MSK 4 Midterm

Question 1

what type of injury of the shoulder will most likely result in a Bankart lesion

a. rotator cuff tear

b shoulder dislocation

c fracture of the greater tuberosity of the humerus

d biceps longhead rupture

Answer 1

b shoulder dislocation

Correct Answer: b. shoulder dislocation

Explanation:

a. Rotator cuff tear: A rotator cuff tear typically involves injury to the muscles and tendons around the shoulder joint, particularly the supraspinatus, infraspinatus, teres minor, and subscapularis. It does not usually cause a Bankart lesion, which involves a tear in the labrum.

b. Shoulder dislocation: Correct. A Bankart lesion is most commonly associated with an anterior shoulder dislocation. This injury involves a tear of the labrum, which is the cartilage rim around the shoulder socket, specifically in the lower part of the glenoid.

c. Fracture of the greater tuberosity of the humerus: This injury involves a break in the part of the humerus where the rotator cuff muscles attach. It does not typically result in a Bankart lesion.

d. Biceps long head rupture: This injury involves the tendon of the long head of the biceps brachii muscle, which can cause pain and weakness but is not related to a Bankart lesion.

Question 2

you are evaluating a patient who is one week s/p biceps tenodesis which of the following activities should be avoided to avoid damage to surgical site

a . PROM of the glenohumeral joint

b arom of radiocarpal joint

c arom of humeroulnar joint

d scapular retraction and adduction exercises

Answer 2

c arom of humeroulnar joint

Correct Answer: c. AROM of humeroulnar joint

Explanation:

a. PROM of the glenohumeral joint: Passive range of motion (PROM) of the shoulder joint is generally safe and often encouraged post-surgery to prevent stiffness.

b. AROM of radiocarpal joint: Active range of motion (AROM) of the wrist joint does not stress the surgical site of a biceps tenodesis and is typically allowed.

c. AROM of humeroulnar joint: Correct. Active range of motion at the elbow can place stress on the repaired biceps tendon, potentially leading to damage or re-injury at the surgical site.

d. Scapular retraction and adduction exercises: These exercises generally do not stress the surgical site of a biceps tenodesis and can often be safely performed.

Question 3

a surgical procedure that grafts bone from the coracoid process to augment the anterior glenoid rim is called

a. latarjet procedure

b hill Sachs reconstruction

c Bankart procedure

d slap repair

Answer 3

a. latarjet procedure

Correct Answer: a. Latarjet procedure

Explanation:

a. Latarjet procedure: Correct. The Latarjet procedure involves transferring a piece of bone from the coracoid process to the anterior part of the glenoid, providing additional stability to the shoulder joint.

b. Hill-Sachs reconstruction: This procedure addresses the Hill-Sachs lesion, which is a compression fracture of the humeral head, and does not involve grafting bone from the coracoid process.

c. Bankart procedure: This surgery repairs the labrum without using a bone graft from the coracoid process.

d. SLAP repair: This surgery repairs a specific type of labral tear (Superior Labrum Anterior and Posterior) and does not involve a bone graft from the coracoid process.

Question 4

a patient inquires about the difference between a bicep tenotomy and bicep tenodesis you state that:

a. tenodesis is a reattachment of the long head of the biceps into the humerus

b tenotomy is a reattachment of the long head of the biceps into the humerus

c tenotomy uses a tendon graft to make the repair

d tenodesis uses a tendon graft to make the repair

Answer 4

a. tenodesis is a reattachment of the long head of the biceps into the humerus

Correct Answer: a. Tenodesis is a reattachment of the long head of the biceps into the humerus

Explanation:

a. Tenodesis is a reattachment of the long head of the biceps into the humerus: Correct. Tenodesis involves reattaching the long head of the biceps tendon to the humerus.

b. Tenotomy is a reattachment of the long head of the biceps into the humerus: Incorrect. Tenotomy involves cutting the long head of the biceps tendon, allowing it to retract and relieve pain, without reattachment.

c. Tenotomy uses a tendon graft to make the repair: Incorrect. Tenotomy does not involve the use of a tendon graft; it simply cuts the tendon.

d. Tenodesis uses a tendon graft to make the repair: Incorrect. Tenodesis reattaches the existing tendon to the humerus without the use of a graft.

Question 5

a patient presents with shoulder pain that increases with shoulder and elbow flexion shoulder abduction is not painful the patient has a 5/5 strength in the upper quarter the Hawkin’s Kennedy test is negative and yergason’s test is positive which is the most likely condition

a. shoulder impingement syndrome

b anterior glenohumeral instability

c posterior glenohumeral instability

d bicipital tenosynovitis

Answer 5

d bicipital tenosynovitis

Correct Answer: d. Bicipital tenosynovitis

Explanation:

a. Shoulder impingement syndrome: This condition would likely present with a positive Hawkins-Kennedy test and pain with shoulder abduction.

b. Anterior glenohumeral instability: This would not typically cause pain with elbow flexion or a positive Yergason’s test.

c. Posterior glenohumeral instability: This condition would not typically present with pain during elbow flexion or a positive Yergason’s test.

d. Bicipital tenosynovitis: Correct. Pain that increases with shoulder and elbow flexion, combined with a positive Yergason’s test, is indicative of inflammation of the biceps tendon.

