Deck 15 Flashcards
If the ulnar nerve is cut at the elbow, which of the following would be numb?
A. Ulnar forearm, small and ring fingers
B. Only the ulnar forearm
C. Only the small and ring fingers
D. None of the above
C. Only the small and ring fingers
45M body builder who presents 2 days s/p acute injury to UE/elbow. Injury occurred while performing preacher curls with heavy resistance. Reports a pop sensation during the eccentric phase of elbow flexion strengthening followed by acute weakness and mod bruising in the antecubital fossa. You are concerned for distal biceps rupture, esp given his hx of anabolic steroid use
What special test is most useful for ruling in a distal biceps rupture?
A. Popeye sign
B. Hook test
C. Biceps squeeze test
D. Speeds test
B. Hook test
Woman with 15 yr hx of RA was referred for therapy after whiplash injury during an MVA. D/t new c/o intermittent tingling sensations in B hands, you decide to screen for upper cervical instability using a Sharp Purser test. Which example below is the correct performance of the test with a positive response?
A. Gently flex neck, stabilize C2 with pinch grip and translate occiput/axis posteriorly; pt reports a reduction of distal complaints
B. Gently flex neck, stabilize occiput/axis and translate C2 anteriorly using a pinch grip; pt reports reduction in distal complaints
C. Gently flex neck, stabilize C2 with pinch grip and translate occiput/axis posteriorly; pt reports exacerbation of distal complaints
D. Gently flex neck, stabilize occiput/axis and translate C2 anteriorly using a pinch grip; pt reports exacerbation of distal complaints
A. Gently flex neck, stabilize C2 with pinch grip and translate occiput/axis posteriorly; pt reports a reduction of distal complaints
46F factory worker reports chronic R plantar heel pain over the past 4 mos. Describes a sharp pain with 1st initial steps in the morning that slowly improve over the first waking hour. She reports beginning yoga around 5 mos ago and thinks it may have caused her foot pain. Sx are exacerbated with WB after immobilization and worsen after standing on the factory floor as her day goes on. Pt has BMI of 31. Her ankle MMT is 5/5 all planes. DF ROM is 4˚ on R and 6˚ on L. With trial tx of anti-pronation taping, pt reports a moderate reduction of pain during ambulation
Which of the following is not a risk factor in the development of heel pain?
A. WB activity at work
B. Reduced DF ROM
C. Elevated BMI
D. Recent change in activity with addition of yoga
D. Recent change in activity with addition of yoga
46F factory worker reports chronic R plantar heel pain over the past 4 mos. Describes a sharp pain with 1st initial steps in the morning that slowly improve over the first waking hour. She reports beginning yoga around 5 mos ago and thinks it may have caused her foot pain. Sx are exacerbated with WB after immobilization and worsen after standing on the factory floor as her day goes on. Pt has BMI of 31. Her ankle MMT is 5/5 all planes. DF ROM is 4˚ on R and 6˚ on L. With trial tx of anti-pronation taping, pt reports a moderate reduction of pain during ambulation
What treatment is recommended for chronic plantar fasciitis?
A. Short term use of night splint
B. Custom foot orthoses
C. Rocker bottom shoe prescription
D. Intrinsic foot strengthening and referral out for nutrition and weight loss counseling
B. Custom foot orthoses
34F presents to clinic with c/o acute buttock pain. Her injury occurred 21 days prior when she was sledding with her young daughter sitting on her lap. While sledding, she fell off hitting her tailbone against a tree root sticking out of the ground. Pt initially presented to an ortho urgent care and obtained standard radiographs and MRI, which failed to show any abnormalities. Sx have improved considerably since the injury, but she still has a moderate pain with sitting on firm surfaces, sexual intercourse, bowel movements, and performing quick transitional movements.
Based on current evidence, all of the following interventions would be recommended except
A. Coccyx mobilizations
B. Education of passive coping strategies including sitting on towel donut
C. Pelvic floor muscle re-education
D. Coccygeal nerve mobilizations
D. Coccygeal nerve mobilizations
48F referred for acute LBP and R buttock pain. Sx began abruptly 6 days ago when picking her cat off the floor. You observe the pt sitting uncomfortably in the waiting room, shifted primarily onto her L buttock. When ambulating back to the tx room, you notice an antalgic gait pattern characterized by a reduced step length on the R. Reports constant 3-4 ache at rest with intermittent 8/10 sudden back/buttock pain during transitional movements, coughing, sneezing, and fwd flexion. When sitting > 10 mins, sx progressively increase in her back/buttock. She reports improvement in sx with standing, lying down, with activity, and generally improves when the day goes on with worst pain first thing in the morning.
