system. D: Pyruvic acid conversion is part of the aerobic/oxidative pathway, which is too slow for a 10-second sprint.

Answer 211

D. There is two to three times more phosphocreatine in muscle cells than ATP ## Footnote Phosphocreatine decomposes and release a large amount of energy to construct APT. There is two to three times more phosphocreatine in cells of muscles than ATP. - This process occurs almost instantaneously, allowing for ready and available energy needed by the muscles. - The system provides energy for muscle contraction for up to 15 seconds Refutation: A: This is a factual reversal; phosphocreatine concentrations are higher than ATP. B: Phosphocreatine is used simultaneously to resynthesize ATP as it is broken down; it doesn't wait for total depletion. C: The ATP-PC system is anaerobic and does not require oxygen to function.

Answer 212

A. The system does not depend on a long series of chemical reactions. ## Footnote ATP-PC is able to function so rapidly because: - It does not depend on a long series of chemical reactions - It does not depend on transporting O2 we breath to the working muscles - Both ATP and PC are stored directly within the contractile mechanisms of the muscles Refutation: B: Oxidation of fatty acids is an aerobic process and is significantly slower. C: The breakdown of glucose into pyruvic acid refers to glycolysis, which is a longer chemical pathway than ATP-PC. D: This system is anaerobic; it does not rely on oxygen transport.

Answer 213

D. It does not depend on transporting the oxygen we breathe to the working muscles. ## Footnote ATP-PC is able to function so rapidly because: - It does not depend on a long series of chemical reactions - It does not depend on transporting O2 we breath to the working muscles - Both ATP and PC are stored directly within the contractile mechanisms of the muscles Refutation: A: The ATP-PC system is anaerobic and does not use oxygen. B: Lactic acid is a byproduct of anaerobic glycolysis, not the ATP-PC system, and typically hinders performance. C: Carbon dioxide is a byproduct of metabolism, not a catalyst for energy release in this system

Answer 214

A. Both ATP and phosphocreatine are stored directly within the contractile mechanisms of the muscles. ## Footnote ATP-PC is able to function so rapidly because: - It does not depend on a long series of chemical reactions - It does not depend on transporting O2 we breath to the working muscles - Both ATP and PC are stored directly within the contractile mechanisms of the muscles Refutation: B: Phosphocreatine is stored locally in the muscle, not the liver, for immediate use. C: Adipose tissue stores fats, which are used for low-intensity, long-duration (aerobic) exercise. D: The ATP-PC system is an anaerobic, cytosolic process; it does not occur within the mitochondria

Answer 215

A. Anaerobic Glycolysis System ## Footnote This is a major supplier of ATP during high intensity, short duration activities such as sprinting 400 to 800 meters. Refutation: B: The Aerobic System is used for low-intensity, long-duration exercise (e.g., marathons). C: The ATP-PC system is the primary provider for shorter bursts, typically lasting only up to 15 seconds (e.g., 100-meter dash). D: Fatty acid oxidation is a component of the Aerobic system and is not the primary source for high-intensity sprinting

Answer 216

D. Anaerobic Glycolysis System ## Footnote This is a major supplier of ATP during high intensity, short duration activities such as sprinting 400 to 800 meters. Refutation: A: While glycolysis occurs in the aerobic system, "Anaerobic Glycolysis" is the specific term for the high-intensity supplier used when oxygen demand exceeds supply. B: The Phosphagen (ATP-PC) system would be largely depleted after the first 15 seconds of a 60-second bout. C: Beta-oxidation is the process of breaking down fats for the Aerobic system, which is too slow to be the primary supplier for high-intensity 60-second work.

Answer 217

A. Stored glycolysis is split into glucose, which is then split into pyruvic acid. ## Footnote Stored glycolysis is split into glucose, and through glycolysis, split again into pyruvic acid. The energy released during this process forms APT. - The process does not require O2. - Anaerobic glycolysis results in the formation of lactic acid, which causes muscular fatigue Refutation: B: This describes aerobic metabolism, which requires oxygen. C: Pyruvic acid and phosphocreatine are parts of different energy systems (Glycolytic vs. Phosphagen). D: The anaerobic system relies on carbohydrates (glycogen/glucose), not amino acids

Answer 218

D. The formation of lactic acid during the metabolic process ## Footnote Stored glycolysis is split into glucose, and through glycolysis, split again into pyruvic acid. The energy released during this process forms APT. - The process does not require O2. - Anaerobic glycolysis results in the formation of lactic acid, which causes muscular fatigue Refutation: A: Fatty acids are used in the aerobic system and do not cause the acute fatigue seen in short sprints. B: Phosphocreatine depletion (not abundance) would limit the ATP-PC system, not the glycolytic system. C: Oxygen transport is an aerobic feature and generally delays fatigue rather than causing it.

Answer 219

A. It is nearly 50% slower than the ATP-PC system. ## Footnote Stored glycolysis is split into glucose, and through glycolysis, split again into pyruvic acid. The energy released during this process forms APT. - The process does not require O2. - Anaerobic glycolysis results in the formation of lactic acid, which causes muscular fatigue **This system is is nearly 50% slower than the phosphocreatine system (ATP-PC) and can provide a person within 30 to 40 seconds of muscle contraction** Refutation: B & D: The ATP-PC system is the fastest energy system because it has fewer chemical steps; glycolysis is slower by comparison. C: The two systems have different metabolic rates; the ATP-PC system is instantaneous, while glycolysis takes longer to produce ATP.

Answer 220

A. It does not require the presence of oxygen (O2) to produce energy. ## Footnote The Anaerobic Glycolysis System is able to function because: - It does not require the presense of O2 - It only uses carbohydrates (glycogen and glucose) - It releases enough energy for the resynthesis of only small amounts of ATP Refutation: B & D: These describe the Aerobic system, which is dependent on oxygen. C: The electron transport chain is a component of aerobic metabolism, not anaerobic glycolysis.

Answer 221

D. Carbohydrates (glycogen and glucose) ## Footnote The Anaerobic Glycolysis System is able to function because: - It does not require the presense of O2 - It only uses carbohydrates (glycogen and glucose) - It releases enough energy for the resynthesis of only small amounts of ATP Refutation: A & B: Fatty acids, amino acids, and proteins are utilized by the Aerobic system, not the anaerobic glycolytic pathway. C: Ketone bodies are an alternative fuel source used primarily during aerobic metabolism or prolonged fasting.

Answer 222

A. It releases enough energy for the resynthesis of only small amounts of ATP. ## Footnote The Anaerobic Glycolysis System is able to function because: - It does not require the presense of O2 - It only uses carbohydrates (glycogen and glucose) - It releases enough energy for the resynthesis of only small amounts of ATP Refutation: B & D: These characteristics describe the Aerobic system, which yields the most ATP. C: This is factually incorrect; the Aerobic system is much more efficient, producing significantly more ATP per glucose molecule than the anaerobic pathway.

Answer 223

A. Aerobic System ## Footnote The Aerobic System is used predominantly during low intensity long duration exercise such as running a marathon Refutation: B & D: The Phosphagen (or ATP-PC) system is only used for very high-intensity, short-duration bursts (up to 15 seconds). C: Anaerobic Glycolysis is the major supplier for high-intensity activities lasting between 30 and 120 seconds, which is insufficient for the duration of a marathon.

Answer 224

A. It yields by far the most Adenosine Triphosphate (ATP) compared to other systems. ## Footnote The O2 system **yields by far the most ATP**, but it requires several series of complex chemical reactions. - This system provides energy through the oxidation of food. - The combination of fatty acids, amino acids, and glucose with O2 releases energy that forms ATP. - This system will provide energy as long as there are nutrients to utilize Refutation: B: The aerobic system is for long-duration exercise, not just the first 30 seconds. C: Phosphocreatine decomposition is the mechanism for the ATP-PC system. D: This is factually incorrect; the aerobic system is the most efficient and yields the highest amount of ATP.

Answer 225

D. Fatty acids, amino acids, and glucose ## Footnote The O2 system yields by far the most ATP, but it requires several series of complex chemical reactions. - This system provides energy through the oxidation of food. - **The combination of fatty acids, amino acids, and glucose with O2 releases energy that forms ATP**. - This system will provide energy as long as there are nutrients to utilize

Answer 226

B. Frontal plane around an anterior-posterior axis ## Footnote This divides the body into anterior and posterior sections - Motions in this plane are Abduction and Adduction - Motions occur around an anterior-posterior axis Refutation: A & D: The Sagittal plane involves flexion and extension. While D correctly identifies the axis for the frontal plane, it incorrectly pairs it with the sagittal plane. C: The Transverse plane involves rotational movements around a vertical axis.

Answer 227

D. Frontal Plane ## Footnote This divides the body into anterior and posterior sections - Motions in this plane are Abduction and Adduction - Motions occur around an anterior-posterior axis Refutation: A: The Horizontal (Transverse) plane divides the body into upper and lower sections. B & C: The Sagittal and Midsagittal planes divide the body into right and left sections.

Answer 228

A. Sagittal plane around a medial-lateral axis ## Footnote This divides the body into right and left sections. - Motions include flexion and extension - Motions occur around a medial-lateral axis Refutation: B: This describes the frontal plane (abduction/adduction). C: This describes the transverse plane (rotation). D: While the plane is correct, the axis for sagittal motion is medial-lateral, not vertical.

Answer 229

C. The plane divides the body into upper and lower sections around a vertical axis. ## Footnote The Transverse Plane divides the body into upper and lower sections - Motions include medial and lateral rotation - Motions occur in the vertical axis

Answer 230

B. The axis of rotation (fulcrum) is positioned between the effort and the resistance. ## Footnote Refutation: A: This describes a Class 2 lever. C: This describes a Class 3 lever. D: This is a characteristic often associated with Class 2 levers; in Class 1 levers, the arm lengths can vary.