Question 6

you are evaluating a patient who is one week s/p reverse total shoulder arthroplasty (rTSA) to reduce the change dislocating the shoulder arthroplasty what combined shoulder motion should be avoided

a. extension adduction, internal rotation

b abduction, external rotation

c scapular plane elevation, external rotation

d flexion, external rotation

Answer 6

a. extension adduction, internal rotation

Correct Answer: a. Extension, adduction, internal rotation

Explanation:

a. Extension, adduction, internal rotation: Correct. This combination of movements can increase the risk of dislocating the shoulder following a reverse total shoulder arthroplasty.

b. Abduction, external rotation: This combination is less likely to cause dislocation compared to extension, adduction, and internal rotation.

c. Scapular plane elevation, external rotation: This movement is generally safe and not typically associated with a high risk of dislocation.

d. Flexion, external rotation: These movements are generally safe following rTSA and not typically associated with a high risk of dislocation

Question 7

when using acronym TUBS in association with glenohumeral instability what does the B in tubs stand for

a. bilateral

b Bankart

c Buford

d biceps

Answer 7

b Bankart

Correct Answer: b. Bankart

Explanation:

a. Bilateral: TUBS does not refer to bilateral instability.

b. Bankart: Correct. TUBS stands for Traumatic, Unidirectional, Bankart lesion, Surgery.

c. Buford: The Buford complex is a normal variant in shoulder anatomy, not related to TUBS.

d. Biceps: The biceps tendon is not referenced in the TUBS acronym.

Question 8

which of following is a factor that contributes to frozen shoulder

a. male

b dominant arm

c 20-30 years of age

d diabetes

Answer 8

d diabetes

Correct Answer: d. Diabetes

Explanation:

a. Male: Frozen shoulder is more common in females than in males.

b. Dominant arm: Frozen shoulder can affect either arm and is not necessarily associated with the dominant arm.

c. 20-30 years of age: Frozen shoulder is more common in people aged 40-60 years.

d. Diabetes: Correct. Diabetes is a known risk factor for developing frozen shoulder.

Question 9

which muscle is given a mechanical advantage following reverse total shoulder arthroplasty and is primarily responsible for shoulder elevation

a. trapezius

b biceps

c deltoid

d pectoralis major

Answer 9

c deltoid

Correct Answer: c. Deltoid

Explanation:

a. Trapezius: The trapezius muscle primarily contributes to scapular movement, not shoulder elevation.

b. Biceps: The biceps muscle primarily functions in elbow flexion and forearm supination, not shoulder elevation.

c. Deltoid: Correct. The deltoid muscle gains a mechanical advantage following reverse total shoulder arthroplasty and is primarily responsible for shoulder elevation.

d. Pectoralis major: The pectoralis major muscle primarily contributes to shoulder adduction and internal rotation, not elevation.

Question 10

a patient presents with weak and painless shoulder abduction and paresthesia of the lateral aspect of the deltoid this presentation is most consistent with

a . C6 radiculopathy

b spinal accessory nerve injury

c suprascapular nerve injury

d axillary nerve injury

Answer 10

d axillary nerve injury

Correct Answer: d. Axillary nerve injury

Explanation:

a. C6 radiculopathy: C6 radiculopathy typically presents with pain and/or weakness in the biceps and wrist extensors, not isolated shoulder abduction weakness.

b. Spinal accessory nerve injury: This injury would affect the trapezius muscle, leading to shoulder shrug weakness, not isolated shoulder abduction.

c. Suprascapular nerve injury: This would typically cause pain and weakness in shoulder abduction, but not paresthesia of the lateral deltoid.

d. Axillary nerve injury: Correct. The axillary nerve innervates the deltoid and teres minor muscles and provides sensation to the lateral aspect of the deltoid. An injury here would result in weak and painless shoulder abduction and paresthesia of the lateral deltoid.

Question 11

during an eval you suspect that a patient has subacromial impingement syndrome which special test would be most appropriate to confirm this diagnosis

a. Hawkins Kennedy test

b Jobe relocation test

c shoulder scour test

d clunk test

Answer 11

a. Hawkins Kennedy test

Correct Answer: a. Hawkins-Kennedy test

Explanation:

a. Hawkins-Kennedy test: Correct. This test involves flexing the shoulder and elbow to 90 degrees and then internally rotating the shoulder. Pain during this maneuver indicates
subacromial impingement.

b. Jobe relocation test: This test is used to diagnose anterior shoulder instability, not subacromial impingement.

c. Shoulder scour test: This test is used to assess for labral tears or joint surface irregularities, not specifically for subacromial impingement.

d. Clunk test: This test is used to detect a labral tear, not subacromial impingement.

Question 12

following a glenohumeral dislocation at what point is it safe to start a core rotator cuff exercise program

a. 1-3 weeks

b 3-6 weeks

c 6-8 weeks

d 8-12 weeks

Answer 12

b 3-6 weeks

Correct Answer: b. 3-6 weeks

Explanation:

a. 1-3 weeks: This time frame is generally too early for starting core rotator cuff exercises as it is typically a period for immobilization and initial healing.

b. 3-6 weeks: Correct. This time frame allows for some initial healing and stabilization, making it safer to begin a core rotator cuff exercise program.

c. 6-8 weeks: While this period is also safe, it is usually recommended to start rotator cuff exercises earlier to prevent muscle atrophy.

d. 8-12 weeks: This time frame is often too late, as starting rotator cuff exercises earlier is beneficial for rehabilitation.