Lumbar ROM: 20% flex w/ LBP and buttock pain | unchanged lumbar pain, reduced buttock pain with extension | R SB 75%, inc back and buttock pain | L SB 100%, inc back and buttock pain
Hip ROM: 120˚ flex | 10˚ ext | 45˚ ER | 20˚ IR L, 38˚ IR R
Neuro: dermatomes, myotomes, DTRs WNL
Accessory mobility: hypo and painful L4,5
Special tests: SLR approximately 45˚ with reproduction of primary complaint
Based off the above info, what intervention is most appropriate?
A. Lumbar HVLAT and mobility exercise
B. Repeated movements in attempt to centralize sx and avoidance of sitting
C. Advice to remain active and sub-threshold sciatic nerve slider exercises
D. Initiate a walking program with graded exposure toward sitting
B. Repeated movements in attempt to centralize sx and avoidance of sitting
Approximately 6 mos ago while playing dodgeball in a middle school gym class, Suzie experienced a patellar dislocation. Describes MOI that she was in a flexed position of the knee with valgus/IR on a planted foot. Since her original dislocation she has experienced 2 recurrent dislocations and has a general sense of apprehension/instability. She was recommended surgical intervention from an ortho surgeon d/t underlying anatomical risk factors, but presents to your clinic alongside her mother for consultation regarding nonoperative options for recurrent instability.
Which of the below anatomic variants is LEAST likely predisposing factor for her recurrent instability
A. Trochlear dysplasia B. Lateralization of the tibial tuberosity C. 22˚ lateral patellar tilt D. Patella alta E. 18˚ Q angle
E. 18˚ Q angle
38M referred from primary care. Describes a 3 week hx of gradual onset intermittent L groin pain with occasional referral into anterior thigh and buttocks. Pain described as deep and throbbing and ranges from 2-8/10. Lists ortho hx of CAI and patellar dislocation as well as medical hx of asthma which as been treated successfully with corticosteroids. No hx of tobacco use, social alcohol consumer. Pt is now quite concerned bc he is beginning to experience the same symptoms to a lesser degree on the CL side. Pt amb with antalgic gait pattern characterized by reduced step length.
R hip PROM: flex 110˚ | ext 15˚ | IR 35˚
L hip PROM: flex 85˚* and LE drifts into ER/abd | ext 0˚* | IR 10˚*
FADIR/FABER tests deferred d/t strong pain with single plane movement testing, esp IR
Given the above info, you elected to proceed with GIII LAD mobilizations to the L hip joint using a mobilization belt. Several bouts of 30 seconds were performed resulting in immediate improvements in gait, but results quickly dissipated after 2-3 mins and antalgic pattern resumed.
Based on the above info, what is the best course of action in proceeding with this pt?
A. Lumbar spine evaluation
B. Soft tissue based interventions for lateral hip musculature
C. Referral back to PCP
D. Lumbar spine manipulation and neurodynamic exercises
E. Lateral glide hip joint mobs and hip AROM exercises
C. Referral back to PCP
After calling your 2:30PM pt back to your exam room for initial evaluation, you recognize a unique gait pattern. When ambulating you observe unusually high levels of hip flex on his involved side in order to clear the foot during swing phase. What dx is c/w the above gait pattern?
A. L4 radiculopathy B. S1 radiculopathy C. Superficial fibular nerve injury D. Deep fibular nerve injury E. Both A and D
E. Both A and D
The ulnar nerve (does/does not) provide sensation to the medial forearm
does not
What nerve provides sensation to the medial forearm?
medial antebrachial cutaneous nerve (C8-T1)
C8-T1 supply the medial antebrachial cutaneous nerve via
medial cord of the brachial plexus
The Hook test has a sensitivity and specificity of
1
The Hook test is a test for
distal biceps rupture
How long should night splints be trialed for the treatment of plantar fasciitis?
1-3 mos
Clinicians should use foot orthoses, either prefabricated or custom, to support the medial longitudinal arch and cushion the heel in pts with heel pain/plantar fasciitis to reduce pain and improve function for (timeframe)
short (2 weeks) to long term (1 year)
Clinicians should use foot orthoses, either prefabricated or custom, to support the medial longitudinal arch and cushion the heel in pts with heel pain/plantar fasciitis to reduce pain and improve function for short (2 weeks) or long term (1 year) in individuals who respond positively to
anti-pronation taping techniques.
Level A evidence
