Deck 23 Flashcards
In the pathogenesis of knee osteoarthritis, which of the following occurs last in the course of progressive osteoarthritis?
A. Development of osteophytes
B. Irreversible matrix degradation
C. Loss of cartilage
D. Synovitis
A. Development of osteophytes
Irreversible matrix degradation occurs when in progressive OA
early
A patient with adhesive capsulitis has 9/10 consistent pain in her right shoulder both at rest and at night. The physical therapist is working on putting together an appropriate intervention plan for the day. Which of the following would not be appropriate?
A. Electrical stimulation for pain control
B. Grade 1 and 2 glenohumeral joint mobilizations
C. Pain-free active assisted range of motion exercises
D. End-range stretching exercises
D. End-range stretching exercises
A 68-year-old male patient underwent an arthroscopic surgery for medial compartment osteoarthritis three months prior to this referral to physical therapy. He has had a poor outcome to this point and is somewhat frustrated since he has followed all physician directions since the surgery. He had been diagnosed with osteoarthritis three years prior to the surgery but kept his weight in the “normal” category per BMI standards, did not smoke, and had a physical job as a foreman for a local contractor. He had developed significant varus at this knee prior to the surgery. Based on this patient’s situation, which of the following could contribute to the poor outcome after surgery?
A. Diagnosis of osteoarthritis three years prior to the surgery
B. Age
C. Physical job
D. Varus at the knees
A. Diagnosis of osteoarthritis three years prior to the surgery
Knee osteoarthritis is more common in African American _____ than in White _____.
A. Men; men
B. Men; women
C. Women; men
D. Women; women
D. Women; women
A 72-year-old female patient with knee osteoarthritis has been reporting difficulty with physical activity both in physical therapy and at home. She states that she is fearful of participating in any physical activity because she is afraid it will make her knee worse. What should the physical therapist do regarding this patient’s thoughts?
A. Allow her to control the amount of exercise she does since she thinks that physical activity makes her symptoms worse
B. Encourage her to continue to participate in physical activity to improve her symptoms
C. Provide the patient with a referral for a consultation to a psychologist, but continue to work with her during physical therapy
D. Stop all physical therapy with this patient and refer her for psychological assistance with her fear avoidance
B. Encourage her to continue to participate in physical activity to improve her symptoms
A 67-year-old female with knee osteoarthritis is referred to physical therapy. Active range of motion knee flexion was 115 degrees, and passive range of motion knee flexion was 118 degrees. Hip flexion, extension, and external rotation were all WNL, but passive hip internal rotation was only 15 degrees. Joint mobility assessment of both the hip and knee were limited in all directions in the femoroacetabular joint and in all directions with both tibiofemoral and patellofemoral joint assessment. The patient noted that she sometimes had anterior thigh pain. Because of the hip pain, the physical therapist assessed the FABER test, which was positive. She rated the pain as 2/10 at the hip and 5/10 at the knee. The patient indicates that she had been doing some things for the knee pain with other health care providers prior to coming to physical therapy to manage her symptoms. Which of the following has moderate evidence for reducing pain?
A. Acupuncture
B. Massage
C. Thermotherapy
D. US
A. Acupuncture
There is ___ evidence that acupuncture, TENS, and low level laser therapy will reduce pain in pts with knee OA
moderate
A 67-year-old female with knee osteoarthritis is referred to physical therapy. Active range of motion knee flexion was 115 degrees, and passive range of motion knee flexion was 118 degrees. Hip flexion, extension, and external rotation were all WNL, but passive hip internal rotation was only 15 degrees. Joint mobility assessment of both the hip and knee were limited in all directions in the femoroacetabular joint and in all directions with both tibiofemoral and patellofemoral joint assessment. The patient noted that she sometimes had anterior thigh pain. Because of the hip pain, the physical therapist assessed the FABER test, which was positive. She rated the pain as 2/10 at the hip and 5/10 at the knee. The patient indicates that she had been doing some things for the knee pain with other health care providers prior to coming to physical therapy to manage her symptoms.
The physical therapist decides to use a manual intervention with the patient on the first day of treatment. Which is the most appropriate based on the patient’s clinical presentation?
