Deck 14 Flashcards
58M presents to PT with c/o mod anterior and lateral hip pain during WB activities. Additionally he describes a morning stiffness that lasts roughly 40 minutes, improving with mat during his morning routine. Objective exam reveals PROM IR 20˚ on involved side with pain and 25˚ on uninvolved side, PROM 110˚ on involved side and 125˚ on uninvolved side. UA to extend hips past neutral B.
Based off the above info and in accordance with published CPG, which outcome measure would NOT be useful to track functional progress for this pt?
A. WOMAC
B. Hip disability and Osteoarthritis Outcome Score (HOOS)
C. Harris Hip Score (HHS)
D. Copenhagen Hip and Groin Outcome Score (HAGOS)
D. Copenhagen Hip and Groin Outcome Score (HAGOS)
58M presents to PT with c/o mod anterior and lateral hip pain during WB activities. Additionally he describes a morning stiffness that lasts roughly 40 minutes, improving with mat during his morning routine. Objective exam reveals PROM IR 20˚ on involved side with pain and 25˚ on uninvolved side, PROM 110˚ on involved side and 125˚ on uninvolved side. UA to extend hips past neutral B.
Which intervention has the best evidence in tx of mod hip OA for the above pt?
A. Long axis thrust manipulation and passive stretching into extension
B. Gait and balance training
C. Individualized prescription of therapeutic activities based on the pt’s needs (STS, step-ups, etc)
D. US and weight loss
A. Long axis thrust manipulation and passive stretching into extension
16F competitive swimmer with generalized R shoulder pain. No MOI but states pain has been present over the past year but has recently gotten worse as the vigor of her training has ramped up. Pt c/o pain when swimming freestyle and with OH movements during ADLs. The pt is RHD with no signifiant PMH.
Observation: mod FHP, R shoulder slightly lower than L
ROM: WNL UE/cervical
Strength: LUE 5/5 grossly, RUE 4/5* with ER, flex, abd, 4/5 with scap retraction
Sensation: intact and B symmetrical to light touch to both UEs
Palpation: ttp noted over R infraspinatus/teres minor mm bellies
Special tests: (-) crossbody adduction | (-) Empty can | (-) drop arm | (+) HK | (+) sulcus | (-) apprehension but painful | (+) relocation test for pain reduction
What is the best description of this pt’s primary dx?
A. Primary shoulder impingement
B. MDI
C. Secondary shoulder impingement
D. Scapular dyskinesia
C. Secondary shoulder impingement
24 yo recreational runner c/o buttock pain around the ischial tuberosity when running, especially uphill. After a few minutes of running symptoms generally improve, but persist following the run Additionally, sx worse with deep squat, lunging, and prolonged sitting i.e. driving and sitting on hard chairs. No sx with standing, lying, slow walking on a level surface.
Objectively the pt has (-) sacral thrust/thigh thrust/compression/distraction tests. Slight buttock pain with full lumbar flexion but no pain in lumbar flexion when knees are bent. (-) SLR/slump. Pt reported 2/10 pain with SL bridging and 3/10 pain during a SLDL/arabesque that subsides after completion.
What is a gait modification that may be introduced to reduce her symptoms while running?
A. Inc fwd trunk lean
B. Inc anterior pelvic tilt
C. Inc cadence
D. Inc stride length
C. Inc cadence
48M with hx of chronic episodic LBP referred for PT eval and tx by physician. The pt describes his pain as an “unrelenting, boring pain” that is constant regardless of movement or posture changes. It does vary with time of day Additionally, over the previous 3 weeks he noted inc difficulty getting comfortable in bed and more frequent awakening at night 2/2 LBP. ROS revealed no c/o recent wt loss, fever, chills, sweats, nausea, fatigue, dyspnea, cardiac dysfunction, no changes with b/b function, no personal hx of CA. He reports a 12 pack-years of cigarette smoking and hx of atherosclerotic disease. Leisure activities include jogging, water skiing, walking his dog.
Given the info provided from the pt hx, what sinister pathology must be ruled out?
A. Prostate metastatic cancer
B. Abdominal aortic aneurysm
C. Renal/urinary tract disorder
D. Osteomyelitis
B. Abdominal aortic aneurysm
50F with 3 mo hx of shoulder pain. C/o sharp pain when reaching OH and across her body to fasten her seatbelt. Objectively she has painful arc from 70-120˚ and inc pain with OP into flexion at 180˚. Upon evaluation, you decide to perform a PA HVLA thrust to upper, middle, and lower thoracic spine. Immediately following, you re-test shoulder flex and her painful arc has fully resolved with less pain into OP at 180˚.
Which is true regarding the immediate effect of thoracic SMT on shoulder pain in individuals with shoulder pain?
A. Inc RTC cross-sectional area
B. Change in thoracic kinematics
C. Inc LT strength
D. Altered scapular kinematics
C. Inc LT strength
Pt is an obese warehouse employee who has worked manual labor for the past 20 yrs. He is convinced his job of working with a forklift, and getting on/off the floor as well as loading through his back has resulted in disc degeneration seen on his recent spinal imaging. According to the best available evidence, the factor that is most likely to contribute to the development of disc degeneration is?
A. Vibration loading (forklift)
B. Genetics
C. Repeated spinal loading
D. Obesity
B. Genetics
Pt presents to PT with c/o 1 mo hx of LBP. Sx occurred immediately after picking up her 20# puppy and were described as sharp with certain movements. Sx have improved after approximately 1-2 weeks and are now stable and rated as 3-4/10 at worst. Back pain is primarily reproduced with fwd flex (while bending fwd and when returning upright), car txfrs, and lifting.
Based on the updated lumbar tx based classification system, this pt can be classified into what specific rehabilitation management category.
A. Symptom modulation
B. Movement control
C. Functional optimization
D. Specific exercise
B. Movement control
41 yo obese female who recently started jogging in an attempt to lower her weight. Prefers outdoor running on pavement and runs in flexible shoes, Nike Frees, that are comfortable on her feet while walking at work. Her primary complaint is medial ankle and heel pain that started roughly 1 mo prior.
Gait eval reveals excessive pronation. She has tenderness to palpation/tapping posterior to medial malleolus. Sensory exam reveals sensory loss to medial heel. Neurodynamic assessment reveals pain with slump test when foot is maximally DF/ev, otherwise symptom free in a pure sagittal plane testing position.
Based on the above info, what dx most accurately explains her symptoms?
A. S1 radiculopathy
B. Posterior tibialis tendinopathy
C. TTS
D. Plantar fasciitis
C. TTS
Which is NOT considered a poor prognostic indicator for pelvic girdle pain in the antepartum population?
A. Inc lumbar lordosis
B. Prior hx of pregnancy
C. Belief their prognosis will not improve with therapy
D. Inc BMI
A. Inc lumbar lordosis
What does HAGOS stand for?
Copenhagen Hip and Groin Outcome Score
HAGOS is an outcome score recommended for pts with
non-arthritic hip pain
level of evidence for hip OA: manual therapy
A
level of evidence for hip OA: exercise (strengthening/flexibility)
A
level of evidence for hip OA: gait/balance/functional activities
C
level of evidence for hip OA: weight loss
C