Question 13

what does A in ambrII stand for

a. atraumatic

b avuncular

c accustomed

d adysplastic

Answer 13

a. atraumatic

Correct Answer: a. Atraumatic

Explanation:

a. Atraumatic: Correct. AMBRII stands for Atraumatic Multidirectional Bilateral Rehabilitation, with possible Inferior capsular shift and Interval closure. It refers to a type of shoulder instability.

b. Avuncular: This term is unrelated to shoulder instability.

c. Accustomed: This term is unrelated to shoulder instability.

d. Adysplastic: This term is unrelated to shoulder instability.

Question 14

you are going to perform a joint mobilization at the sternoclavicular joint with shoulder elevation range of motion in which direction and grade should you perform

a. superior

b inferior

c anterior

d posterior

Answer 14

b inferior

Correct Answer: b. Inferior

Explanation:

a. Superior: Mobilization in the superior direction would not aid shoulder elevation.

b. Inferior: Correct. To increase shoulder elevation, the sternoclavicular joint should be mobilized inferiorly, following the convex-concave rule.

c. Anterior: This direction would assist with protraction, not elevation.

d. Posterior: This direction would assist with retraction, not elevation.

Question 15

if injured which nerves below could present like a patient that has a rotator cuff tear

a. suprascapular

b thoracodorsal

c lower trunk brachial plexus

d radial

Answer 15

a. suprascapular

Correct Answer: a. Suprascapular

Explanation:

a. Suprascapular: Correct. Injury to the suprascapular nerve can lead to weakness in the supraspinatus and infraspinatus muscles, mimicking a rotator cuff tear.

b. Thoracodorsal: This nerve innervates the latissimus dorsi, not the rotator cuff muscles.

c. Lower trunk brachial plexus: Injury here would affect a broader range of muscles, not specifically mimicking a rotator cuff tear.

d. Radial: This nerve primarily affects the muscles in the posterior compartment of the arm and forearm, not the rotator cuff.

Question 16

a patient presents with decreased shoulder abduction secondary to a capsular restriction based on the convex concave rule in which direction should you mobilize the glenohumeral joint

a. superior

b inferior

c posterior

d anterior

Answer 16

b inferior

Correct Answer: b. Inferior

Explanation:

a. Superior: Mobilizing in the superior direction would not help increase shoulder abduction.

b. Inferior: Correct. According to the convex-concave rule, mobilizing the convex humeral head inferiorly will help increase shoulder abduction.

c. Posterior: This direction is more appropriate for improving internal rotation.

d. Anterior: This direction is more appropriate for improving external rotation.

Question 17

which of the below visceral structures would refer pain to the left shoulder

a. diaphragm

b stomach

c gallbladder

d liver

Answer 17

a. diaphragm

Correct Answer: a. Diaphragm

Explanation:

a. Diaphragm: Correct. Irritation of the diaphragm can refer pain to the left shoulder via the phrenic nerve.

b. Stomach: Pain from the stomach generally refers to the epigastric region, not the shoulder.

c. Gallbladder: Gallbladder pain typically refers to the right shoulder or scapular area.

d. Liver: Liver pain usually refers to the right upper quadrant and right shoulder.

Question 18

a patient is 3 weeks s/p rotator cuff repair which of the following is most appropriate intervention at this time

a. shoulder AAROM into flexion and abduction

b shoulder isometrics of the shoulder external rotators

c shoulder PROM into all cardinal planes

d shoulder isotonic exercises in external rotation and scaption

Answer 18

c shoulder PROM into all cardinal planes

Correct Answer: c. Shoulder PROM into all cardinal planes

Explanation:

a. Shoulder AAROM into flexion and abduction: Active-assisted range of motion may still place too much stress on the repair site at this early stage.

b. Shoulder isometrics of the shoulder external rotators: Isometrics might still be too early depending on the protocol and surgeon’s recommendations.

c. Shoulder PROM into all cardinal planes: Correct. Passive range of motion is typically safe and recommended to prevent stiffness and adhesions.

d. Shoulder isotonic exercises in external rotation and scaption: Isotonic exercises are usually introduced later in the rehabilitation process, not at 3 weeks post-op.

Question 19

a patient exhibits a 3/5 mmt of shoulder external rotation you believe the weakness is due to peripheral nerve injury which nerve if injured would result in this strength deficit

a. dorsal scapular

b suprascapular

c musculocutaneous

d radial

Answer 19

b suprascapular

Correct Answer: b. Suprascapular

Explanation:

a. Dorsal scapular: This nerve innervates the rhomboids and levator scapulae, not the muscles responsible for external rotation.

b. Suprascapular: Correct. The suprascapular nerve innervates the supraspinatus and infraspinatus muscles, both of which are responsible for external rotation of the shoulder.

c. Musculocutaneous: This nerve innervates the biceps brachii and brachialis, not the muscles responsible for shoulder external rotation.

d. Radial: This nerve primarily affects the muscles in the posterior compartment of the arm and forearm, not the shoulder external rotators.

Question 20

you are covering football game and run out to a player on the field to eval them. the player states his shoulder glenohumeral joint is dislocated where would you palpate their shoulder first to determine the direction of dislocation

a. anterior

b posterior

c inferior

d superior

Answer 20

a. anterior

Correct Answer: a. Anterior

Explanation:

a. Anterior: Correct. The most common direction for a shoulder dislocation is anterior. Palpation in this area would help confirm the direction of the dislocation.

b. Posterior: Posterior dislocations are less common and typically occur due to specific mechanisms of injury.

c. Inferior: Inferior dislocations are rare and often occur due to hyperabduction of the arm.

d. Superior: Superior dislocations are extremely rare and typically result from high-energy trauma.