A. Knee extension mobilization
B. Knee flexion mobilization
C. Hip distraction thrust manipulation
D. Hip anterior posterior mobilization
D. Hip anterior posterior mobilization
Currier et al. described 5 variables that comprised a CPR for use of hip mobs in those with knee OA. What are they?
- anterior thigh pain
- PROM knee flex < 122˚
- PROM IR < 17˚
- hip/groin pain or paresthesia
- Pain with hip distraction
A 67-year-old female with knee osteoarthritis is referred to physical therapy. Active range of motion knee flexion was 115 degrees, and passive range of motion knee flexion was 118 degrees. Hip flexion, extension, and external rotation were all WNL, but passive hip internal rotation was only 15 degrees. Joint mobility assessment of both the hip and knee were limited in all directions in the femoroacetabular joint and in all directions with both tibiofemoral and patellofemoral joint assessment. The patient noted that she sometimes had anterior thigh pain. Because of the hip pain, the physical therapist assessed the FABER test, which was positive. She rated the pain as 2/10 at the hip and 5/10 at the knee. The patient indicates that she had been doing some things for the knee pain with other health care providers prior to coming to physical therapy to manage her symptoms.
What variables from the Currier et al. clinical prediction rule was the patient in this case missing?
A. Hip/groin pain or paresthesia and pain with hip distraction
B. Hip/groin pain or paresthesia and pain with knee extension
C. Knee pain or paresthesia and pain with hip distraction
D. Knee pain or paresthesia and pain with knee extension
A. Hip/groin pain or paresthesia and pain with hip distraction
A 67-year-old female with knee osteoarthritis is referred to physical therapy. Active range of motion knee flexion was 115 degrees, and passive range of motion knee flexion was 118 degrees. Hip flexion, extension, and external rotation were all WNL, but passive hip internal rotation was only 15 degrees. Joint mobility assessment of both the hip and knee were limited in all directions in the femoroacetabular joint and in all directions with both tibiofemoral and patellofemoral joint assessment. The patient noted that she sometimes had anterior thigh pain. Because of the hip pain, the physical therapist assessed the FABER test, which was positive. She rated the pain as 2/10 at the hip and 5/10 at the knee. The patient indicates that she had been doing some things for the knee pain with other health care providers prior to coming to physical therapy to manage her symptoms.
The patient has continued pain and stiffness over the duration of physical therapy and ultimately is referred back to a physician for follow-up, where imaging is performed. Which of the following found on imaging is associated with pain and stiffness?
A. Large joint effusion
B. Presence of an osteophyte
C. Presence of subchondral cyst
D. Subluxation of the meniscus
A. Large joint effusion
Knee OA: The presence of an osteophyte was associated with ____, not ____
pain, NOT stiffness
A patient describes pins and needles in his thumb. This is the only location where there are pins and needles, and the symptoms do not travel proximally, distally, or anywhere else in the hand. Which structure is the probable cause of the pins and needles feeling?
A. C5 nerve root
B. C6 nerve root
C. Median nerve
D. Radial nerve
B. C6 nerve root
The Neck Disability Index (NDI) has often been used for those with neck pain. Which outcome measure is it often closely associated with the NDI and measures similar outcomes to the NDI?
A. Global Rating of Change Scale (GROC)
B. Neck Pain and Disability Scale (NPDS)
C. Patient-Specific Functional Scale (PSFS)
D. SF-36 (physical and mental components)
D. SF-36 (physical and mental components)
A physical therapist assesses the upper limb tension test for the median nerve on a patient. The patient has no reproduction of symptoms in the median nerve distribution, but the patient feels some pulling in the radial nerve distribution. The physical therapist still documents a positive upper limb tension test in his note. How can this patient still be positive for the upper limb tension test even though the patient has no reproduction of symptoms?