Answer 231

A. The resistance is between the axis and the effort, and the effort arm is longer than the resistance arm. ## Footnote The resistance (load) is between the axis of rotation (fulcrum) and the effort (force) - The length of the effort arm is always longer than the resistance arm - In most instances, gravity is the effort and muscle activity is the resistance, however, there are class 2 levers where the muscle is the effort when the distal attachment is on a weight bearing segment Refutation: B: This describes a Class 3 lever. C: This describes a Class 1 lever. D: In a Class 2 lever, the effort arm is always the longer of the two, providing a mechanical advantage

Answer 232

B. The effort arm is always shorter than the resistance arm. ## Footnote The effort (force) is between the axis of rotation (fulcrum) and the resistance (load) - The length of the effort arm is always shorter than the length of the resistance arm - Class 3 levers usually permit large movements at rapid speeds and are the most common type of lever in the body Refutation: A: This describes a Class 2 lever, which favors power over speed. C: This is the definition of a Class 2 lever. D: This is the definition of a Class 1 lever

Answer 233

A. Tonic ## Footnote Type 1 muscle fibers are classified as Tonic, as well as Aerobic, Red, Slow-twitch, and Slow-oxidative.

Answer 234

C. Slow-oxidative ## Footnote Classifications of Type 1 fibers include: Aerobic, Red,Tonic, Slow twitch, and Slow-oxidative Refutation: A & B: These describe Type 2 fibers, which rely on glycolysis and contract quickly. D: Type 1 fibers are classified as Red due to high myoglobin and capillary content; Type 2b fibers are typically described as White.

Answer 235

B. Phasic ## Footnote Type 2 muscle fibers are classified as Phasic, as well as Anaerobic, Fast-twitch, and Fast-glycolytic. Refutation: A, C, & D: These are all classifications for Type 1 (slow-twitch) fibers, which are designed for endurance and postural control rather than explosive power

Answer 236

D. Type 2a fibers appear red, while Type 2b fibers appear white ## Footnote Refutation: A: Type 2a fibers actually appear red. B: Type 2b fibers are anaerobic and appear white

Answer 237

A. Large amount of mitochondria ## Footnote Type 1 fibers contain a large amount of mitochondria, which facilitates aerobic metabolism and results in low fatigability. Refutation: B: Type 1 fibers actually have high capillary density to support oxygen delivery. C: They have high myoglobin content (which gives them their red color). D: Type 1 fibers are characterized as being smaller in diameter compared to Type 2 fibers

Answer 238

C. Swimming ## Footnote Swimming and Marathons as primary examples of activities that utilize the endurance-based functional characteristics of Type 1 fibers Refutation: A, B, & D: These are high-intensity, short-duration activities that primarily rely on Type 2 (fast-twitch) muscle fibers for explosive power and speed

Answer 239

B. Extensive blood supply and smaller fiber diameter ## Footnote Type 1 fibers (used in marathons) are characterized by having an extensive blood supply and smaller fibers. Refutation: A: This describes Type 2b fibers, which have a limited blood supply and large diameter for power. C: While they have high capillary density, Type 1 fibers are small, not large. D: While the size is correct, Type 1 fibers have an extensive (not less) blood supply to provide oxygen for aerobic metabolism.

Answer 240

D. Low fatigability ## Footnote Low Fatigability is a primary functional characteristic of Type 1 muscle fibers, which are used for tonic/postural contractions. Refutation: A & C: These are characteristics of Type 2 fibers (fast-twitch), which fatigue quickly. B: Type 1 fibers are typically associated with smaller motor units for fine control and endurance, whereas Type 2 fibers have larger motor units for force production.

Answer 241

A. Larger fiber diameter ## Footnote 2 muscle fibers (used in high jump and sprinting) are characterized by having larger fibers Refutation: B & D: These are characteristics of Type 1 (slow-twitch) fibers, which require high myoglobin and mitochondria for aerobic metabolism. C: Type 2 fibers actually have less blood supply and lower capillary density compared to Type 1 fibers

Answer 242

C. Fewer mitochondria ## Footnote Type 2 fibers have fewer mitochondria, which aligns with their reliance on anaerobic/glycolytic pathways rather than aerobic metabolism. Refutation: A: Type 2 fibers have high fatigability. B: They have low capillary density

Answer 243

B. Muscle Spindle ## Footnote Muscle spindles are distributed throughout the muscle belly and function to send information to the nervous system about muscle length and/or the rate of change of its length. Refutation: A: The Golgi Tendon Organ (GTO) is sensitive to tension, not muscle length. C: Pacinian corpuscles are joint receptors sensitive to high-frequency vibration and acceleration. D: Free nerve endings are primarily sensitive to mechanical stress or noxious stimuli.

Answer 244

D. It helps control posture and involuntary movement via the gamma system ## Footnote The muscle spindle is important to control posture and with the help of the gamma system, involuntary movement

Answer 245

A. Tension produced from an active muscle contraction ## Footnote GTOs are encapsulated sensory receptors through which the muscle tendons pass immediately beyond their attachment to the muscle fibers - They are **sensitive to tension, especially when produced from an active muscle contraction** Refutation: B: This is the primary stimulus for the Muscle Spindle. C: This is the stimulus for Golgi-Mazzoni corpuscles. D: This is a stimulus detected by Pacinian corpuscles

Answer 246

B. Lateral Pterygoid ## Footnote TMJ Depressors include: Lateral Pterygoid, Suprahyoid, and Infrahyoid Refutation: A, C, & D: These three muscles (Medial Pterygoid, Masseter, and Temporalis) are the primary elevators of the TMJ (closing the jaw) and actually oppose the action of depression

Answer 247

D. Suprahyoid ## Footnote TMJ Depressors include: Lateral Pterygoid, Suprahyoid, and Infrahyoid Refutation: A: The Erector Spinae group is responsible for trunk and spine extension. B: The Splenius Cervicis is involved in cervical extension and rotation. C: The Scalenes are primarily involved in cervical flexion, lateral bending, and rib elevation during respiration

Answer 248

A. Masseter ## Footnote TMJ Elevators include: Temporalis, Masseter, and Medial Pterygoid Refutation: B, C, & D: These muscles are all responsible for depressing the TMJ (opening the mouth) rather than elevating it

Answer 249

C. Medial Pterygoid and Temporalis ## Footnote Temporalis, Masseter, and Medial Pterygoid are the muscles that elevate the TMJ. Refutation: A: The Lateral Pterygoid is a depressor. B: The Suprahyoid is a depressor. D: The Infrahyoid is a depressor

Answer 250

B. Lateral Pterygoid ## Footnote The muscles responsible for protruding the TMJ are the Masseter and the Lateral and Medial Pterygoids Refutation: A & C: These muscles (Temporalis and Digastric) are actually responsible for retrusion (moving the jaw backward). D: The Suprahyoids are primarily involved in TMJ depression

Answer 251

D. Lateral and Medial Pterygoid ## Footnote The muscles responsible for protruding the TMJ are the Masseter and the Lateral and Medial Pterygoids

Answer 252

A. Temporalis ## Footnote The Temporalis, Massater, and Digastric are the muscles responsible for retruding the TMJ Refutation: B & C: The Pterygoids (Lateral and Medial) are responsible for protrusion (moving the jaw forward). D: The Infrahyoid is primarily involved in depression of the TMJ

Answer 253

C. Temporalis and Digastric ## Footnote The Temporalis, Massater, and Digastric are the muscles responsible for retruding the TMJ Refutation: A, B, & D: These options all contain muscles (Pterygoids or Hyoids) that are either responsible for protrusion or depression, rather than pulling the mandible posteriorly

Answer 254

D. Masseter and Temporalis ## Footnote Masseter and Temporalis (along with both Pterygoids) are the muscles responsible for lateral excursion. Refutation: A, B, & C: Each of these options contains a muscle (Suprahyoid, Digastric, or Infrahyoid) that is not involved in lateral excursion but rather in opening or retracting the jaw

Answer 255

B. Longus Colli ## Footnote Longus Colli (along with the SCM and Scalenes) are the primary muscle for C-Spine flexion Refutation: A, C, & D: These muscles are all responsible for cervical extension, which is the opposite movement of flexion

Answer 256

D. SCM and Scalenes ## Footnote SCM (Sternocleidomastoid), Longus Colli, and Scalenes are the muscles that perform cervical flexion. Refutation: A, B, & C: These options all contain muscles from the "Cervicis" group (Semispinalis, Iliocostalis, Longissimus) or the Multifidus, which are categorized as extensors of the cervical spine

Answer 257

A. Splenius Cervicis ## Footnote Splenius Cervicis along with Semispinalis Cervicis, Iliocostalis Cervicis, Longissimus Cervicis, Multifidus, and Trapezius are responsible for C-Spine extension Refutation: B, C, & D: These muscles (Longus Colli, SCM, and Scalenes) are identified as flexors of the cervical spine

Answer 258

C. Semispinalis Cervicis and Multifidus ## Footnote Splenius Cervicis along with Semispinalis Cervicis, Iliocostalis Cervicis, Longissimus Cervicis, Multifidus, and Trapezius are responsible for C-Spine extension

Answer 259

B. Rectus Abdominis ## Footnote Rectus Abdominis (along with the Internal and External Obliques) is the primary muscle group responsible for flexion Refutation: A & C: These muscles are involved in rotation, lateral bending, or extension, but not primary trunk flexion. D: The Erector Spinae group is the primary extensor of the spine

Answer 260

D. Internal and External Obliques ## Footnote Internal and External Obliques (along with the Rectus Abdominis) as the muscles that perform flexion of the thoracic and lumbar joints Refutation: A, B, & C: These muscles are responsible for extension, rotation, or lateral bending. They do not contribute to pure sagittal plane flexion of the trunk.

Answer 261

A. Upper Trapezius ## Footnote Upper Trapezius (along with the Levator Scapulae) is one of the primary muscles responsible for scapular elevation. Refutation: B: The Lower Trapezius is a scapular depressor. C: The Serratus Anterior is primarily a protractor and upward rotator. D: The Pectoralis Minor is a scapular depressor and downward rotator

Answer 262

C. Levator Scapulae and Upper Trapezius ## Footnote Upper Trapezius and Levator Scapulae as the muscles that elevate the scapula.

Answer 263

A. Latissimus Dorsi ## Footnote the Latissimus Dorsi is a primary scapular depressor, which is functionally essential for activities requiring the body to be lifted while the arms are fixed (closed-chain).

