Guidelines/studies

Question 1

Kellgren guidelines

Answer 1

Grade 1 shows NO Radiographic changes,
Grade 2 Small osteophytes, but doubtful joint space narrowing
Grade 3 Moderate joint space narrowing and moderate osteophytes
Grade 4 most Severe osteophytes, severe joint space narrowing, bone contour, subchondral schlerosis

Question 2

Neer Impingment classification

Answer 2

Stage 1 under 25 young active minimal changes inflammation, oedema, and hemorrhage
Stage 2 25-40 undergoes fibrosis and tendonitis
Stage 3 Over 40 mechanical disruption - coracoacromial osteophyte formation, dec subacromial space

Question 3

Lumbar traction

Answer 3

New patient 5-10 min static,
40-60% of body weight for a maximum of 12 minutes
60 sec hold 10 sec rest

Question 4

PHQ-2 Questions

Answer 4

Little interest in doing things

Feeling down, depressed or hopeless

Question 5

Risk for Myelopathy

Answer 5

Larger vertebral body, smaller spinal canal, Torg/pavlol ration difference small 0.8 stenosis

Question 6

CPR carpal tunnel

Answer 6

1. Shaking hands for symptom relief
2. Wrist-ratio index greater than .67
3. Symptom Severity Scale score greater than 1.9
4. Reduced median sensory field of digit 1
5. Age greater than 45 years

Question 7

CPR Cervical manipulation Tseng

Answer 7

Tseng

1. Neck Disability Index < 11.5
2. Bilateral involvement
3. Not performing sedentary work > 5 hours a day
4. Feeling better while moving neck
5. Did not feel worse with cervical extension
6. Diagnosis of spondylosis without radiculopathy

Question 8

CPR Cervical manipulation

Puentedura et al., 2012:

Answer 8

1. Symptom duration of less than 38 days
2. Positive expectation that manipulation will help
3. Side-to-side difference in cervical rotation ROM of 10° or greater
4. Pain with posteroanterior spring testing of the middle cervical spine

Question 9

ACL/PCL function

Answer 9

ACL - Post lateral bundle - provides ant restraint 0-20 deg, rotational stability
Ant medial taught in flexion
PCL - limits post translation - Ant lateral bundle taught in flexion, Post medial ext

Question 10

Factors affecting the outcome of arthroscopy in medial-compartment osteoarthritis of the knee.

Answer 10

OA for greater than 24 months (OR, 3.6), obesity (OR, 8.8), smoking (OR, 3.1), medial tibial osteophytes (OR, 5.4), medial joint space width on standing radiographs of less than 5 mm (OR, 7.3), absence of effusion (OR, 6.5), absence of synovitis (OR, 6.1), presence of crystal deposits (OR, 4.3), deep tibial cartilage defect (OR, 12.5), and need for subtotal or total meniscectomy (OR, 2.2).

Question 11

PCL HEP

Answer 11

Eccentric and Quad strengthening

After surgery 4 weeks in brace

Question 12

Arcuate complex -

Answer 12

lateral and little medial stability - static

Question 13

Posterior medial knee stabilty

Answer 13

OPL - Reinforces the posteromedial knee joint capsule obliquely on a lateral-to-medial diagonal from proximal to distal
POL - Reinforces the posteromedial knee joint capsule obliquely on a medial-to-lateral diagonal from proximal to distal

Question 14

Lag signs for RTC tear,

Answer 14

ER + SP Infraspinatus, low SN, IR + SN subscap

Question 15

Wedge for medial knee OA

Answer 15

Lateral

Question 16

Adhesive capsulitis

Answer 16

40-65,
5-34% chance contralat shoulder
factors include: trauma, prolonged immobilisation, thyroid disease, stroke, myocardial infarcts, and presence of autoimmune disease

Question 17

Abd Anyurism -

Answer 17

There is often a rapid, severe onset of groin pain that occurs along with the low back pain in individuals who have an abdominal aortic aneurysm. They will describe the pain as throbbing, pulsating, tearing or ripping. (Small 2005)