Question 21

a patient presents with a traction injury of the left shoulder you suspect damage to the superior glenohumeral ligament with this injury you would expect joint laxity in which direction

a. superior

b posterior

c anterior

d inferior

Answer 21

d inferior

Correct Answer: d. Inferior

Explanation:

a. Superior: The superior glenohumeral ligament provides support against inferior translation of the humeral head. Superior laxity is not typically associated with its injury.

b. Posterior: Posterior laxity is usually associated with the posterior structures, not the superior glenohumeral ligament.

c. Anterior: Anterior laxity involves the anterior structures of the shoulder, not the superior glenohumeral ligament.

d. Inferior: Correct. The superior glenohumeral ligament primarily restricts inferior translation of the humeral head, so its damage would result in inferior joint laxity.

Question 22

a S.L.A.P. lesion can involve which of the below structures

a. supraspinatus

b biceps (shorthead)

c glenoid labrum

d middle glenohumeral ligament

Answer 22

c glenoid labrum

Correct Answer: c. Glenoid labrum

Explanation:

a. Supraspinatus: This muscle is part of the rotator cuff and not directly involved in a SLAP lesion.

b. Biceps (short head): The short head of the biceps attaches to the coracoid process, not the labrum.

c. Glenoid labrum: Correct. A SLAP (Superior Labrum Anterior and Posterior) lesion involves the superior part of the glenoid labrum.

d. Middle glenohumeral ligament: This ligament stabilizes the shoulder but is not involved in a SLAP lesion.

Question 23

frozen shoulder can take up to blank time to resolve

a. 6 months

b 2 years

c 5 years

d 10 years

Answer 23

b 2 years

Correct Answer: b. 2 years

Explanation:

a. 6 months: Frozen shoulder typically takes longer than 6 months to fully resolve.

b. 2 years: Correct. Frozen shoulder can take up to 2 years to resolve, as it progresses through the freezing, frozen, and thawing phases.

c. 5 years: This duration is generally longer than the typical course of frozen shoulder.

d. 10 years: Frozen shoulder does not usually take this long to resolve.

Question 24

a 20 year old pitcher reports posterior shoulder pain during throwing they report pain occurs during cocking phase of throwing which of the following is most likely contributing factor to patient’s pain

a. primary impingement

b frozen shoulder

c anterior shoulder instability

d Os acromial

Answer 24

c anterior shoulder instability

Correct Answer: c. Anterior shoulder instability

Explanation:

a. Primary impingement: This condition usually causes pain in the anterior shoulder, not posterior.

b. Frozen shoulder: This condition limits shoulder range of motion and is unlikely in a young, active pitcher.

c. Anterior shoulder instability: Correct. Anterior instability can cause posterior shoulder pain due to overuse and compensatory mechanisms during the cocking phase of throwing.

d. Os acromiale: This condition involves a failure of acromial ossification, which is rare and less likely to be the primary cause of the described symptoms.

Question 25

a patient sustained a hill Sachs lesion based on nature of the injury which direction did the humeral head dislocate

a anterior

b posterior

c inferior

d superior

Answer 25

a anterior

Correct Answer: a. Anterior

Explanation:

a. Anterior: Correct. A Hill-Sachs lesion is a compression fracture of the posterolateral aspect of the humeral head, commonly caused by anterior dislocation.

b. Posterior: Posterior dislocations do not typically result in a Hill-Sachs lesion.

c. Inferior: Inferior dislocations are rare and not associated with Hill-Sachs lesions.

d. Superior: Superior dislocations are extremely rare and not associated with Hill-Sachs lesions.

Question 26

a patient sustained a shoulder injury they are weak with combined glenohumeral extension adduction and internal rotation given the weakness with the combined motion which nerve is most likely injured

a. lower subscapular nerve

b scapulothoracic nerve

c dorsal scapular nerve

d radial nerve

Answer 26

a. lower subscapular nerve

Correct Answer: a. Lower subscapular nerve

Explanation:

a. Lower subscapular nerve: Correct. This nerve innervates the
subscapularis and teres major muscles, which are responsible for internal rotation, extension, and adduction of the shoulder

b. Scapulothoracic nerve: This nerve does not exist. It might be a mix-up with nerves innervating scapular muscles.

c. Dorsal scapular nerve: This nerve innervates the rhomboids and levator scapulae, not the muscles involved in the described movements.

d. Radial nerve: This nerve primarily innervates the extensor muscles of the forearm, not the shoulder muscles.

Question 27

You are reading a patient’s chart and note the patient had a negative load and shift test and sulcus sign. This decreases the likelihood of what condition?

A. Glenohumeral instability
B. Subacromial impingement
C. Deltoid bursitis
D. Adhesive capsulitis

Answer 27

A. Glenohumeral instability

Correct Answer: a. Glenohumeral instability

Explanation:

a. Glenohumeral instability: Correct. Negative load and shift test and sulcus sign decrease the likelihood of glenohumeral instability.

b. Subacromial impingement: These tests are not used to diagnose subacromial impingement.

c. Deltoid bursitis: These tests are not used to diagnose deltoid bursitis.

d. Adhesive capsulitis: These tests are not used to diagnose adhesive capsulitis.