Answer 264

B. Lower Trapezius ## Footnote Lower Trapezius as a key muscle for scapular depression, which acts to counteract the elevating forces of the Upper Trapezius. Other Scapular Depresssors include: Lats, Pec Maj/Min

Answer 265

A. Serratus Anterior ## Footnote Serratus Anterior is a primary protractor. Clinically, it is responsible for holding the scapula against the thoracic wall; weakness leads to winging

Answer 266

B. Pectoralis Minor ## Footnote Pectoralis Minor and the Serratus Anterior as the two muscles responsible for scapular protraction

Answer 267

C. Pectoralis Minor ## Footnote A, C and D are not scapular protractors

Answer 268

D. Serratus Anterior and Pectoralis Minor ## Footnote Serratus Anterior and Pectoralis Minor are the muscles that perform protraction.

Answer 269

A. Rhomboids ## Footnote The Rhomboids (Major and Minor) and the Middle Trapezius are the primary muscles responsible for scapular retraction. Strengthening them pulls the scapulae back toward the spine

Answer 270

B. Middle Trapezius ## Footnote Middle Trapezius and Rhomboids as the muscles responsible for retraction. Refutation: A: The Lower Trapezius is primarily a depressor and upward rotator. C: The Latissimus Dorsi is a shoulder extensor/adductor and scapular depressor. D: The Levator Scapulae is an elevator and downward rotator

Answer 271

C. Upper Trapezius, Lower Trapezius, and Serratus Anterior ## Footnote Upper and Lower Trapezius along with the Serratus Anterior work together to rotate the scap upward.

Answer 272

A. Rhomboids ## Footnote The Rhomboids (Major and Minor), Levator Scap, and Pec Minor are the muscles responsible for downward rotation of the scapula.

Answer 273

A. Levator Scapulae ## Footnote Levator Scapulae (along with the Rhomboids and Pec Minor) as a downward rotator. Chronic tightness or overactivity in this muscle can pull the superior angle of the scapula upward and medially, resulting in downward rotation

Answer 274

C. Coracobrachialis ## Footnote Of the options, Coracobrachialis is the only flexor that attaches to the Coracoid Process. If there is fracture, this muscle will be the most affected Refutations: A: While a shoulder flexor, it does not attact at the coracoid process. It attaches at the clavicle. B. The Clavicular Head of the Pec Major flexes the shoulder, not the Sternal head C: The long head of the bicep does not attach at the coracoid process, as it passes throught bicipital groove and attaches on the superior portion of the glenod cavity.

Answer 275

D. Pectoralis Major (Clavicular head) ## Footnote Clavicular head of the Pectoralis Major (along with the Anterior Delt, Coracobrachialis, and Biceps) is a primary engine for shoulder flexion Refutation: A, B, & C: These muscles are extensors of the shoulder, which would oppose the action of flexion

Answer 276

B. Triceps Brachii (Long head) ## Footnote Long head of the Triceps Brachii is a shoulder extensor. Because it crosses both the shoulder and elbow joints, it contributes to both extension actions. - Other Shoulder Extensors are: Lats, Posterior Delt, and Teres Major

Answer 277

A. Supraspinatus ## Footnote The Supraspinatus is a primary abductor. Clinically, it is the primary muscle responsible for the initiation of abduction before the deltoid reaches a more advantageous line of pull.

Answer 278

B. Middle Deltoid ## Footnote Middle Deltoid (along with the Supraspinatus) are the primary muscles for shoulder abduction

Answer 279

C. Infraspinatus ## Footnote Infraspinatus and Teres Minor (the external rotators) are the muscles that assist the Posterior Deltoid in horizontal abduction

Answer 280

A. Dorsal Interossei ## Footnote Dorsal Interossei are the primary muscles for finger abduction. A common mnemonic provided in your deck is "DAB" (Dorsal ABduction).

Answer 281

B. Abductor Digiti Minimi ## Footnote Abductor Digiti Minimi as the muscle responsible for the abduction of the 5th digit.

Answer 282

C. Palmar Interossei ## Footnote Palmar Interossei are the primary muscles for finger adduction. Mnemonic "PAD" (Palmar ADDuction).

Answer 283

B. Tensor Fasciae Latae (TFL) ## Footnote TFL is a hip abductor. Clinically, it works alongside the gluteals to abduct the hip and provides tension to the IT band for lateral knee stability

Answer 284

B. The capsular pattern of the GH joint ## Footnote capsular pattern of the GH joint is characterized by a specific sequence of limited motion: External Rotation > Abduction > Internal Rotation

Answer 285

A. Superior Glenohumeral Ligament ## Footnote The Superior portion limits Adduction of shoulder as well as ER with the shoulder in 45° of Abduction

Answer 286

B. Middle Glenohumeral Ligament ## Footnote Middle portion of the Glenohumeral Ligament limits external rotation specifically when the shoulder is in 45-90° of abduction.

Answer 287

C. Inferior Glenohumeral Ligament ## Footnote Inferior portion as the structure that limits both ER and IR above 90° of abduction.

Answer 288

A. Flexion > Extension > Supination > Pronation ## Footnote capsular pattern for the radiohumeral joint is Flexion, Extension, Supination, and Pronation Refutation: Choice B: Incorrect. Extension is listed after flexion in the established pattern. Choice C: Incorrect. This reverses the order of importance, as sagittal plane motions (flexion/extension) are typically more limited than transverse plane motions (supination/pronation) in this specific joint's capsular description. Choice D: Incorrect. While it starts with Flexion and Extension, it incorrectly flips the order of Supination and Pronation

Answer 289

B. Abductor pollicis longus and extensor pollicis brevis ## Footnote the anatomical snuffbox is bordered by the tendons of the Abductor Pollicis Longus, Extensor Pollicis Brevis, and Extensor Pollicis Longus

Answer 290

C. Scaphoid

Answer 291

A. Flexion, Abduction, Internal Rotation

Answer 292

C. Inguinal ligament ## Footnote A space located in the Anterior Hip that is bordered by the Inguinal Ligament, Sartorius, and Adductor Longus - Within the space, the Femoral Nerve, Femoral Artery, Femoral Vein, Empty Space, Lymph Nodes

Answer 293

B. Femoral nerve, Femoral artery, Femoral vein, Lymph nodes ## Footnote the mnemonic NAVEL (Nerve, Artery, Vein, Empty space, Lymph nodes) to describe the contents of the femoral triangle from lateral to medial

Answer 294

D. Iliofemoral ligament ## Footnote Considered Strongest Ligament in body - Prevents Excessive Hip Extension, Abduction, Adduction and assist to maintain upright posture

Answer 295

C. Hyperextension and Adduction ## Footnote Weakest of the 3 ligaments - Prevents Hyperextension and Adduction

Answer 296

B. Extension and Abduction ## Footnote The Pubofemoral Lig. prevents excessive Abduction and Hip Extension

Answer 297

B. Pain and increased laxity during passive hip extension and abduction.

Answer 298

C. Flexion is more limited than extension.

Answer 299

C. Plicae ## Footnote The Plicae is an extension of the synovial membrane that are sometimes found in the anterior knee, most commonly medial to the patella. - Can be a source of anterior knee pain

Answer 300

B. A noncontact twisting injury associated with hyperextension and valgus stress. ## Footnote The common MOI for the ACL is a "noncontact twisting injury associated with hyperextension and valgus or varus stress." - Special Test for the ACL include Anterior drawer, Lachman, Lateral Pivot Shift Test, and Slocum Test

Answer 301

A. Plantarflexion is more limited than dorsiflexion.

Answer 302

A. Limitation of varus range of motion

Answer 303

A. Plantarflexion and Inversion ## Footnote The Anterior Talofibular Ligament (ATFL) is taut during plantarflexion and resists inversion of the talus and calcaneus.

Answer 304

A. It resists inversion of the talus within the midrange of talocrural motion.

Answer 305

A. Resisting excessive eversion of the talus

Answer 306

A. Posterior talofibular ligament

Answer 307

A. It permits the majority of rotation of the skull.

Answer 308

C. Flexion and extension of the cranium ## Footnote the Atlanto-Occipital (AO) Joint permits flexion and extension of the cranium, similar to nodding "yes."

Answer 309

B. Contralateral rotation and contralateral side bending ## Footnote the Alar Ligament functions to resist flexion, contralateral side bending, and contralateral rotation

Answer 310

B. Lateral flexion and rotation are equally limited, followed by extension.

Answer 311

B. L5 ## Footnote The L5 dermatome covers the Fibular head and dorsum of foot, and the myotome for Great toe extension

Answer 312

C. L4 ## Footnote When doing a Lower Quater screen, and doing a functional test if a person cannot heel walk L4 is most likely impaired

Answer 313

C. S1 ## Footnote When doing a Lower Quater screen, and doing a functional test if a person cannot toe walk S1 is most likely impaired. Also Achilles Reflex and the dermatome in this questions are all from the S1 level

Answer 314

D. C1 ## Footnote The Myotome for C-Spine Rotation is C1

Answer 315

D. Plethysmography ## Footnote Plethysmography - This calculates the density of the body utilizing the amount of air displacement during testing within a specialized closed chamber. The change in pressure within the chamber is measured and converted to the percentage of body fat using an equation

Answer 316

A. 2–2.5% ## Footnote Hydrostatic Weighing - This calculates the density of the body by immersing a person in water and measuring the amount of water that becomes displased - Standard Error is 2 - 2.5%

Answer 317

B. Hammer Toes ## Footnote Toes bend up at the first joint and down at middle joints so that the weight rests on the tips of the toes (**hammer toes**). This fault is often associated with wearing shoes that are too short

Answer 318

C. Wearing shoes that are too narrow and pointed at the toes. ## Footnote Big toe slants inward toward the midline of the foot (hallux valgus). “Bunion”. - This fault is often associated with wearing shoes that are too narrow and pointed at the toes

Answer 319

C. -2/5 (Poor Minus) ## Footnote -2: - Poor Minus - Pt does not complete ROM in a Gravity-Eliminated position

Answer 320

B. Poor Plus (2+/5) ## Footnote A grade of Poor Plus (2+/5) is defined as a patient who "is able to initiate movement against Gravity.