Question 18

Carotid Artery direction

Answer 18

• 5D’s 3 N’s + pregnancy

Question 19

Pt MVA neck sx 6 months

Answer 19

It is likely this patient will have a larger relative cross sectional area of the cervical paraspinals
Reason:In patients who have chronic whiplash associated disorder, a larger relative cross sectional area of the cervical paraspinals has been seen, and it is possible due to the fatty infiltrate that fills this area after chronic whiplash associated disorder. (Elliott 2008 1, Elliott 2008 2 and Childs 2008)

Question 20

RTC tear size

Answer 20

small <1, Med 1-3, large 3-5 and Massive >5

Question 21

Types of hand deformities

Answer 21

Swan neck - flexion DIP, extension PIP
Boutonniere deformity ext DIP, flex PIP
Mallett finger flexion DIP

Question 22

Levels of Evidence

Answer 22

Evaluate the Strength of Evidence
I Evidence obtained form high-quality diagnostic studies prospective
studies, or randomized controlled trials
IIfEvidence obtained from lesser-quality diagnostic studies, prospective
studies, or randomized controlled trials (for example, weaker diagnostic
criteria and reference standards, improper randomization, no blinding,
<80% follow-up)
III Case-controlled studies or retrospective studies
IV Case series
V Expert opinion

Question 23

Grades of Recommendation Strength of Evidence

Answer 23

A Strong Evidence A prepoderance of level I and/or level II studies support the recommendation. This must include at least 1 level I study.
B Moderate Evidence A single high-quality randomized controlled trial or a preponderance of level II studies support the recommendation
C Weak Evidence A single level II study or a preponderance of level III and IV studies including statements of consensus by content experts support the recommendation
D Conflicting Evidence Higher-quality studies conducted on this topic disagree with respect to thier conclusions. The recommendation is based on these conflicting studies
E Theoretical/ Foundational Evidence A preponderance of evidence from animal or cadaver studies, from conceptual models/principles, or from basic sciences/bench research support this conclusion
F Expert Opinion Best practice based on the clinical experience of the guidelines development team

Question 24

Carpal tunnel
Guyon Tunnel
Cubital tunnel

Answer 24

Carpal Tunnel -
flexor digitorum profundus (four tendons)
flexor digitorum superficialis (four tendons)
flexor pollicis longus (one tendon)
Median nerve
Guyon Tunnel- Ulnar Nerve
Presentation varies based on location of compression within Guyon’s canal and may be
pure motor
pure sensory
mixed motor and sensory
Symptoms
pain and paresthesias in ulnar 1-1/2 digits
weakness to intrinsics, ring and small finger digital flexion or thumb adduction
Cubit Tunnel - Ulnar tunnel
the little finger
ulnar half of the ring finger
intrinsic muscles of the hand

Question 25

Types of Arthritis

Answer 25

Psoriatic - distal interphalangeal joints of the fingers and toes is one of the five possible clinical presentations of this type of arthritis. Iritis is also seen in individuals with psoriatic arthritis, along with other possible inflammatory eye conditions.
Reactive arthritis- Reactive arthritis is commonly seen in the larger joints in the lower extremities, but it is possible that it could be seen in smaller joints also. It is possible to have ocular involvement, but with this patient, the presence of symptoms only in the distal interphalangeal joints of the fingers and toes points away from reactive arthritis
RA- Rheumatoid arthritis is not commonly seen in just the distal interphalangeal joints of the fingers and/or toes. In fact, it rarely is seen in the distal interphalangeal joints at all, and is instead located in the proximal interphalangeal joints.

Question 26

Joint separation for sprains MCL

Answer 26

Normal 1-2cm
Nearly normal 3-5
Abnormal 6-10
Severely abnormal

Question 27

PCL ER Grades

Answer 27

Grades
1 1-5
2 5-10
3->10

Question 28

Cervical Myelopathy

Answer 28

male Gender, >70, Thickening of ligamentous tissue,

Asians

Question 29

Development of Knee OA

Answer 29

1 Irreversible matrix degradation

2. Synovitis
3. Loss of cartilage
4. Development of osteophytes