Question 28

A 19-year-old female swimmer reports to physical therapy complaining of right shoulder pain during and after swimming. The pain is diffuse about the shoulder; however, she does have one specific focal point just below the anterior/lateral aspect of the acromion that is extremely tender. She reports her pain as a “7” on a 1-10 scale during swimming and 1-2 after swimming. She does report recurrent ankle sprains and a history of a subluxing patella. She denies neck pain.

Observation: Forward flexed head, rounded shoulders, elbow hyperextension, and genu recurvatum bilaterally.
ROM: AROM & PROM of the bilateral upper limbs are all WNL. Many of the upper limb joint ROMs are greater than normal.
MMT: The right supraspinatus, infraspinatus, teres minor, and subscapularis are 4/5.
Reflex/Sensation: +1 Biceps/Brachioradialis/Triceps-bilateral, Sensation is WNL bilateral.

During the observation portion of this examination, you noted a forward flexed head and rounded shoulders. What two muscle groups, if abnormally shortened, would cause these postural changes seen in this patient?

A. Pectoralis Major and Deep Anterior Cervical Flexors
B. Pectoralis Minor and Sub-Occipitals
C. Middle Trapezius and Rhomboids
D. Lower Trapezius and Serratus Anterior

Answer 28

B. Pectoralis Minor and Sub-Occipitals

Correct Answer: b. Pectoralis Minor and Sub-Occipitals

Explanation:

a. Pectoralis Major and Deep Anterior Cervical Flexors: While the pectoralis major can contribute to rounded shoulders, the deep anterior cervical flexors would cause forward head posture, not specifically related to rounded shoulders.

b. Pectoralis Minor and Sub-Occipitals: Correct. The pectoralis minor contributes to rounded shoulders, and the sub-occipital muscles contribute to a forward flexed head posture.

c. Middle Trapezius and Rhomboids: These muscles, when weak, contribute to poor posture but are not responsible for the described postural changes.

d. Lower Trapezius and Serratus Anterior: Weakness in these muscles can cause poor scapular stability, but they do not contribute to the described postural changes directly.

Question 29

A 19-year-old college baseball pitcher presents with complaints of left shoulder pain, clicking, and reports that his shoulder goes ‘dead shoulder’ when pitching. Combined passive horizontal adduction and internal rotation do not reproduce his symptoms. His presentation is consistent with?

A. Subacromial impingement syndrome
B. Chronic shoulder instability and/or labral pathology
C. Rotator cuff tear
D. Chronic glenohumeral osteoarthritis

Answer 29

B. Chronic shoulder instability and/or labral pathology

Correct Answer: b. Chronic shoulder instability and/or labral pathology

Explanation:

a. Subacromial impingement syndrome: This condition would typically present with pain during shoulder elevation and specific impingement tests, not ‘dead shoulder.’

b. Chronic shoulder instability and/or labral pathology: Correct. The symptoms of clicking, pain, and ‘dead shoulder’ suggest instability or labral issues, common in overhead athletes.

c. Rotator cuff tear: While a rotator cuff tear can cause pain, the described symptoms suggest instability or labral pathology.

d. Chronic glenohumeral osteoarthritis: This condition would typically present with pain and stiffness, not the described symptoms of ‘dead shoulder.’

Question 30

You are evaluating a patient who is one-week S/P biceps tenodesis. Which of the following activities should be avoided to avoid damage to the surgical site?

A. PROM of the glenohumeral joint
B. AROM of radiocarpal joint
C. AROM of humeroulnar joint
D. Scapular retraction and adduction exercises

Answer 30

A. PROM of the glenohumeral joint

Correct Answer: c. AROM of humeroulnar joint

Explanation:

a. PROM of the glenohumeral joint: PROM is generally safe post-surgery to maintain mobility without stressing the repaired tendon.

b. AROM of radiocarpal joint: AROM of the wrist joint does not stress the surgical site and is typically allowed.

c. AROM of humeroulnar joint: Correct. Active range of motion at the elbow can place stress on the repaired biceps tendon, potentially leading to damage or re-injury at the surgical site.

d. Scapular retraction and adduction exercises: These exercises generally do not stress the surgical site of a biceps tenodesis and can often be safely performed.

Question 31

During shoulder abduction, how many degrees of motion are contributed by the scapulothoracic joint, assuming total shoulder abduction is 180 degrees?

A. 180
B. 120
C. 80
D. 60

Answer 31

D. 60

Correct Answer: d. 60

Explanation:

a. 180: This is the total range of shoulder abduction, not just the scapulothoracic joint contribution.

b. 120: This is the contribution of the glenohumeral joint to shoulder abduction, not the scapulothoracic joint.

c. 80: This number is incorrect based on the typical scapulohumeral rhythm.

d. 60: Correct. The scapulothoracic joint contributes approximately 60 degrees to the total 180 degrees of shoulder abduction.

Question 32

What type of injury of the shoulder will most likely result in a Bankart lesion?

A. Rotator Cuff Tear
B. Shoulder Dislocation
C. Fracture of the greater tuberosity of the humerus
D. Biceps Longhead Rupture

Answer 32

B. Shoulder Dislocation

Correct Answer: b. Shoulder Dislocation

Explanation:

a. Rotator Cuff Tear: This injury involves the tendons and muscles surrounding the shoulder joint but does not cause a Bankart lesion.

b. Shoulder Dislocation: Correct. An anterior shoulder dislocation commonly causes a Bankart lesion, which is a tear of the anterior inferior labrum.

c. Fracture of the greater tuberosity of the humerus: This type of fracture does not typically result in a Bankart lesion.

d. Biceps Longhead Rupture: This injury involves the biceps tendon and does not cause a Bankart lesion.