Answer 321

B. Fair Minus (-3/5) ## Footnote A grade of Fair Minus (-3/5) is defined as: "Pt does not complete the ROM against Gravity, but does complete more than half of the range." In this case, 100 degrees is more than half of the 180-degree total.

Answer 322

A. Fair (3/5) ## Footnote a grade of Fair (3/5) is defined as: "Pt complete ROM against Gravity without resistance."

Answer 323

A. Fair Plus (3+/5) ## Footnote a grade of Fair Plus (3+/5) is defined as: "Pt completes ROM against Gravity with only minimal resistance."

Answer 324

A. Active Insufficiency ## Footnote Active Insufficiency occurs when a "two-joint muscle is incapable of shortening to the extent required to produce full ROM at all joints crossed simultaneously."

Answer 325

C. Passive insufficiency of the hamstrings. ## Footnote Passive Insufficiency occurs when a "two-joint muscle cannot lengthen to the extent required to allow full ROM of all joints it crosses simultaneously

Answer 326

C. The fingers are flexed, the wrist is in ulnar deviation, and there is slight wrist extension. ## Footnote A Power Grip is used when a strong or forceful grip is needed and involves stabilization of the object against the palm of the hand. The fingers are flexed, the wrist in ulnar deviation and slight extension

Answer 327

C. The entire hand wraps around the object with the thumb on one side and the four fingers on the opposite side. ## Footnote A Cylindrical Grasp is "characterized by the entire hand wrapping around the object with the thumb on one side and the four fingers on the opposite side." - This type of grasp is used for cylindrically shaped objects like a soda can

Answer 328

D. Gripping the handle of a standard carpenter’s hammer ## Footnote Fist Grasp involves grasping around a narrower object so that the thumb and fingers overlap. This type of grasp is used for smaller cylindrically shaped objects like a hammer

Answer 329

C. Palming a handball or baseball. ## Footnote Spherical Grasp is characterized by the entire hand wrapping around a spherical object. It differs from a cylindrical grasp in that the fingers are seperated from one another and there is a greater amount of thumb opposition. This type of grasp is used for spherical objects, such as baseball

Answer 330

D. Pulp-to-pulp contact between the thumb, index finger, and middle finger ## Footnote Digital Prehension Grip is characterized by pulp-to-pulp contact between the thumb, index finger and middle finger. - This type of grip may be used when holding a pencil

Answer 331

A. Contact between the thumb and the lateral side of the index finger. ## Footnote Lateral Prehension Grip is characterized by contact between the thumb and lateral side of the index finger. This type of grip may be used when holding a key

Answer 332

A. 0–180° with a firm end-feel

Answer 333

B. Supine, knees bent; Lateral aspect of the acromion

Answer 334

D. 0 – 60°

Answer 335

C. 0 – 70°

Answer 336

C. 0 – 90°; Firm

Answer 337

D. 0 – 150°; Soft

Answer 338

C. 0 – 20°

Answer 339

A. 0 – 30°; Firm

Answer 340

C. 0 – 120°

Answer 341

C. 0 – 30°; Firm

Answer 342

D. 0 – 135°

Answer 343

B. Restriction of accessory motion ## Footnote Indications for Mobilizations include: - Restricted joint mobility - Restricted Accessory Motion - Desired Neurophysiological Effect Refutation: Choice A, C, and D are contraindications

Answer 344

C. Restricted joint mobility ## Footnote Indications for Mobilizations include: - Restricted joint mobility - Restricted Accessory Motion - Desired Neurophysiological Effect Refutation: Choice A, B, and D are all contraindications for joint mobilizations, as they could exacerbate the patient's condition or lead to injury

Answer 345

C. Grade I ## Footnote Grade 1 defined as a "small amplitude movement performed at the beginning of the range.

Answer 346

A. Small amplitude oscillations at the beginning of the range.

Answer 347

B. Grade II ## Footnote Grade 2 is defined as a "large amplitude movement performed within the range, but not reaching the limit of the range and not returning to the beginning of range."

Answer 348

C. Grade III ## Footnote Grade 3 is defined as a "large amplitude movement performed up to the limit of range."

Answer 349

D. Grade IV ## Footnote Grade 4 is defined as a "small amplitude movement performed at the limit of range."

Answer 350

C. Grade V

Answer 351

B. Posterior and Inferior

Answer 352

C. Anterior

Answer 353

A. Inferior

Answer 354

B. Posterior

Answer 355

C. Anterior

Answer 356

D. Posterior

Answer 357

A. Anterior

Answer 358

A. Anterior (humeroradial) and Distal (humeroulnar)

Answer 359

D. Posterior

Answer 360

C. Posterior glide of the proximal radioulnar joint; Anterior glide of the distal radioulnar joint.

Answer 361

A. Anterior glide (Proximal Radioulnar); Posterior glide (Distal Radioulnar)

Answer 362

A. Posterior

Answer 363

A. Anterior

Answer 364

B. Lateral

Answer 365

A. Posterior

Answer 366

C. Anterior

Answer 367

A. Inferior and Medial

Answer 368

D. Lateral

Answer 369

D. Posterior

Answer 370

A. Anterior

Answer 371

C. Posterior (Tibiofemoral); Inferior (Patellofemoral)

Answer 372

B. Anterior (Tibiofemoral); Superior (Patellofemoral)

Answer 373

D. Posterior

Answer 374

A. Anterior

Answer 375

A. Lateral

Answer 376

A. Initiate controlled passive motion within a pain-free range. ## Footnote ROM activities should NOT be performed when motion is detrimental to the healing of tissue However, controlled motion within a pain-free range has been shown to be beneficial in the early stages of healing Increased pain or inflammation are signs that ROM activities may be too aggressive Refutations: B: Aggressive stretching is contraindicated in the early healing phase as it can disrupt the surgical repair. C: While motion must be controlled, total immobilization is often less beneficial than early, pain-free controlled motion for tissue health. D: Resistive strengthening is contraindicated in the acute post-operative phase of a tendon repair

Answer 377

A. The patient is unable to physically or cognitively move the body segment. ## Footnote Other Indications for performing PROM: - The pt is unable to physically move the body segment (e.g., comatose, paralyzed) - The pt is cognitively imparied and unable to move the body segment - Active movement is contraindicated (e.g., post-op) - Active movement is painful for the pt - The PT is preparing the joint for stretching - The PT is teaching an active movement to the pt Refutations: B: PROM does not improve muscle strength as there is no muscle activation. C: PROM is performed within available range; high-intensity stretching is a different indication. D: A patient in a coma cannot follow motor commands; PROM is used because they cannot participate

Answer 378

B. Enhancing the movement of synovial fluid for articular cartilage nutrition. ## Footnote Other benefits of PROM: - Improves the mobility of connective tissue and muscles - Prevents joints contracture formation - Improves circulation - Improves synovial fluid movement for cartilage health - Decreases pain - Improves the pts awareness of movement Refutations: A: PROM does not involve muscle contraction; therefore, it cannot increase muscular power. C: Permanent elongation describes "plasticity" or stretching; PROM stays within the available range and does not aim for permanent length changes. D: PROM provides minimal systemic demand and does not significantly alter metabolic rate compared to active exercise

Answer 379

A. Active-Assisted Range of Motion (AAROM) ## Footnote AAROM is the movement that is produced by the pt through active muscular contraction with some assistance from an external force Refutations: B: The patient is actively contributing to the movement, so it is not passive. C: AROM implies the patient performs the full range independently without external assistance. D: Resisted ROM involves adding a load to oppose the movement; here, the therapist is helping the movement

Answer 380

D. It improves kinesthesia and proprioception of the joint. ## Footnote Other benefits of AAROM: - Improves mobility of connective tissue and muscles - Prevents joint contracture formation - Improves circulation - Improves synovial fluid movement for cartilage health - Decreases pain - Improves neuromuscular activity - Improves kinesthesia and proprioception Refutations: A: AAROM provides submaximal stimulus and is insufficient for significant hypertrophy. B: While AAROM is low intensity, it does not "prevent" DOMS if the patient later overexerts during progression C: AAROM is a transitional phase; resistance training is still needed for strength gains.

Answer 381

D. Improving synovial fluid movement within the joint space ## Footnote Other benefits of AAROM: - Improves mobility of connective tissue and muscles - Prevents joint contracture formation - Improves circulation - Improves synovial fluid movement for cartilage health - Decreases pain - Improves neuromuscular activity - Improves kinesthesia and proprioception Refutations: A: Range of motion exercises do not typically aim to or result in a significantly increased resting heart rate. B: AAROM is performed within the available range, not as a high-velocity stretch. C: ROM activities maintain mobility but do not significantly "strengthen" ligaments, which respond better to controlled loading

Answer 382

D. Active ROM to teach the desired movement pattern ## Footnote The indications of AROM inlcude: - Pt is able to contract a muscle, but demonstrates weakness - Performed prior to initiating resistance training to teach the desired movement Refutations: A: Stretching addresses flexibility, not the motor learning or strength of the abductors. B: Isokinetic testing is inappropriate for a muscle with only 3/5 strength. C: If a patient has 3/5 strength, they can move through the range against gravity independently; assistance is not indicated

Answer 383

C. Improvement in strength of the weak muscle. ## Footnote Other benefits of AROM: - Improves mobility of connective tissue and muscles - Prevents joint contractures - Improves circulation - Improves synovial fluid movement for cartilage health - Decreases pain - Improves neuromuscular activity - Improves kinesthesia and proprioception - Improves strength in very weak muscles (e.g., 3/5)

Answer 384

C. To address decreased muscle flexibility and joint ROM. ## Footnote Refutations: A: Stretching is used to improve length, not to increase the strength of the agonist or antagonist. D: Dynamic movement is typically used for a warm-up; static stretching is specifically indicated for flexibility deficits

Answer 385

B. Avoid stretching the finger flexors as the hypomobility is functional. ## Footnote Other Contraindications for stretching: - Acute inflammation - During soft tissue healing (e.g., following a tendon repair) - ROM limited by bone-on-bone contact - Recent fracture - Hypermobility - **Hypomobility that allows for improved function (e.g., tenodesis grip)** - Acute pain associated with stretching Refutations: A, C, D: Stretching these muscles would eliminate the "tenodesis effect," causing the patient to lose their ability to grasp objects, which is a major contraindication for stretching

Answer 386

C. Elasticity ## Footnote Elasticity is defined as the ability of soft tissue to return to its previous length after a stretch is no longer applied Refutations: A: Plasticity refers to a permanent change in length. B: Viscoelasticity involves a time-dependent resistance and slow elongation. D: Creep refers to the elongation over time that does not immediately reverse

Answer 387

A. Viscoelasticity ## Footnote A time-dependent property of soft tissue that results in resistance to stretch when it is initially applied, but allows for tissue elongation as the stretch is held for longer durations. As with elasticity, the tissue will return to its previous length after the stretch is no longer applied Refutations: B: Elasticity does not account for the time-dependent resistance. C: The Toe Region is the initial phase where wavy fibers straighten, but it doesn't describe the time-dependent resistance of the whole tissue. D: Plasticity is the result of the stretch (permanent change), not the property governing the initial resistance.

