Deck 20 Flashcards
A 59-year-old female presents in physical therapy with left shoulder pain that started several years ago. She states that it “ebbs and flows” based on what activities she partakes in. She is an active individual and plays pickle ball and golf, and also gardens for a hobby. She states the shoulder gets sore after these activities and increases to a 6/10 pain level, when normal baseline is 1/10. The pain is located in the anterior region of the shoulder with some radiation to the mid deltoid region. Upon examination, the physical therapist notes poor scapulohumeral rhythm, forward head posture, rounded shoulders, a negative load-and-shift test, a positive internal rotation resisted test, and a positive Hawkins–Kennedy test. Radiographs reveal a “flat acromion” but no other significant findings. Based on this patient’s presentation and radiology findings, which morphologic type of acromion does this patient have?
A. Type I
B. Type II
C. Type III
D. Type IV
A. Type I
A 59-year-old female presents in physical therapy with left shoulder pain that started several years ago. She states that it “ebbs and flows” based on what activities she partakes in. She is an active individual and plays pickle ball and golf, and also gardens for a hobby. She states the shoulder gets sore after these activities and increases to a 6/10 pain level, when normal baseline is 1/10. The pain is located in the anterior region of the shoulder with some radiation to the mid deltoid region. Upon examination, the physical therapist notes poor scapulohumeral rhythm, forward head posture, rounded shoulders, a negative load-and-shift test, a positive internal rotation resisted test, and a positive Hawkins–Kennedy test. Radiographs reveal a “flat acromion” but no other significant findings. Where on the Neer classification system does this patient fit?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
C. Stage 3
A Bankart lesion is most closely associated with which of the following?
A. ACJ instability
B. AMBRI
C. SCJ instability
D. TUBS
D. TUBS
A 59-year-old female presents in physical therapy with left shoulder pain that started several years ago. She states that it “ebbs and flows” based on what activities she partakes in. She is an active individual and plays pickle ball and golf, and also gardens for a hobby. She states the shoulder gets sore after these activities and increases to a 6/10 pain level, when normal baseline is 1/10. The pain is located in the anterior region of the shoulder with some radiation to the mid deltoid region. Upon examination, the physical therapist notes poor scapulohumeral rhythm, forward head posture, rounded shoulders, a negative load-and-shift test, a positive internal rotation resisted test, and a positive Hawkins–Kennedy test. Radiographs reveal a “flat acromion” but no other significant findings. What type of impingement does this patient likely have, based on the subjective and objective information provided above?
A. Internal
B. Primary
C. Secondary
D. Tertiary
B. Primary
A 45-year-old female presents with left shoulder pain that began approximately eight months ago. She points to the deltoid region when asked where the pain is but indicates it often radiates upward from there (points to supraspinous fossa). She has poor posture but can improve it with tactile cueing. Her active range of motion is 160 degrees of flexion and 170 degrees of abduction with a painful arc during both movements, external rotation of 60 degrees (painful), and internal rotation of 50 degrees (pain-free). She has 4/5 strength in shoulder flexion, abduction, and external and internal rotation, and all but internal rotation are painful. Neer impingement and drop arm test are positive and Hawkins–Kennedy test is negative. Based on this information, what is the most likely diagnosis for this patient?
A. Adhesive capsulitis
B. Full-thickness rotator cuff tear
C. Infraspinatus tendinitis
D. Supraspinatus tendinitis
B. Full-thickness rotator cuff tear
A 45-year-old female presents with left shoulder pain that began approximately eight months ago. She points to the deltoid region when asked where the pain is but indicates it often radiates upward from there (points to supraspinous fossa). She has poor posture but can improve it with tactile cueing. Her active range of motion is 160 degrees of flexion and 170 degrees of abduction with a painful arc during both movements, external rotation of 60 degrees (painful), and internal rotation of 50 degrees (pain-free). She has 4/5 strength in shoulder flexion, abduction, and external and internal rotation, and all but internal rotation are painful. Neer impingement and drop arm test are positive and Hawkins–Kennedy test is negative. If this patient had come to physical therapy with a diagnosis of calcific tendinitis, which of the following interventions would have been the most beneficial for the patient, based on current evidence?
A. Isometric strengthening for shoulder flexors and external rotators
B. PROM for shoulder flexion and abduction
C. Pulleys for AAROM shoulder flexion and abduction
D. Pulsed ultrasound
D. Pulsed ultrasound
If a patient has atrophy in the infraspinous fossa along with weak and pain-free abduction, which of the following is likely the cause of the patient’s atrophy?
A. Accessory movement involvement
B. Contractile tissue involvement
C. Inert tissue involvement
D. Nervous tissue involvement
D. Nervous tissue involvement
If a patient has anterior shoulder pain during activities that require shoulder flexion, adduction and internal rotation, what is the most likely diagnosis?
A. ACJ instability
B. Adhesive capsulitis
C. Coracoid impingement syndrome
D. RTC tear
C. Coracoid impingement syndrome
A 41-year-old male engineer and cyclist presents to a physical therapy clinic with complaints of neck and arm pain. The patient’s pain diagram shows right-sided neck pain extending into the right posterior upper arm. The patient has complaints of numbness and tingling present in the arm. The NDI was scored at 20%. The key findings from the examination are below:
+ Spurling’s test
+ ULTT - A
+ Distraction test
+ Shoulder abduction sign
Cervical ROM rotation: 50 degrees bilaterally; R rotation increased pain; C-spine extension was full, but pain peripheralized into dorsal wrist with cervical extension
Hypomobility was present with PA assessment at C5–C7
Diminished light touch sensation in the C7 dermatome
Muscle strength revealed 4/5 right triceps, 3/5 middle and lower traps, and weak deep neck flexors
No tenderness to palpation
Forward head posture and protracted shoulders were noted
Which objective findings from this case will be most helpful to the resident physical therapist for determining the appropriate physical therapy diagnosis?
A. Cervical AROM rotation, positive Spurling’s test, positive distraction test, and positive upper limb tension test A
B. Cervical AROM rotation, weakness in deep neck flexors, middle and lower trapezius, and triceps
C. Positive findings in Spurling’s test, distraction test, shoulder abduction test, and upper limb tension test A
D. Weakness in deep neck flexors, middle and lower trapezius, triceps, and hypomobility in C5–C7
A. Cervical AROM rotation, positive Spurling’s test, positive distraction test, and positive upper limb tension test A
With cervical range of motion, the physical therapist assessed cervical flexion and side flexion. Which of the following is considered a normal active range of motion for both cervical flexion and side flexion?
A. 30˚
B. 45˚
C. 60˚
D. 90˚
B. 45˚
A patient has been referred to physical therapy with a preganglionic brachial plexus injury and is having very high amounts of pain that do not seem to be decreasing. What type of pain describes this patient’s symptoms?
A. Causalgic pain
B. Neuropathic pain
C. Somatic pain
D. Visceral pain
A. Causalgic pain
What is causalgia pain often described as?
burning
causalgia pain is commonly seen in pts who have what types of brachial plexus injuries?
preganglionic
somatic pain often described as
dull/achy
A 64-year-old female has noticed an increase in left shoulder pain two minutes into her 3-mile walks each afternoon. The pain will radiate into her biceps region if she continues walking. She indicates that after she rests, the pain starts to subside and that within three minutes of rest, the pain is gone. She feels like she has altered her walking mechanics by changing her arm swing to see if the pain decreases, but the pain level has not decreased. Which of the following is most likely the cause of the patient’s shoulder pain?
A. Adhesive capsulitis
B. Angina
C. Cervical radiculopathy
D. TOS
B. Angina