A. The patient exhibited a side-to-side difference of greater than 10 degrees of elbow extension or wrist extension
B. The patient felt a stretch in the upper trapezius bilaterally during contralateral and ipsilateral side flexion during the test
C. The patient had limited forearm supination during the test
D. The patient reported symptoms in the radial nerve distribution, so this is still a positive test
A. The patient exhibited a side-to-side difference of greater than 10 degrees of elbow extension or wrist extension
A patient has been seen for three weeks in physical therapy for knee osteoarthritis, and she is making slow progress. The physical therapist is wondering if the patient should be sent home with a home exercise program instead of coming to physical therapy. Which of the following is true regarding physical therapy versus a home exercise program for knee osteoarthritis?
A. A home exercise program for knee osteoarthritis is as equally effective as supervised physical therapy when measured over one month
B. Individuals participating in a home exercise program instead of supervised physical therapy for knee osteoarthritis will use less medication
C. Supervised physical therapy is more effective than a home exercise program for knee osteoarthritis when outcomes are measured at one year
D. Supervised physical therapy is more effective than a home exercise program for knee osteoarthritis when measured over one month
D. Supervised physical therapy is more effective than a home exercise program for knee osteoarthritis when measured over one month
A physical therapist would like to use manual therapy on a patient with an onset of neck pain two weeks prior to referral to physical therapy. The patient points to symptoms bilaterally in the levator scapulae and upper trapezius region. The patient scores 20 points on the Neck Disability Index (NDI), 8 on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire (FABQ), and 16 on the work subscale of the FABQ. During examination, the patient has 35 degrees of cervical flexion, 25 degrees of cervical extension, 20 degrees of bilateral side flexion, and 45 degrees of bilateral rotation. Which of the following intervention choices is most appropriate for this patient?
A. Cervical non-thrust manipulation
B. Cervical thrust manipulation
C. Thoracic non-thrust manipulation
D. Thoracic thrust manipulation
D. Thoracic thrust manipulation
A physical therapist is using the craniocervical flexion test to assess for the strength of the deep neck flexors. The physical therapist wants to make sure the patient does not substitute with other muscles during the test, so he tells the patient to put her tongue on the roof of her mouth. By doing this, what muscle is deactivated?
A. Digastric
B. Platysma
C. Sternocleidomastoid
D. Sternothyroid
B. Platysma
A patient has neck pain and radiating symptoms to the anterior mid forearm. Which of the following interventions would be most beneficial for the patient?
A. Mechanical intermittent traction
B. Stretching exercises
C. Thoracic manual therapy
D. Upper quarter and nerve mobilization procedures
A. Mechanical intermittent traction
A physical therapist is quite certain a patient has neck pain with headaches as defined by the ICF classification. Which of the following objective information is most helpful for determining this is true?
A. Cervical flexion rotation test
B. Deep neck flexor endurance test
C. Distraction test
D. Thoracic segmental mobility
A. Cervical flexion rotation test
In a patient diagnosed with neck pain with radiating pain, which of the following impairments would not be expected during an examination/evaluation?
A. Neck pain that radiates during cervical flexion
B. Positive upper limb tension test
C. Relief with neck distraction
D. Upper extremity weakness
A. Neck pain that radiates during cervical flexion
Which of the following muscles does not assist in wrist flexion?
A. Abductor pollicis longus
B. Flexor digitorum profundus
C. Flexor pollicis longus
D. Palmaris longus
A. Abductor pollicis longus
A physical therapist is treating a triangular fibrocartilage complex (TFCC) injury. The patient is struggling to regain pronation and supination, and the therapist feels it is due to a ligament that should be taut in supination but currently is not taut because of the injury. Which of the following ligaments should be taut in supination?
A. Dorsal radioulnar ligament
B. Inferior radioulnar ligament
C. Palmar radioulnar ligament
D. Superior radioulnar ligament
C. Palmar radioulnar ligament
A physical therapist is treating a triangular fibrocartilage complex (TFCC) injury. The patient is struggling to regain pronation and supination, and the therapist feels it is due to a ligament that should be taut in supination but currently is not taut because of the injury. Which of the following ligaments should be taut in supination?
A. Dorsal radioulnar ligament
B. Inferior radioulnar ligament
C. Palmar radioulnar ligament
D. Superior radioulnar ligament
C. Palmar radioulnar ligament
