Deck 24 Flashcards
A 46-year-old patient with a peripheral nerve injury has pain in the shoulder, cervical spine, and scapula on the right side. Any overhead activity is difficult due to weakness with shoulder flexion and decreased active range of motion in flexion. The patient complains of glenohumeral instability and notes that when he attempts to be active, he has more pain in his shoulder, neck, and scapula. Lastly, there is winging in the patient’s scapula. What muscle should be strengthened first based on the objective findings presented?
A. Deltoid
B. Infraspinatus
C. Serratus anterior
D. Supraspinatus
C. Serratus anterior
A patient has a drooping shoulder girdle and an altered scapulohumeral rhythm as seen with observation and during active range of motion. The patient also has scapular winging during shoulder abduction (not flexion), and reduced range of motion during shoulder flexion and abduction. The physical therapist decides to begin strengthening for an accessory nerve injury. Which of the following muscles should be strengthened right away because of the diagnosis and the clinical findings here?
A. Deltoid
B. Serratus anterior
C. SCM
D. Supraspinatus
C. SCM
A 52-year-old male who works as a plumber has recently experienced weakness during gripping of wrenches. Just yesterday, he noticed that he was having difficulty feeling the entire region of the thenar eminence of his right hand. Which of the following nerves is likely causing the weakness and sensory deficits?
A. Median nerve
B. Musculocutaneous nerve
C. Radial nerve
D. Ulnar nerve
A. Median nerve
A 16-year-old female hockey player is referred to physical therapy after she was checked by another player during a game and the player’s hockey stick hit her posteriorly. She consequently has pain in the mid to lower cervical region and the upper trapezius region on the right side. There is weakness in the trapezius muscle, and the patient exhibits scapular winging with abduction but not flexion. Active range of motion is reduced with flexion and abduction. Which of the following nerves is implicated?
A. Axillary nerve
B. Long thoracic nerve
C. Spinal accessory nerve
D. Suprascapular nerve
C. Spinal accessory nerve
What accessory (or secondary) muscle should the physical therapist include in the strengthening plan to strengthen the radial deviators?
A. Abductor pollicis brevis
B. Abductor pollicis longus
C. Flexor pollicis brevis
D. Flexor pollicis longus
B. Abductor pollicis longus
A 45-year-old male tax accountant has been referred to physical therapy for radial wrist symptoms that began during the recent tax season. He states that his symptoms are on the dorsal aspect of the thumb and over the lateral aspect of the wrist. He states that he has consistent pain in this region, rated 2/10 at rest and 7/10 after working for several hours at one time. He states he has no time to rest until after the tax season is completed, which is two weeks from the time of initial evaluation. Based on the location of the patient’s symptoms, which of the following is least likely implicated?
A. C6 nerve root
B. C7 nerve root
C. Lateral cord of the brachial plexus
D. Upper trunk of the brachial plexus
B. C7 nerve root
A 45-year-old male tax accountant has been referred to physical therapy for radial wrist symptoms that began during the recent tax season. He states that his symptoms are on the dorsal aspect of the thumb and over the lateral aspect of the wrist. He states that he has consistent pain in this region, rated 2/10 at rest and 7/10 after working for several hours at one time. He states he has no time to rest until after the tax season is completed, which is two weeks from the time of initial evaluation.
The physical therapist performing the examination/evaluation on this patient feels the patient’s symptoms are from the superficial radial nerve. How might this patient present?
A. Deep aching pain distal to lateral epicondyle
B. Inability to extend his wrist
C. Numbness to the back of the hand/wrist, inability to straighten wrist or extend thumb, triceps unaffected
D. Sensory loss over the dorsum of the hand, no motor loss
D. Sensory loss over the dorsum of the hand, no motor loss
If a patient presents with symptoms that look like de Quervain’s tenosynovitis, there are many expected joints that could be involved and require manual intervention. If a physical therapist wants to utilize manual therapy with this patient, which of the following joints is NOT expected to be restricted?
