Elbow

Question 1

Brachialis Nerve Innervation

Answer 1

Musculocutaneous Nerve

C5-C7

Question 1

Brachialis Nerve Innervation

Answer 1

Nerve: Musculocutaneous Nerve

Question 2

Radial Nerve Innervations and Roots

Answer 2

Nerve Roots: C5-T1
Brachioradialis
Triceps
Supinator
Anconeus

Question 3

Pronator Teres Innervation

Answer 3

Medial Nerve

Nerve Roots: C6-C7

Question 4

A 14-year-old female competitive gymnast presents to your clinic with complaints of lower lumbar pain after falling during a floor routine at a competition over the weekend. She was unable to finish the routine. She is seeking your advice as a sports certified specialist on her next steps. Which of the following diagnoses is least likely to occur in this patient?
Spondylolisthesis
Psychosocial factors
Scheuermann's disease
Mechanical low back pain

Answer 4

Scheuermann’s Disease

Occurs in thoracic spine and accompanied by significant thoracic kyphosis and lumbar hyperlordosis

Question 5

The "Scottie dog" deformity seen on diagnostic imaging is used to diagnose lumbar spondylolisthesis. Which of the following is the most accurate to identify lumbar spondylolisthesis?
Oblique view x-ray
Posterior view x-ray
Lateral view x-ray
CT

Answer 5

CT

Most likely to identify lumbar spondylolisthesis

Question 6

What are the criteria for the mobility category of cervical dysfunction?

Answer 6

Low pain, limited mobility, lack of radicular symptoms, and no positive neuro signs

Question 7

What are the criteria for the centralization category for cervical dysfunction?

Answer 7

UE symptoms/radicular sign/symptoms impacted by cervical activities

Question 8

Describe the levels of severity with OA

Answer 8

Severe OA: joint space less than 1-2 mm and subchondral scelerosis
Moderate OA: more than 1-2 mm of space on x-ray and small cysts present

Question 9

What is the correct progression of mobilizations to restore hip flexion ROM in a post-op hip surgery patient?

Answer 9

Long-axis distraction; inferior glides at 90°; inferior glides with progressive passive flexion

Question 10

Common findings in Osgood-Schlatter disease

Answer 10

Swelling, decreased quad flexibility, tenderness at tibial tuberosity, quad lag with SLR
Not likely to find patellar hypomobility

Question 11

With periodization, plyos in a post-op cartilage injury patient should be performed during late off-season and beginning of preseason at what frequency and intensity?

Answer 11

Low to moderate intensity 2x a week

Question 12

On radiograph, the athlete who fell onto his shoulder demonstrates a 2cm shortening compared to the uninvolved side. What is the best treatment option?
Open reduction and plate fixation
Figure-8 brace for 3-6 weeks
Closed reduction and figure-8 brace
Immobilization for 6 weeks

Answer 12

Open reduction and plate fixation
Early plate fixation for displaced clavicles results in improved outcomes, early return to function, and decreased rates of nonunion/malunion

Question 13

The athlete with clavicular fracture complains on the field of left-hand numbness. What injury is suspected? 
Subclavian arter
TOS
Brachial Plexus injury
Brachial arter

Answer 13

Subclavian artery
Despite no muscle weakness, the full hand numbness is often associated with clavicle fracture after penetrating and blunt trauma.
Compression between 1st rib and clavicle for brachial plexus injury would often cause ulnar symptoms or symptoms based on a specific nerve versus the whole hand

Question 14

For the athlete with a clavicular fracture, when would you expect him to return to play if non-operated?
8-10 weeks
10-12 weeks
12-14 weeks
14-16 weeks

Answer 14

10-12 weeks

Mean time to return to play is 83 days, but 8 weeks is often pushing it in time for full return.

Question 15

A 16-year-old male wide receiver tore his right knee when he was running a route; his right foot caught in the turf as he planted and twisted. He underwent anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft. Other concomitant injuries include a medial meniscus repair of the posterior horn with two sutures and an osteochondral lesion on the medial femoral condyle addressed using a microfracture procedure. His main goal is to get back to running as soon as possible as he is also involved in track, where he runs the 4x100 meter relay. The patient arrives today, and his examination is as follows:

Range of motion (ROM): right knee = 0-1-114 degrees, left knee = 5-0-134 degrees
Knee extension MMT: right knee = 4/5 (good), left knee = 5/5 (normal)
Functional Assessment: poor control during descent of stair climbing

Based on the above history and examination findings, which intervention at eight weeks post-op is the most appropriate to help this patient restore function and achieve his goal?