Question 32

A grade III acromioclavicular separation results in damage to the following ligaments.

A. Rupture of the coracoacromial ligament, superior/inferior AC joint ligaments, and the coracohumeral ligament.
B. Rupture of the coracohumeral ligament, superior/inferior AC joint ligaments, and the coracoclavicular ligaments.
C. Rupture of the superior/inferior AC joint ligaments and coracohumeral ligaments.
D. Rupture of the superior/inferior AC joint ligaments and the coracoclavicular ligaments.

Answer 32

D. Rupture of the superior/inferior AC joint ligaments and the coracoclavicular ligaments.

Correct Answer: d. Rupture of the superior/inferior AC joint ligaments and the coracoclavicular ligaments.

Explanation:

a. Rupture of the coracoacromial ligament, superior/inferior AC joint ligaments, and the coracohumeral ligament: This combination of ligament damage is incorrect for a grade III AC separation.

b. Rupture of the coracohumeral ligament, superior/inferior AC joint ligaments, and the coracoclavicular ligaments: The coracohumeral ligament is not involved in an AC separation.

c. Rupture of the superior/inferior AC joint ligaments and coracohumeral ligaments: The coracohumeral ligament is not involved in an AC separation.

d. Rupture of the superior/inferior AC joint ligaments and the coracoclavicular ligaments: Correct. A grade III AC separation involves the complete rupture of these ligaments.

Question 33

A patient has a history of multiple shoulder injuries with complaints of intermittent shoulder pain, weakness, and clicking in the glenohumeral joint. As you plan the objective examination, which special tests should be included?

A. Hawkins Kennedy and Neer
B. Acromioclavicular Shear and Cross Body Adduction
C. Load and Shift and Biceps Load II
D. Spurling’s test and Hawkins Kennedy

Answer 33

C. Load and Shift and Biceps Load II

Correct Answer: c. Load and Shift and Biceps Load II

Explanation:

a. Hawkins Kennedy and Neer: These tests are used to diagnose subacromial impingement, not shoulder instability or labral pathology.

b. Acromioclavicular Shear and Cross Body Adduction: These tests assess AC joint pathology, not glenohumeral joint instability or labral issues.

c. Load and Shift and Biceps Load II: Correct. These tests are used to assess glenohumeral joint instability and labral pathology.

d. Spurling’s test and Hawkins Kennedy: Spurling’s test is used for cervical radiculopathy, and Hawkins Kennedy is for subacromial impingement, neither of which are relevant to the described symptoms.

Question 34

A 37-year-old male reports to physical therapy with complaints of recurrent right shoulder pain that never actually fully recovers with rest and medication (To date he has undergone pharmacological treatment consisting of NSAID and 3 steroid injections). He reports having undergone physical therapy on two occasions that “helped little”. If the above-mentioned patient did not have a favorable outcome from a third bout of physical therapy, what would be the next step in this patient’s care?

A. A third trial of physical therapy
B. A 4th Intraarticular steroid injection
C. Subacromial decompression surgery
D. Rotator Cuff Repair surgery

Answer 34

C. Subacromial decompression surgery

Correct Answer: c. Subacromial decompression surgery

Explanation:

a. A third trial of physical therapy: Given the patient’s lack of improvement with previous physical therapy, this is unlikely to be beneficial.

b. A 4th Intraarticular steroid injection: Multiple steroid injections can have adverse effects and are unlikely to provide long-term relief.

c. Subacromial decompression surgery: Correct. This surgical option can relieve pain and improve function when conservative treatments have failed.

d. Rotator Cuff Repair surgery: This surgery is specific to rotator cuff tears and may not be appropriate if the issue is subacromial impingement.

Question 35

You are working with a 22-year-old hockey player who sustained a left shoulder injury. Utilizing the picture, what condition is most likely?

A. Acromioclavicular joint sprain
B. Sternoclavicular joint sprain
C. Anterior Glenohumeral joint subluxation
D. Rotator cuff tear

Answer 35

A. Acromioclavicular joint sprain

Correct Answer: a. Acromioclavicular joint sprain

Explanation:

a. Acromioclavicular joint sprain: Correct. The mechanism of injury and common occurrence in contact sports make this the most likely diagnosis.

b. Sternoclavicular joint sprain: Less likely in this context compared to AC joint sprain.

c. Anterior Glenohumeral joint subluxation: This is possible but less likely given the mechanism and description.

d. Rotator cuff tear: This could occur, but the described scenario fits an AC joint sprain better.

Question 36

A 19-year-old female swimmer reports to physical therapy complaining of right shoulder pain during and after swimming. The pain is diffuse about the shoulder; however, she does have one specific focal point just below the anterior/lateral aspect of the acromion that is extremely tender. She reports her pain as a “7” on a 1-10 scale during swimming and 1-2 after swimming. She does report recurrent ankle sprains and a history of a subluxing patella. She denies neck pain.

Observation: Forward flexed head, rounded shoulders, elbow hyperextension, and genu recurvatum bilaterally.
ROM: AROM & PROM of the bilateral upper limbs are all WNL. Many of the upper limb joint ROMs are greater than normal.
MMT: The right supraspinatus, infraspinatus, teres minor, and subscapularis are 4/5. MMT of supraspinatus muscle test generates mild-moderate pain. Biceps/triceps = 5/5.
Reflex/Sensation: +1 Biceps/Brachioradialis/Triceps-bilateral, Sensation is WNL bilateral.