A. Distal radioulnar joint
B. First carpometacarpal joint
C. Intercarpal joint
D. Radiocarpal joint
A. Distal radioulnar joint
A 54-year-old female patient with a two-year history of heel pain reports to physical therapy via direct access, and she has brought her radiology report. The report states the patient has a calcaneal spur, and the patient says her podiatrist told her that the calcaneal spur is the likely cause for her heel pain. What does current evidence say regarding calcaneal spurs and heel pain?
A. A radiograph that shows a calcaneal spur in a patient with heel pain confirms the diagnosis of fat pad atrophy
B. A radiograph that shows a calcaneal spur in a patient with heel pain confirms the diagnosis of plantar fasciitis
C. A radiograph that shows a calcaneal spur in a patient with heel pain does not confirm the diagnosis of plantar fasciitis
D. A radiograph that shows a calcaneal spur in a patient with heel pain does not confirm the diagnosis of fat pad atrophy but does confirm the diagnosis of plantar fasciitis
C. A radiograph that shows a calcaneal spur in a patient with heel pain does not confirm the diagnosis of plantar fasciitis
A patient with heel pain is treated with a pragmatic prescription of manual therapy based on her impairments and is provided with a home exercise program. Which of the following self-mobilizations would be most beneficial to a patient with heel pain?
A. Self-mobilization for ankle eversion
B. Self-mobilization for intertarsal mobility
C. Self-mobilization of the cuboid
D. Self-mobilization with movement for improving dorsiflexion
A. Self-mobilization for ankle eversion
A 23-year-old female with a three-month history of lateral elbow pain is referred to physical therapy for examination/evaluation. The patient shows the physical therapist where the symptoms are located and states that she feels she is getting weaker with gripping items as each day goes by and that the symptoms are getting worse. The symptoms are located near the lateral epicondyle, extend into the mid-forearm region, and are reported as a burning pain after activity and achy when at rest. She does have some diminished sensation in the region after long periods of activity too, which just recently started in the last week. Which of the following diagnoses can be ruled out with this information?
A. Anterior interosseous nerve syndrome
B. C5–C6 radiculopathy
C. Elbow ligament sprain
D. Radial tunnel syndrome
A. Anterior interosseous nerve syndrome
After the objective data is completed, a physical therapist is still confused about the findings regarding his patient. He is unsure of the physical therapy diagnosis. The patient has pain with palpation in the medial arch, extending from the calcaneus to the distal metatarsals. The patient also has restricted ankle dorsiflexion and plantar flexion. There is some tingling in the medial arch after long bouts of activity. Based on this limited objective information, which of the following diagnoses is least likely?
A. Calcaneal stress fracture
B. Navicular stress fracture
C. Plantar fasciitis
D. Tarsal tunnel syndrome
B. Navicular stress fracture
A 58-year-old male machinist is seen in physical therapy for lateral elbow pain. He has a three-week history of lateral elbow pain that is described as achy and cramping after one hour of work and is rated 5/10. At rest, the pain is a 3/10 and still achy. He indicates that he previously had the same symptoms—approximately five years prior. He treated himself at home and did not seek any intervention. He states that this did not help. Since that time, he has had times of flare-up, and currently he is having the worst flare-up he’s ever had. After the objective examination, the physical therapist decides to utilize a manual therapy intervention with the patient. Of the following, which is least likely to impact the patient’s symptoms?
A. Cervicothoracic junction nonthrust manipulation
B. Radioulnar joint nonthrust manipulation
C. Scapulothoracic joint nonthrust manipulation
D. Sustained natural apophyseal glide (SNAG) technique
C. Scapulothoracic joint nonthrust manipulation
The physical therapist wants to know if there are any clinical criteria that would assist in producing a positive outcome via intervention in those with lateral elbow pain. He remembers learning about a clinical prediction rule for the use of mobilization with movement at the elbow, but he is unclear about the included variables. Which of the following is not one of the included variables in the clinical prediction rule?
A. Affected upper extremity pain-free grip strength of greater than 25 pounds
B. Age less than 49 years of age
C. Pain with resisted third-finger extension
D. Unaffected upper extremity pain-free grip strength of less than 75.5 pounds
C. Pain with resisted third-finger extension
What are the 3 variables in a CPR for use of MWM for lateral elbow pain?
- pain free grip strength > 25#
- age < 49
- unaffected UE painfree grip strength < 75.5#