Isotonic R knee ext exercises at 3x8-10 for hypertrophy
Prolonged low-load knee extension stretching and grade III extension mobilizations for increased knee extension ROM
Wall squats with unilateral eccentric lowering at 2 sets of 12–15 repetitions for muscle endurance
Modified prone quad stretching performed at 3 sets of 30 seconds each to increase knee flexion ROM

Answer 15

Prolonged low-load knee extension stretching and grade III extension mobilizations for increased knee extension ROM
Performing knee ext exercises with a combined knee flexion contracture puts the quad in a disadvantaged position when contracting thus reducing max recruitment

Question 16

It is the responsibility of the sports certified specialist to help determine an athlete’s readiness for returning to full sport participation. Which tests have the best evidence to support this athlete’s ability to return to sport participation after ACL reconstruction?

1. Y-Balance Test: 4 cm
2. FMS Overhead Squat: 2
3. Balance Error Scoring System (BESS): 5 errors on unstable surface
4. Symmetrical Hop Test: 90%

Answer 16

1 and 4 only
BESS is mainly for concussion and FMS overhead squat has evidence backing importance of movement symmetry in injury prevention but only YBT and hop testing have research behind readiness for RTS

Question 17

A 16-year-old male wide receiver tore his right knee when he was running a route; his right foot caught in the turf as he planted and twisted. He underwent anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft. Other concomitant injuries include a medial meniscus repair of the posterior horn with two sutures and an osteochondral lesion on the medial femoral condyle addressed using a microfracture procedure. His main goal is to get back to running as soon as possible as he is also involved in track, where he runs the 4x100 meter relay. The surgeon cleared the athlete of all precautions at 12 weeks and prescribed progressive resistance exercises to address strength deficits. As the athlete gets closer to returning to participating in his sports, the sports certified specialist can progress from general athletic fitness to a more sport-specific athletic fitness. Which variables would provide the most benefit to address the inherent demands of the athlete’s sports?

1. Resistance training consisting of loaded hip hyperextension exercises performed for 3–4 sets at an RPE of 4–6 and resisted sled sprint conditioning for 4 sets of 15 yards
2. Resistance training consisting of bilateral compound knee extension exercises performed for 4–5 sets at an RPE of 3–4 emphasizing bar speed and conditioning consisting of 3 sets of 300-yard shuttles
3. Resistance training consisting of bilateral and unilateral compound concentric and eccentric hamstring exercises performed as a superset with unilateral compound knee extension exercises performed for 3 sets at an RPE of 3–4 with a work-to-rest ratio of 1:3

Answer 17

1 and 3 only
Sprinting involves horizontally directed acceleration produced primarily by the posterior chain muscle groups. During the late swing and through the stance phase of the running cycle, the leg is slowed down and brought underneath the body by an eccentric to concentric contraction of the hamstrings. With the foot on the ground, the hip extensor group rapidly produces horizontal propulsive forces into a hip-hyperextended position right before toe-off. Performing choice 1 and choice 3 addresses these focal muscle groups in a similar action as produced when running, as well as addressing the phosphagen energy system utilized during the sprinting activity. Choice 2 involves rapidly producing a primary vertical force and improves conditioning utilizing the glycolytic energy system.

Question 18

A sports clinical specialist is providing coverage at a collegiate track meet. After running of the 3000 m race, a female athlete reports tightness and cramping pain in the right lower leg. The patient reports the pain increasing as the race progressed. She reports that similar pain usually occurs at approximately 1500 m during practice runs but that she can usually run through it. She reports today's pain was much more intense after the race. Now that the race has ended, she reports that the pain is subsiding but is taking much longer than usual. During your on-field exam, you notice a unilateral decrease in dorsiflexion strength of the right foot. In which nerve and which lower leg compartment are symptoms consistent? 
Tibial; Anterior compartment
Common Fibular; Posterior compartment
Tibial; Posterior compartment
Deep Fibular; Anterior compartment

Answer 18

Deep fibular; Anterior

Deep fibular innervates the anterior tibialis, and anterior compartment Is the most commonly involved

Question 19

Which modality is used to best diagnose exertional compartment syndrome?

Needle manometer
Dynamic bone scan
MRI
ABI

Answer 19

Needle Manometer

Assesses intercompartmental pressure and is the only one listed that assess pressure within various compartments

Question 20

What intercompartmental pressures are indicative of one being clinically diagnosed with exertional compartment syndrome?