Based on the above information, what is the most likely diagnosis for this patient based on the subjective and objective findings?

A. Primary Impingement
B. Secondary Impingement
C. Labral injury (SLAP, Bankart)
D. Rotator cuff tear

Answer 36

B. Secondary Impingement

Correct Answer: b. Secondary Impingement

Explanation:

a. Primary Impingement: This typically occurs in older adults due to degenerative changes, not in young athletes with hypermobility.

b. Secondary Impingement: Correct. This condition is common in young athletes with hypermobility and muscle imbalances, leading to abnormal movement patterns and impingement.

c. Labral injury (SLAP, Bankart): While possible, the diffuse pain and hypermobility make secondary impingement more likely.

d. Rotator cuff tear: While there is some pain with supraspinatus testing, the overall presentation is more consistent with secondary impingement.

Question 37

You are preparing to evaluate a patient with shoulder pain. The patient has had an orthopedic medical consult states the patient has a grade 2 “Load and Shift” test. The most likely interpretation of this statement is?

A. The humeral head rides over the glenoid rim and stays dislocated
B. Normal laxity
C. The humeral head rides over the glenoid rim but reduces
D. The humeral head rides up to but not over the glenoid rim

Answer 37

C. The humeral head rides over the glenoid rim but reduces

Correct Answer: c. The humeral head rides over the glenoid rim but reduces

Explanation:

a. The humeral head rides over the glenoid rim and stays dislocated: This would indicate a grade 3 instability.

b. Normal laxity: This would be a grade 0 or 1 on the load and shift test.

c. The humeral head rides over the glenoid rim but reduces: Correct. Grade 2 indicates the humeral head dislocates but then reduces spontaneously.

d. The humeral head rides up to but not over the glenoid rim: This describes a grade 1 instability.

Question 38

A 43-year-old female with diabetes presents with shoulder pain and symptoms consistent with adhesive capsulitis, exhibiting a high level of irritability. At this stage of her recovery, what should the physical therapist focus on in their treatment approach?

A. Regaining shoulder elevation by using grade III and IV mobilizations
B. Patient education and encourage patient to wear a sling when she is out of her home
C. Pain control by using grade I and II mobilizations and pain-free mobility exercises
D. Progressive strength training with a focus on functional activities

Answer 38

C. Pain control by using grade I and II mobilizations and pain-free mobility exercises

Correct Answer: c. Pain control by using grade I and II mobilizations and pain-free mobility exercises

Explanation:

a. Regaining shoulder elevation by using grade III and IV mobilizations: Aggressive mobilizations are not appropriate in the high-irritability stage.

b. Patient education and encourage patient to wear a sling when she is out of her home: This may promote stiffness and is not generally recommended.

c. Pain control by using grade I and II mobilizations and pain-free mobility exercises: Correct. Gentle mobilizations and pain-free exercises help manage pain and maintain some mobility.

d. Progressive strength training with a focus on functional activities: Strength training is more appropriate in later stages when irritability is lower.

Question 39

A patient presents with difficulty moving their left shoulder into abduction, which is not associated with pain. They state it started 3 weeks ago after they dislocated their left shoulder. The middle deltoid demonstrates a 3/5 MMT and is painless. What is your preliminary impression?

A. Supraspinatus tear
B. Infraspinatus tear
C. Axillary nerve injury
D. Biceps Long Head Rupture

Answer 39

C. Axillary nerve injury

Correct Answer: c. Axillary nerve injury

Explanation:

a. Supraspinatus tear: This would likely cause pain and weakness, not painless weakness.

b. Infraspinatus tear: This would cause weakness in external rotation, not abduction.

c. Axillary nerve injury: Correct. The axillary nerve innervates the deltoid muscle, and its injury can cause painless weakness in shoulder abduction.

d. Biceps Long Head Rupture: This would cause weakness in elbow flexion and shoulder flexion, not isolated weakness in abduction.

Question 40

A patient presents with right shoulder pain secondary to a fall on the shoulder during a soccer match.

Findings include:

Point tenderness over the lateral aspect of the shoulder
Positive horizontal adduction test
Pain with shoulder flexion and scapular plane elevation in the last few degrees of the motion arc.
These findings are most consistent with?

A. Rotator Cuff Tear
B. Acromioclavicular joint sprain
C. Sternoclavicular joint sprain
D. Fracture of the acromion

Answer 40

B. Acromioclavicular joint sprain

Correct Answer: b. Acromioclavicular joint sprain

Explanation:

a. Rotator Cuff Tear: A rotator cuff tear typically presents with pain during shoulder movements but is more commonly associated with weakness in specific rotator cuff muscles and positive impingement tests.

b. Acromioclavicular joint sprain: Correct. Point tenderness over the lateral aspect of the shoulder, a positive horizontal adduction test, and pain with shoulder flexion and scapular plane elevation are consistent with an AC joint sprain.

c. Sternoclavicular joint sprain: This injury would present with pain and tenderness near the sternoclavicular joint, not the lateral aspect of the shoulder.

d. Fracture of the acromion: A fracture would likely present with severe pain, possibly deformity, and a history of significant trauma.

Question 41

A 16-year-old female softball player (third baseman) reports pain in the right shoulder. She reports that throwing increases her shoulder pain and that she is unable to lie on her right shoulder at night. She states that most of her pain is located over the anterior aspect of her shoulder and that she can pinpoint the exact location.