Answer 388

C. Plasticity ## Footnote Refutations: A, B: Both of these properties describe the tissue returning to its original length. D: The Toe Region is just the initial straightening of fibers and does not imply permanent length changes

Answer 389

A. Wavy collagen fibers straightening and aligning. ## Footnote The Toe Region is the vinitial stress that results in the wavy collagen fibers becoming straight and aligning with one another Refutations: B: Micro-failure occurs in the Plastic Region, not the Toe Region. C: Permanent elongation is Plasticity, which occurs later in the curve. D: Muscle spindle activation is a neurophysiological response, not a mechanical property of the Toe Region

Answer 390

C. 30 seconds ## Footnote With Static Stretching, 30 seconds has been shown to result in significant ROM gains Refutations: A, B, and C: Short durations (under 30s) are typically insufficient to overcome the initial viscoelastic resistance or allow for enough stress-relaxation

Answer 391

B. It results in less activation of the muscle spindles, reducing resistance. ## Footnote Static Stretching involves placing the muscle at its maximal length and holding the position against an external force for a prolonged period of time - Characterized by low intensity and long duration - Considered the safest form and results in the greatest gains in tissue extensibility - This leads to less activation of the muscle spindlesand thus less resistance to stretch Refutations: A: High spindle activation causes the muscle to contract and resist the stretch. C: Static stretching does not rely on reciprocal inhibition as its primary mechanism (unlike PNF). D: Increasing firing rates would cause muscle contraction, which opposes the goal of stretching

Answer 392

A. Muscle soreness and potential injury ## Footnote Ballistic Stretching is characterized by quick, jerky movements that result in a rapid change in muscle length. The muscle is placed near its end ROM and then the pt bounces back and forth to place repetitive stretch on th emuscle - High intensity, short duration - This activated muscle spindles and results in greater resistance to stretch - Not as effective for improving tissue extensibility, though it may be more effective when preparing the muscles for athletic activity - **It is more likely to lead to soreness and injury due to the high intensity of stretch force**

Answer 393

A. 10 reps at 50 lbs. ## Footnote The protocol for DeLorme Exercise Program consist of: First Set - 10 reps x 50% of 10 rep Max Second Set - 10 reps x 75% of 10 rep Max Third Set - 10 reps x 100% of 10 rep Max

Answer 394

C. The third set. ## Footnote The protocol for Oxford Exercise Program consist of: First Set - 10 reps x 100% of 10 rep Max Second Set - 10 reps x 75% of 10 rep Max Third Set - 10 reps x 50% of 10 rep Max

Answer 395

B. Within 1-2 weeks of stopping. ## Footnote The Reversibility Principle states that the adaptations seen with resistance training are reversible if the body is not regularly challenged with the same level of resistance or greater - These reversible effects can begin within 1-2 weeks of stopping an exercise program

Answer 396

C. Slowly increase the intensity and focus on concentric/isometric movements initially. ## Footnote By slowly increasing the intensity of a new exercise program. Additionally, performing only concentric and isometric exercises significantly reduces the liklihood that DOMS will occur

Answer 397

A. A complete laminectomy results in greater segmental instability than a partial laminectomy. ## Footnote This is usually performed in the presence of a disk protrusion or spinal stenosis - A complete laminectomy involves the removal of the entire lamina, the spinous process, and the associated ligamentum flavum - A partial laminectomy involves the removal of only one lamina - In **cases where a complete laminectomy is performed, the vertebral segment will be much less stable than when a partial laminectomy is performed**

Answer 398

B. Posterior approach ## Footnote Both cervical and lumbar laminectomies are generally performed using a posterior approach

Answer 399

C. Spinal stenosis ## Footnote This is usually performed in the presence of a disk protrusion or spinal stenosis

Answer 400

A. Active spinal extension ## Footnote Post-Laminectomy there will likely be restrictions on how much weight can be lifted following surgery. **The surgeon may also place restrictions on active motions, especially extension**.

Answer 401

C. Iliac crest

Answer 402

A. Hypermobility and degeneration at the L3-L4 and L5-S1 segments. ## Footnote Because a fusion creates immobility at one spinal segments, it inherently leads to hypermobility at adjacent segments, which can hasten the onset of degeneration

Answer 403

C. Anterior approach ## Footnote Cervical fusion typically uses an anterior approach, while a lumbar fusion typically uses a posterior approach

Answer 404

B. To immobilize the segments while a bony callus forms. ## Footnote Generally the surgeon will use instrumentation (e.g., pedicle screws) to immobilize the segments while a bony callus forms between the segments

Answer 405

A. Limitation of lifting, twisting, and bending (BLTs). ## Footnote The surgeon will likely place restrictions on how much can be lifted following surgery. The surgeon may also place restrictions on active motion, such as bending or twisting motions.

Answer 406

A. Instruction in log roll bed mobility and transfer training ## Footnote The surgeon will likely place restrictions on how much can be lifted following surgery. The surgeon may also place restrictions on active motion, such as bending or twisting motions. - **Early therapy occurs post-op in the hospital and involves teaching bed mobility and transfers with the pt to help them become more mobile without compromising the established precautions** Refutation: B: Active motion (bending/twisting) is typically restricted post-fusion. C: Bracing is more likely used if the surgeon **does not use** instrumentation; since instrumentation was used here, a TLSO is less likely to be the primary focus over mobility. D: While formal outpatient therapy often starts at 6 weeks, early therapy in the hospital is indicated for bed mobility and transfers

Answer 407

C. A cervical collar ## Footnote Bracing (e.g., cervical collar, TLSO) may be used to help pts comply with the movement precautions. Bracing is more likely to be used if the surgeon does not use instrumentation to stabilize the segments. Formal OP therapy does not usually occur until ~6 weeks after the surgery. Refutation: A: Formal outpatient therapy typically does not occur until ~6 weeks post-op, and aggressive stabilization would not occur immediately. B: A surgical revision is a complication management, not a standard post-op compliance adjunct. D: Surgeons typically place restrictions on lifting, and 10 lbs may exceed the specific restriction for a fusion patient in the early healing phase.

Answer 408

D. Bending or twisting motions of the spine ## Footnote The surgeon will likely place restrictions on active motion, specifically mentioning bending or twisting motions to protect the fusion site. Refutation: A: Proper body mechanics are emphasized and encouraged, not avoided. B: Ambulation and mobility are goals of early hospital-based therapy C: Core stabilization is an emphasized part of the rehab process, particularly once therapy progresses.

Answer 409

A. Reverse total shoulder arthroplasty ## Footnote A Reverse total shoulder arthroplasty is performed by reversing the concave-convex relationship of the prosthetic components and is used as the surgery of choice when the pt has a dysfunctional rotator cuff Refutation: B: Subacromial decompression is for impingement without a major tear or joint degeneration. C: Hemiarthroplasty replaces only one component and is typically not the primary choice for a patient with a dysfunctional rotator cuff. D: An anatomical TSA requires a functional rotator cuff to stabilize the joint; it would likely fail in a patient with a "dysfunctional" cuff.

Answer 410

A. Subscapularis ## Footnote The TSA and Reverse TSA usually involved an anterior approach in which the **subscapularis** muscle is detached for easier access to the joint

Answer 411

A. Hemiarthroplasty ## Footnote A shoulder hemiarthroplasty replaces only one of the components (usually the humeral head), whereas a total shoulder arthroplasty replaces both the glenoid and humeral components.

Answer 412

B. Degenerative joint components that have become arthritic ## Footnote TSA is often performed when joint components have become arthritic, though may also be done secondary to fracture or rotator cuff arthropathy Refutation: A: Tendonitis is managed conservatively or with minor debridement, not a total joint replacement. C: Partial-thickness tears are typically managed with debridement or repair, not arthroplasty. D: Instability without arthritis is typically managed with stabilization surgeries (capsular shift/labral repair), not joint replacement

Answer 413

D. Active Shoulder Extension and External Rotation ## Footnote Protocals vary widely after these surgies, but there likely will be some movement precautions for a short period of time (e.g., 6-8 weeks) - For Ex., the pt often **has to avoid Extension and ER to help protect the healing subscapularis muscle and anterior portion of the capsule. Resisted IR is also avoided for some time for the same reason**. Refutation: A: Passive internal rotation does not stretch the subscapularis; however, resisted internal rotation would be avoided. B: Distal AROM (elbow/wrist/hand) is generally encouraged to prevent stiffness and manage edema. C: Passive flexion is often allowed within specified limits early on.