Answer 20

Pre-exercise pressure > 15 mmHg
1 minute post exercise > 30 mmHg
5 minutes post exercise > 20 mmHg

Question 21

Athlete decides to go surgical route to address exertional compartment syndrome. They ask you when they will be back to competitive running. Your recommendation for safe return is:

2-4 weeks
12-16 weeks
24-28 weeks
36-40 weeks

Answer 21

12-16 weeks
Once the wound heals, walking and bicycling are encouraged. Patients may begin a light jog in two weeks and resume running at 6 weeks. Often takes 3 months prior to return to competition

Question 22

A 16-year-old male baseball player is seen in the clinic for medial elbow pain. He reports his pain began while pitching in a showcase a few weeks after the season ended. He reported he was unable to finish the showcase due to the pain and inability to maintain his usual pitching speed. Upon examination, he presents with pain with palpation on his medial epicondyle, ulnar collateral ligament, and flexor-pronator mass. Elbow ROM measures a lack of 5 degrees from full extension. He demonstrates 110 degrees of shoulder external rotation and 50 degrees of shoulder internal rotation. He presents with positive milking sign and moving valgus stress test. Based on the these findings, you would:

x-ray to rule out medial epicondyle avulsion
MRI to rule out UCL tear
Avoid pitching for 6 weeks and treat conservatively for medial epicondyle apophysitis
Dynamic splinting for elbow extension to treat for valgus extension overload syndrome (thrower’s arm)

Answer 22

MRI
Clinical findings and subjective highly suggest UCL tear. While repeated throwing contributes to thrower’s elbow, and a loss of extension ROM is present, UCL tear is most signficant

Question 23

Extremes in positive and/or negative emotionality

Answer 23

Mood Disorders

Question 24

Excessive fear and anxiety in non-life-threatening situations

Answer 24

Anxiety Disorders

Question 25

Physical symptoms that might not have a physiological cause

Answer 25

Psychosomatic concerns

Question 26

Disorders making it difficult to adjust to life’s demands

Answer 26

Adjustment disorders

Question 27

Cindy is a college tennis players with a diagnosis of triceps tendinitis with overhead serves. What muscle groups and what phase of training is needed?

Answer 27

Triceps and pronator; concentrically
This often occurs at the acceleration and deceleration phases, requiring triceps and pronators working concentrically to extend the elbow and pronate

Question 28

Stevie is a college pitcher who had UCL reconstruction. He is ready for exercises to prepare him for throwing. Which would be the best recommendation at this stage? 
Concentric shoulder ER strengthening
Skill-based throwing technique drills
Eccentric shoulder ER strengthening
Rotational core stabilization training

Answer 28

Rotational core stabilization training
Proper timing and coordination of the pelvis and trunk rotation assist in absorbing the forces to the trunk Instead of the arm. concentric ER strengthening puts added stress to the UCL which is still needing healing time. Skill-based throwing takes place after throwing progression has begun. Need eccentric IR not ER strength

Question 29

You are analyzing an athlete’s golf swing and they report wrist pain at the top of the backswing. What is the likely diagnosis causing the wrist pain?

Answer 29

DeQuervain’s syndrome: most common tendinitis of the wrist developed from activities requiring grip and wrist extension (backswing). Intersection syndrome occurs where tendons of first and second compartment cross, often found in activities requiring wrist flexion/extension and firm gripping. ECU tendinitis is second most common sports-related overuse injury in racket sports requiring repetitive wrist motions. FCU tendinitis is inflammation of FCU along ulnopalmar region in activities requiring wrist flexion and ulnar deviation

Question 30

A first-year high school student added padding to his helmet because it was too big. He wore glasses while playing, and therefore used the largest face mask available. In addition, the athlete had not been training over the summer and was struggling, physically, with the preseason practice. As the visiting physical therapist, you noticed the team doesn’t regularly have a physical therapist or athletic trainer on the sidelines. You are concerned about the likelihood of a concussion and the potential severity.

The incidence and severity of concussions can be affected by:
Properly fitted helmet
Adding additional padding
Using larger face mask
Sideline personnel training

Answer 30

Properly fitted helmet
improper fit allows for excess movement of the head, which can result in increased movement of the brain in the skull, which may lead to concussion

Question 31

A player is knocked to the ground during a football game. He is unable to remove himself from the game, and palpation of the shoulder reveals a right shoulder dislocation. During emergency management, how is this player managed on the sidelines?

Rest, Ice, and compression
Sling
Ice only
Elevation only

Answer 31

Rest, ice and compression with ACE bandage or equipment (game ready) will help prevent further injury and are standard procedure following acute injury. Sling can provide some relief, but rest, ice, and compression are better in early management