Answer 414

B. The patient will be immobilized in a sling for several weeks or longer. ## Footnote If a repair was performed on muscles or tendons (such as the subscapularis), the patient will be immobilized in a sling for several weeks or longer to allow the tissue to heal. Refutation: A: Repairs require more protection time, not less. C: The "hand-shake" position is for posterior capsule stabilization, not standard TSA/subscapularis repairs. D: Weight-bearing is typically restricted, and a sling is standard post-op

Answer 415

C. Resisted Internal Rotation ## Footnote Resisted Internal Rotation is avoided for a period of time to protect the healing subscapularis muscle, which is detached and reattached during the anterior surgical approach Refutation: A & B: These are typically part of early ROM protocols (P/AAROM). D: Distal strengthening does not stress the shoulder's surgical site and is usually permitted

Answer 416

A. Release of the coracoacromial ligament ## Footnote Subacromial Decompression is preformed when cases of shoulder impingement have not responded to conservative treatment - The approach can be open (deltoid is detached), a mini open (deltoid is only split), or arthroscopic - **The procedure could involve an acromioplasty, bursectomy, removal of the distal clavicle (in cases where it is degenerated), and release of the coracoacromial ligament** Refutation: B: This describes a rotator cuff repair, not a decompression. C: This is more characteristic of a stabilization or labral surgery. D: This is a step used in a total shoulder arthroplasty (TSA) or open stabilization, not a standard decompression

Answer 417

C. The deltoid is only split to allow access ## Footnote Subacromial Decompression is preformed when cases of shoulder impingement have not responded to conservative treatment - The approach can be open (deltoid is detached), **a mini open (deltoid is only split)**, or arthroscopic Refutation: A: This is the definition of the "open" approach, not the "mini-open". B: Even in arthroscopic or mini-open procedures, the deltoid is at least penetrated or split. D: Muscle excision and replacement is not a standard part of this procedure

Answer 418

D. A 45-year-old office worker with shoulder impingement that has not gotten better after 5 months of therapy ## Footnote Subacromial Decompression is preformed when cases of shoulder impingement have not responded to conservative treatment Refutation: A: This patient requires a rotator cuff repair. B: This patient requires stabilization/labral repair. C: This patient is a candidate for a reverse total shoulder arthroplasty.

Answer 419

B. Wear the sling for 1–2 weeks for comfort and protection ## Footnote Typically pt experience a rapid recovery from this surgery. A sling will only be used for 1-2 weeks since no repair has been performed. Refutation: A: While recovery is rapid, a sling is usually provided for a short initial window. C: 6–8 weeks is the timeline for procedures involving a repair (like a TSA or Rotator Cuff repair). D: Abduction pillows are generally reserved for rotator cuff repairs to reduce tension on the graft

Answer 420

C. Passive Shoulder Extension ## Footnote Typically pt experience a rapid recovery from this surgery. A sling will only be used for 1-2 weeks since no repair has been performed. - Early rehab focuses on pain control and gentle ROM, with strength training occuring later in rehab - **If a deltoid repair was performed, passive extension is avoided initially to prevent stress on the repair site** Refutation: A: Internal rotation does not directly stress the deltoid repair site. B: Passive flexion is generally allowed and encouraged for early ROM. D: Distal active motion (elbow/wrist) is encouraged to prevent secondary stiffness

Answer 421

A. Strengthening the scapular upward rotators ## Footnote Treatment should focus on interventions to reduce the occurrence of impingement (e.g., posture, strengthening scapular upward rotators). A full recovery is typically expected

Answer 422

D. A rapid recovery with a full recovery typically expected ## Footnote Refutation: A: There are no long-term lifting restrictions associated with this procedure once healed. B: ROM begins early (initial phase) to prevent stiffness. C: Decompression is for impingement; it does not typically result in instability (unlike stabilization surgeries which treat it).

Answer 423

C. Large ## Footnote Rotator cuff tears are graded according to depth (partical vs full) and according to width (small < 1cm, medium 1-3 c, large 3-5 cm, massive > 5 cm)

Answer 424

A. Active-assisted range of motion (AAROM) ## Footnote Rehab protocols vary, but therapy usually consist of P/AAROM intially, with strengthening occuring later in the course of therapy Refutation: B: Strengthening (resisted exercise) occurs later in the course of therapy. C: Precautions generally include a strict "no lifting" policy for several weeks. D: Active stabilization/AROM is typically restricted in the earliest weeks to protect the repair

Answer 425

A. Passive shoulder extension ## Footnote Precautions generally include NO AROM, lifting, or weight bearing through the arm for several weeks. Depending on which muscle is repaired, there may be precautions set on ROM for rotation as well. **If a deltoid repair was preformed, passive extension is avoided initially to prevent stress on the repair site**

Answer 426

A. No active range of motion of the involved shoulder ## Footnote **Precautions generally include NO AROM, lifting, or weight bearing through the arm for several weeks**. Depending on which muscle is repaired, there may be precautions set on ROM for rotation as well. If a deltoid repair was preformed, passive extension is avoided initially to prevent stress on the repair site - The pt will be immobilized in a sling for several weeks, and the sling may have an Abduction pillow attached to it. Sling use is generally at the discretion of the surgeon and often depends on the extent of the tear/repair. Refutation: B: Passive range of motion (PROM) is generally the primary intervention in the first few weeks, not a restricted activity. C: Weight-bearing is strictly prohibited during the initial phase. D: Slings are typically required for several weeks post-operatively to ensure immobilization and protection of the repair

Answer 427

D. To reduce tension on the repaired tendons by preventing adduction ## Footnote The pt will be immobilized in a sling for several weeks, and the sling may have an Abduction pillow attached to it. Sling use is generally at the discretion of the surgeon and often depends on the extent of the tear/repair. Refutation: A: Resisted internal rotation is a strengthening exercise that occurs much later in the rehabilitation timeline. B: Weight-bearing and the use of the arm for transfers are contraindicated during this stage. C: While stiffness is a concern, the primary reason for the abduction pillow specifically is the protection of the repair site, not the prevention of capsular restrictions

Answer 428

A. Capsular shift ## Footnote The capsular shift procedure is performed in the presence of chronic shoulder instability. - The procedure involves tightening of the joint capsule by cutting the capsule and overlapping the ends to reduce capsular redundancy. The portion of the capsule that is tightened is dependent upon the direction of the instability - Since anterior instability is the most common form of shoulder instability, the anterior capsule is the portion that is most often tightened. Refutation: B: A SLAP repair addresses a tear of the superior labrum, not the redundancy of the capsule itself. C: A Bankart repair specifically targets a tear of the anterior labrum. D: Subacromial decompression is used for impingement syndrome, not for joint instability.

Answer 429

D. Subscapularis ## Footnote The capsular shift procedure is performed in the presence of chronic shoulder instability. - These procedures are generally performed arthroscopically, though can also be done as an open procedure. **If the procedure is open, then the subscapularis muscle may need to be detached**

Answer 430

A. Bankart repair ## Footnote A Bankart repair is defined specifically as the repair of the anterior labrum, which is frequently torn during anterior dislocation events. Refutation: B: A Bristow procedure is a different type of stabilization involving a coracoid transfer. C: A Mumford procedure involves distal clavicle resection, typically for AC joint issues. D: A SLAP repair involves the superior labrum where the long head of the biceps attaches

Answer 431

D. Posterior capsule involvement ## Footnote The type of immobilization used and the precautions will depend on the portion of the capsule that was affected. - **If the Posterior capsule was affected**, the pt would be immobilized in the “hand-shake” position with the shoulder in neutral rotation. The pt should avoid positions of IR, Flexion, and Horizontal ADD. AROM can begin soon after surgery. Therapist should not wait for full ROM before beginning strengthening exercises and should not be overly aggressive in getting full motion early Refutation: A: Anterior capsule involvement typically requires a standard sling, not a neutral "hand-shake" brace. B: A SLAP repair involves different movement precautions (avoiding biceps stress) but does not specifically dictate a "hand-shake" immobilization. C: Biceps tendinosis is a contractile tissue issue and is not the primary driver for specialized capsular immobilization

Answer 432

## Footnote - If the Anterior capsule was affected, then the pt will typically utilize a normal sling. **They should avoid positions of ER, Extension, and Horizontal ABD**. They should avoid resisted IR if the subscapularis was detached during the surgery Refutation: B: This combination of movements stresses the posterior capsule, not the anterior. C: Neutral rotation and distal limb mobility are generally safe and encouraged. D: Controlled elevation in the scapular plane is often part of early ROM, provided the specific rotational precautions are maintained

Answer 433

## Footnote - If a SLAP repair has been performed, the pt should avoid contracting or stretching of the bicep since the bicep is attached to the Superior labrum Refutation: B: Resisted training is typically delayed; specifically, resisted internal rotation is avoided early if the subscapularis was involved in an open approach. C: Therapists should not be overly aggressive in obtaining full range of motion early in stabilization rehab. D: The "hand-shake" brace is indicated for posterior capsule involvement, not specifically for SLAP repairs.

Answer 434

A. Resisted internal rotation ## Footnote - If the Anterior capsule was affected, then the pt will typically utilize a normal sling. They should avoid positions of ER, Extension, and Horizontal ABD. **They should avoid resisted IR if the subscapularis was detached during the surgery** Refutation: B: While external rotation is limited, passive motion within a restricted range is often allowed; however, resisted contraction of the detached muscle is a more direct contraindication. C: AAROM flexion is a standard early intervention for most shoulder surgeries. D: Distal mobility is encouraged to prevent secondary complications like stiffness or edema

Answer 435

A. Osteonecrosis ## Footnote Proximal Hip Fx commonly occur in the femoral neck or in the intertrochanteric region. **Femoral neck Fx’s are intracapsular and may lead to a disruption of the blood supply to the femoral head. Because of this, nonunion and osteonecrosis are more common with these Fx’s**. Refutation: B: Implant failure is a more significant concern for intertrochanteric (extracapsular) fractures because the fixation needed is greater. C: Intracapsular fractures occur within the joint capsule; while bleeding occurs, the primary clinical concern is the disruption of specific arterial supply to the bone. D: The Vastus Lateralis is a muscle that may be affected by the surgical approach, but it is not a direct complication risk of the fracture location itself

Answer 436

D. Implant failure is a significant risk due to the high fixation requirements ## Footnote Intertrochanteric hip Fx’s are extracapsular and therefore do not affect blood supply. Though nonunion is less of an issue, **implant failure is more of a problem with these Fx’s since the fixation needed is greater** Refutation: A: Blood supply is generally preserved in extracapsular fractures. B: Nonunion is actually less of an issue in this region compared to the femoral neck. C: This describes a subtrochanteric fracture, not an intertrochanteric one

Answer 437

D. Total Hip arthroplasty (THA) ## Footnote For older pts with poor healing capacity, THA is often considered. The surgery is always an open procedure. Depending on the approach, the TFL, Glute Med, and Vastus Lateralis may be affected. A Total Hip Arthroplasty (THA) is often considered over an ORIF to provide a more stable, immediate solution Refutation: A, B, C: These are forms of internal fixation. While commonly used for hip fractures, they carry a higher risk of failure or nonunion in patients with poor bone quality or intracapsular injuries

Answer 438

A. Gluteus Medius, TFL, and Vastus Lateralis ## Footnote For older pts with poor healing capacity, THA is often considered. The surgery is always an open procedure. **Depending on the approach, the TFL, Glute Med, and Vastus Lateralis may be affected**

Answer 439

A. Failure of the internal fixation ## Footnote **PTs should be aware of signs of fixation failure**, such as persistant thigh or groin pain, a leg length discrepancy that was not present initially, positioning of the limb in ER, or a trendelenburg sign that does not improve with strengthening

Answer 440

D. Iliopsoas ## Footnote Early rehab consists of ambulation and ROM. Isotonic strengthening is usually postponed until the muscles have been given a chance to heal. The muscles affected depend not only on the surgical approach, but also on the site of the Fx. - For Ex., Fx’s of the greater trochanter will affect the gluteus medius, while **Fx’s of the less trochanter will affect the Iliopsoas**

Answer 441

A. Ambulation and range of motion exercises ## Footnote **Early rehab consists of ambulation and ROM**. Isotonic strengthening is usually postponed until the muscles have been given a chance to heal. The muscles affected depend not only on the surgical approach, but also on the site of the Fx.

Answer 442

D. Osteochondral autograft transplantation ## Footnote There are several different options for fixing focal cartilage defects. The microfracture procedure uses an awl to penetrate subchondral bone, which causes an ingrowth of fibrocartilage - Osteochondral autograft transplantation is a procedure in which cartilage is harvested from several non-weight bearing surfaces to form a plug that can fill the chondral defect Refutation: A: This involves harvesting cells, culturing them in a lab, and then re-implanting them in a second procedure. B: Microfracture involves poking holes in the bone to stimulate a blood clot/fibrocartilage, not transferring a plug of tissue. C: Debridement is the removal of damaged tissue/debris, not a transplantation of healthy tissue

Answer 443

A. Fibrocartilage ## Footnote There are several different options for fixing focal cartilage defects. The microfracture procedure uses an awl to penetrate subchondral bone, which causes an ingrowth of fibrocartilage

Answer 444

A. Autologous chondrocyte implantation ## Footnote Autologous chondrocyte implantation is a procedure in which healthy cartilage is harvested and cultured so it will grow, then later implanted into cartilage defect Refutation: B: Allografts use tissue from a cadaver donor, not the patient’s own cultured cells. C & D: Both are marrow-stimulating techniques that do not involve harvesting or culturing cells outside the body

Answer 445

A. Superior graft fixation due to bone-to-bone healing ## Footnote The use of an autograft is preferred over allograft. A bone-patellar tendon-bone graft is considered the GOLD STANDARD. Because **uses bone-bone healing, it is considered a stronger graft with good fixation** Refutation: B: BPTB grafts are actually associated with a higher risk of anterior knee pain. C: Graft maturation at 100% typically occurs between 12-16 months, not 6 months. D: BPTB utilizes bone-to-bone healing, whereas gracilis or semitendinosus grafts utilize tendon-to-bone healing

Answer 446

A. An autograft is preferred over an allograft and the procedure is generally arthroscopic. ## Footnote ACL Reconstruction is performed on pts with an ACL tear that is causing pain and/or instability. **This surgery is generally performed arthroscopically**. - **The use of an autograft is preferred over allograft**. A bone-patellar tendon-bone graft is considered the GOLD STANDARD. Because uses bone-bone healing, it is considered a stronger graft with good fixation

Answer 447

D. The patient demonstrates good quadriceps control ## Footnote Rehab protocols will vary widely, but there generally is some period of immobilization in a hinge brace (initially locked in extension) in addition to weight bearing restrictions. **The brace usually is unlocked once the pt can demonstrate good Quad control**

Answer 448

A. Exercise caution with quadriceps strengthening due to the risk of anterior knee pain. ## Footnote - **Pts receiving a bone-patellar tendon-bone graft may experience anterior knee pain and should be cautious with quad strengthening**. Likewise those receiving hamstring grafts should be cautious with flexion exercises Refutation: B: Hamstring strengthening is explicitly recommended to occur soon after surgery. C: Open-chain exercises between 0–45° of flexion should be avoided as they place excessive stress on the graft. D: Protocols emphasize achieving full knee extension early in the rehab process, not maintaining flexion

Answer 449

D. The graft is currently at its most vulnerable state as it transforms into ligamentous tissue ## Footnote **It is important for the PT to remember that the graft tissue is most vulnerable at 6-8 weeks after surgery. As the tendon transforms into ligamentous tissue, it actually becomes weaker before it gets stronger**. - Failure of the graft site generally happens around the time secondary to poor compliance with the protocol - Graft maturation has been shown to be at 100% around 12-16 months post-op, however, most protocols allow for return to sport closer to 6 months Refutation: A: Return to sport is typically allowed closer to 6 months, not 7 weeks. B: Graft maturation is not at 100% until 12–16 months post-op. C: Graft failure is generally attributed to poor compliance with the protocol, not the use of closed-chain exercises (which are recommended).

Answer 450

B. 12–16 months post-operatively ## Footnote - Graft maturation has been shown to be at 100% around 12-16 months post-op, however, most protocols allow for return to sport closer to 6 months

Answer 451

A. Exercise caution when performing knee flexion exercises. ## Footnote Pts receiving a bone-patellar tendon-bone graft may experience anterior knee pain and should be cautious with quad strengthening. **Likewise those receiving hamstring grafts should be cautious with flexion exercises** Refutation: B: Caution with quadriceps strengthening due to anterior knee pain is a precaution specific to the bone-patellar tendon-bone graft. C: Closed-chain exercises can occur soon after surgery. D: Full knee extension should be emphasized early in the rehab process for all ACL reconstructions

Answer 452

A. No pain or effusion, full ROM, no instability, and quad strength at 88% of the opposite leg. ## Footnote RTS Criteria for ACL: - No Pain or effusion - Full ROM - No Instability - Quad Strength that is 85-90% of the opposite leg - Hamstring strength that is 90-100% of the opposite leg - Functional testing (e.g., Single leg hop) that is 85-90% of the opposite leg Refutation: B: Hamstring strength must be 90–100% of the opposite leg; 85% is insufficient. C: Hamstring strength must be 90–100% of the opposite leg; 80% is insufficient. D: Functional testing (e.g., single-leg hop) must be 85–90% of the opposite leg; 80% is insufficient

Answer 453

D. Hamstring strength that is 82% of the opposite leg ## Footnote RTS Criteria for ACL: - No Pain or effusion - Full ROM - No Instability - Quad Strength that is 85-90% of the opposite leg - Hamstring strength that is 90-100% of the opposite leg - Functional testing (e.g., Single leg hop) that is 85-90% of the opposite leg A score of 82% does not meet this threshold.

Answer 454

A. Quadriceps strength that is 87% of the opposite leg. ## Footnote Quadriceps strength should be 85–90% of the opposite leg. 87% falls within this acceptable range. RTS Criteria for ACL: - No Pain or effusion - Full ROM - No Instability - Quad Strength that is 85-90% of the opposite leg - Hamstring strength that is 90-100% of the opposite leg - Functional testing (e.g., Single leg hop) that is 85-90% of the opposite leg Refutation: B: Hamstring strength must be higher (90–100%). C: Functional testing must be higher (85–90%). D: The criteria specifically require "Full ROM," not just a percentage or a range close to the other side

Answer 455

D. Hamstring strength 90% and functional testing 85% of the opposite leg ## Footnote RTS Criteria for ACL: - No Pain or effusion - Full ROM - No Instability - Quad Strength that is 85-90% of the opposite leg - Hamstring strength that is 90-100% of the opposite leg - Functional testing (e.g., Single leg hop) that is 85-90% of the opposite leg Refutation: A: 85% hamstring strength is below the 90% minimum. B: 80% functional testing is below the 85% minimum. C: 80% hamstring strength is below the 90% minimum

Answer 456

A. Referral for PCL reconstruction surgery. ## Footnote If the PCL injury occurs in isolation, surgery may not be needed. **Surgery is indicated if pain and/or instability do not improve with therapy**. - Options for grafts are similar to those for ACL

Answer 457

A. The progression with weight bearing and exercises tends to be more gradual. ## Footnote In general, the rehab protocol is the same as the ACL surgery. **However, the progression with weight bearing and the exercises tend to be more gradual** - The PT should choose exercises that will not limit posterior shear forces within the knee. Repetitive knee flexion shoul be avoided Refutation: B: This contradicts the card, which specifies that the progression is more gradual, not accelerated. C: Repetitive knee flexion should be avoided. D: Weight-bearing progression is one of the elements that is more gradual compared to the ACL surgery

Answer 458

D. Repetitive knee flexion ## Footnote In general, the rehab protocol is the same as the ACL surgery. However, the progression with weight bearing and the exercises tend to be more gradual - The PT should choose exercises that will not limit posterior shear forces within the knee. **Repetitive knee flexion should be avoided**

Answer 459

A. A partial meniscectomy in which the torn piece of the meniscus is removed. ## Footnote Meniscus surgery is generally performed arthroscopically. They can be done in 2 ways - The first way is a Partial Menisectomy in which the torn piece of meniscus is removed. **This option is usually chosen for older individuals or when the tear occurs in the inner two-thirds of the meniscus where the healing capacity is poor**

Answer 460

D. An arthroscopic approach to perform a repair of the meniscus ## Footnote This surgery is generally performed **arthroscopically**. They can be done in 2 ways - The first way is a Partial Menisectomy in which the torn piece of meniscus is removed. This option is usually chosen for older individuals or when the tear occurs in the inner two-thirds of the meniscus where the healing capacity is poor - **The other way is to perform a repair of the meniscus in which the tear is sutured back together. This option is more likely to be chosen in younger pts or when the tear is in the outer third of the meniscus**

Answer 461

A. The tear is located in the inner two-thirds of the meniscus. ## Footnote This surgery is generally performed arthroscopically. They can be done in 2 ways - The first way is a Partial Menisectomy in which the torn piece of meniscus is removed. **This option is usually chosen for older individuals or when the tear occurs in the inner two-thirds of the meniscus where the healing capacity is poor** - The other way is to perform a repair of the meniscus in which the tear is sutured back together. This option is more likely to be chosen in younger pts or when the tear is in the outer third of the meniscus

Answer 462

A. Progression of knee flexion range of motion. ## Footnote The rehab protocol will depend on whether or not the meniscus was repaired. Following a Meniscus repair, there will likely be a period of restricted weight bearing in addition to bracing. **There will also likely be limitations placed on the progression of ROM, specifically with flexion**

Answer 463

A. A complete tear of the anterior talofibular ligament (ATFL) or calcaneofibular ligament (CFL). ## Footnote Repair of the lateral ankle ligaments is commonly performed secondary to a complete tear of the ATFL or CFL or secondary to chronic ankle instability. - There are 2 methods for reconstructing the ankle, both of which use an open approach.

Answer 464

B. The fibularis brevis is often harvested or moved to provide stability. ## Footnote There are 2 methods for reconstructing the ankle, both of which use an open approach. - The first method, involves actual repair of the torn ligaments in which they are sutured back together. - The second method, involves the harvesting of an autograft (usually the fibularis brevis) to replace the torn ligaments. Refutation: A: This question is discussing ligament reconstruction, not a total joint arthroplasty (replacement). C: Patellar tendon grafts are discussed for ACL reconstruction, not lateral ankle reconstruction.

Answer 465

A. A protective cast with a period of non-weight bearing. ## Footnote The pt will usually be in a protective cast for a short period of time (e.g., one week), then they are placed in a walking cast or boot for several weeks, followed by a brace. - **Initially the pt is non-weight bearing while in the protective cast**, which is progressed to partial weight bearing and full weight bearing once in the walking boot

Answer 466

C. Ankle inversion ## Footnote Therapy should include precautions for inversion, as this movement tensions the newly repaired or reconstructed lateral ligaments (ATFL/CFL).

Answer 467

A. Augmenting the primary repair with a graft from the plantaris or another tendon. ## Footnote When the repair is delayed after the injury, the surgery may need to be performed as an open procedure. Additionally, augmentation with use of a graft (e.g., Flexor Hallucis Longus, Fibularis Brevis, Plantaris) may be needed for the repair instead of suturing together the origional tendon

Answer 468

A. The patient’s high activity level and the nature of the complete rupture. ## Footnote Achilles Tendon Repair is performed on active pts with an Achilles tendon tear.

Answer 469

A. Casted or braced in slight plantarflexion and non-weight bearing. ## Footnote The pts will likely be casted with the ankle in slight plantar flexion initially. - Additionally, the pt may be non-weight bearing for the first several weeks. Eventually, the pt is transitioned to a cast or boot that places the ankle in neutral and they are allowed to be partial weight bearing Refutation: B: The ankle is positioned in plantarflexion, not dorsiflexion, to avoid tensioning the repair. C: Immediate full weight bearing is not the standard; the patient starts as non-weight bearing

Answer 470

C. Transition to a walking boot or brace that is set to a neutral position. ## Footnote The pts will likely be casted with the ankle in slight plantar flexion initially. - Additionally, the pt may be non-weight bearing for the first several weeks. **Eventually, the pt is transitioned to a cast or boot that places the ankle in neutral and they are allowed to be partial weight bearing**

Answer 471

D. Exercising caution when performing any stretching of the involved tendon ## Footnote During the healing process, **the therapist should take caution with exercises that stretches the Achilles tendon or require active plantar flexion until the tendon is well healed**

Answer 472

D. To reduce the tension placed on the healing surgical repair ## Footnote Placing the ankle in slight plantarflexion (shortening the tendon) reduces the tension on the newly sutured Achilles tendon, protecting it during the initial healing phase

Answer 473

B. Avulsion fracture ## Footnote An Avulsion Fracture is a portion of the bone becomes fragmented at the site of the tendon due to a traumatic and sudden stretch of the tendon Refutation: A is incorrect because a comminuted fracture involves the bone breaking into fragments at the site of injury, not necessarily involving a tendon pull. C is incorrect because a spiral fracture is "S" shaped due to torsion or twisting. D is incorrect because a compound fracture involves the bone protruding through the skin

Answer 474

A. Closed fracture ## Footnote A Closed Fractures is defined as a break in the bone where the skin over the site remains intact Refutation: B is incorrect because a compound fracture involves a break where the bone protrudes through the skin. C is incorrect because a greenstick fracture is a specific break on one side of the bone (common in children). D is incorrect because a non-union fracture refers to a failure to heal after a specific timeframe (9-12 months).

Answer 475

C. Comminuted fracture ## Footnote A comminuted fracture is characterized by a bone that breaks into fragments at the site of the injury Refutation: A is incorrect because a stress fracture is caused by repeated forces. B is incorrect because a spiral fracture is caused by torsion and is "S" shaped. D is incorrect because an avulsion fracture is a fragment pulled away by a tendon

Answer 476

B. Compound fracture ## Footnote A compound fracture is a break in a bone that protrudes through the skin. Refutation: A is incorrect because the skin is not intact. C is incorrect because fragmentation is not the primary defining feature described (the skin breach is). D is incorrect because greenstick fractures do not typically protrude through the skin and involve an intact periosteum on one side.

Answer 477

A. Greenstick fracture ## Footnote A greenstick fracture is a break on one side of a bone that does not damage the periosteum on the opposite side. It is frequently seen in children. Refutation: B is incorrect because a stress fracture is due to repeated forces. C is incorrect because a spiral fracture involves torsion/twisting. D is incorrect because non-union is a healing failure, not a description of the break pattern

Answer 478

B. Non-union fracture ## Footnote A non-union fracture is a break in a bone that has failed to unite and heal after 9-12 months. Refutation: A is incorrect because "closed" describes the state of the skin, not the healing status. C is incorrect because "stress" describes the mechanism of injury (repeated force). D is incorrect because "comminuted" describes the fragmentation of the bone at the time of injury

Answer 479

C. Stress fracture ## Footnote A stress fracture is a break in a bone due to repeated forces to a particular portion of the bone. Refutation: A is incorrect because an avulsion fracture is caused by a sudden, traumatic tendon stretch, not repeated forces. B is incorrect because a spiral fracture is caused by torsion/twisting. D is incorrect because a greenstick fracture is a partial break typically seen in children

Answer 480

B. Spiral fracture ## Footnote A spiral fracture is a break in a bone shaped like an "S" due to torsion and twisting. Refutation: A is incorrect because comminuted fractures involve multiple fragments, not necessarily an "S" shape. C is incorrect because a compound fracture refers to the bone protruding through the skin. D is incorrect because an avulsion fracture is caused by a tendon pulling a fragment away

Answer 481

A. To slow or halt the progression of rheumatic disease ## Footnote These slow or halt the progression of rheumatic disease. - They are used early during the disease process to slow the progression prior to widespread damage of the affected joints - They act to induce remission by modifying the pathology and inhibiting the immune response responsible for rheumatic disease

Answer 482

D. DMARDs inhibit the immune response responsible for rheumatic disease ## Footnote These slow or halt the progression of rheumatic disease. - They are used early during the disease process to slow the progression prior to widespread damage of the affected joints - **They act to induce remission by modifying the pathology and inhibiting the immune response responsible for rheumatic disease**

Answer 483

A. Disease-Modifying Antirheumatic Agents ## Footnote The primary indication for DMARDs is rheumatic disease, with a preference for use during early treatment to maximize the modification of the disease process Refutation: B is incorrect; while glucocorticoids treat rheumatic disorders, they are often used for anti-inflammatory effects or replacement therapy rather than primary disease modification. C and D are incorrect as these manage pain but do not treat the underlying rheumatic pathology

Answer 484

D. During the early stages of the rheumatic disease process ## Footnote DMARDs are preferably used during early treatment to slow progression prior to widespread damage of the affected joints

Answer 485

A. High incidence of toxicity ## Footnote PTs should recognize that many DMARD agents have a high incidence of toxicity, requiring careful monitoring of the patient's systemic health Refutation: B is incorrect because muscle atrophy and osteoporosis are implications for glucocorticoids. C is incorrect because masked pain is an implication for non-opioid agents. D is incorrect because respiratory depression is an implication for opioid agents

Answer 486

A. Vasoconstriction resulting from stabilizing lysosomal membranes ## Footnote Glucocorticoids reduce inflammation through several reactions, including stabilizing lysosomal membranes which leads to vasoconstriction Refutation: B is incorrect because glucocorticoids enhance the effects of catecholamines rather than inhibiting them. C is incorrect because glucocorticoids (and NSAIDs) generally inhibit, rather than stimulate, the inflammatory prostaglandin pathways. D is incorrect as this is not the mechanism for glucocorticoids; inhibiting the immune response is the role of DMARDs

Answer 487

A. Suppression of articular and systemic disease ## Footnote Glucocorticoids (Corticosteroids) provide hormonal, anti-inflammatory, and metabolic effects including suppression of articular and systemic disease. - These agents reduce inflammation in chronic condition that can damage healthy tissue through a series of reactions. Vasoconstriction results from stabilizing lysosomal membranes and enhancing the effects of catecholamines

Answer 488

A. Replacement therapy for endocrine dysfunction ## Footnote Indications for Glucocorticoid Agents include, replacement therapy for endocrine dysfunction, anti-inflammatory and immunosuppressive effects; treatment of rheumatic, respiratory, and various other disorders

Answer 489

A. Wear a mask during the session due to the patient's weakened immune system ## Footnote **A therapist must wear a mask when working with patients on glucocorticoid therapy since their immune system is weakened**. - A therapist must be aware of signs of toxicity including moon face, buffalo hump, and personality changes. Pts are at risk for osteoporosis and muscle wasting - Treatment of an injected joint will require special care due to ligament and tendon laxity or weakening

Answer 490

D. Glucocorticoid toxicity

MSK Flashcards

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