Observation: Very thin and tall stature, increased valgus at the elbows bilaterally, genu recurvatum noted.
ROM: WNL
MMT: 4+/5 supraspinatus (painful), all other rotator cuff muscles 5/5.
Reflex/sensation: intact
Palpation: Tenderness noted over the shoulder’s anterior lateral aspect, inferior to the acromion.
Special tests: Load and Shift = positive, Sulcus sign = positive.

How would you classify this patient’s shoulder dysfunction?

A. Primary impingement
B. Secondary impingement
C. Posterior impingement
D. Labral impingement

Answer 41

B. Secondary impingement

Correct Answer: b. Secondary impingement

Explanation:

a. Primary impingement: This is more common in older adults and typically involves degenerative changes, not common in a young athlete.

b. Secondary impingement: Correct. The history of hypermobility, positive load and shift, and sulcus sign indicate instability leading to secondary impingement.

c. Posterior impingement: This typically occurs with pain during shoulder external rotation and abduction, not described here.

d. Labral impingement: Labral injuries are possible but are typically associated with clicking or catching sensations, not purely anterior shoulder pain with a history of hypermobility.

Question 42

Which diagnosis is most consistent with the following exam findings?

Resisted isometrics: External rotation weak and painful, abduction strong and painless, elbow flexion strong and painless.
Palpation: Tender over posterior greater tuberosity, anterior shoulder non-tender
PROM: Internal rotation limited and painful

A. Infraspinatus tear
B. Subscapularis tear
C. Supraspinatus tear
D. Medial deltoid tear

Answer 42

A. Infraspinatus tear

Correct Answer: a. Infraspinatus tear

Explanation:

a. Infraspinatus tear: Correct. Weak and painful external rotation, tenderness over the posterior greater tuberosity, and painful internal rotation are consistent with an infraspinatus tear.

b. Subscapularis tear: This would likely present with weakness in internal rotation and pain in the anterior shoulder.

c. Supraspinatus tear: This would present with pain and weakness in abduction, not external rotation.

d. Medial deltoid tear: This would present with weakness and possibly pain in abduction.

Question 43

A patient presents with left shoulder pain and limited motion and is referred for evaluation and treatment of left shoulder adhesive capsulitis. They present with full abduction yet accompanied by a painful arc, normal scapulohumeral rhythm, positive Hawkin’s Kennedy and Neer’s tests, and normal passive range of motion, what would be the optimal course of action?

A. Continue with the evaluation, document that the patient’s signs and symptoms are consistent with shoulder impingement syndrome
B. Confirm the diagnosis of adhesive capsulitis
C. Refer the patient back to the primary care physician
D. Continue with the evaluation, document the patient’s signs and symptoms are consistent with glenohumeral instability

Answer 43

A. Continue with the evaluation, document that the patient’s signs and symptoms are consistent with shoulder impingement syndrome

Correct Answer: a. Continue with the evaluation, document that the patient’s signs and symptoms are consistent with shoulder impingement syndrome

Explanation:

a. Continue with the evaluation, document that the patient’s signs and symptoms are consistent with shoulder impingement syndrome: Correct. The described findings are more consistent with impingement rather than adhesive capsulitis.

b. Confirm the diagnosis of adhesive capsulitis: The presence of full abduction and normal passive ROM contradicts this diagnosis.

c. Refer the patient back to the primary care physician: Referral is unnecessary at this stage since the findings align with impingement syndrome.

d. Continue with the evaluation, document the patient’s signs and symptoms are consistent with glenohumeral instability: The findings do not indicate instability.

Question 44

When examining this radiograph of the left shoulder you note the following finding depicted by the red arrow. This radiographic finding is pathognomonic of:

A. Posterior impingement
B. Anterior glenohumeral dislocation
C. Osteoarthritis of the glenohumeral joint
D. Frozen shoulder

Answer 44

B. Anterior glenohumeral dislocation

Correct Answer: b. Anterior glenohumeral dislocation

Explanation:

a. Posterior impingement: This would show a different radiographic finding, usually associated with the posterior shoulder.

b. Anterior glenohumeral dislocation: Correct. The red arrow likely points to a sign such as the Hill-Sachs lesion or displacement indicating anterior dislocation.

c. Osteoarthritis of the glenohumeral joint: This would show joint space narrowing, osteophytes, and sclerosis, not dislocation.

d. Frozen shoulder: This would not show any specific pathognomonic radiographic findings.

Question 45

A 42-year-old patient sustained a grade I AC joint separation. The patient has been in physical therapy for 3 months, he is progressing well and he has been given clearance to resume all activities within his tolerance. One of his goals is to return to Nordic skiing, which requires multiple repetitions of upper extremity swinging. At this stage, the best exercise type to return to this form of exercise would be?

A. Engage in light resistance, high repetition resistance exercise
B. Engage in high-weight, low-repetition resistance exercise
C. Encourage cross-training by engaging in swimming
D. Engage in upper extremity plyometrics to improve power

Answer 45

A. Engage in light resistance, high repetition resistance exercise

Correct Answer: a. Engage in light resistance, high repetition resistance exercise

Explanation:

a. Engage in light resistance, high repetition resistance exercise: Correct. This approach is best to build endurance and prepare the shoulder for repetitive activities.

b. Engage in high-weight, low-repetition resistance exercise: This is more suitable for strength building, not endurance.

c. Encourage cross-training by engaging in swimming: While beneficial, it does not specifically target the endurance required for Nordic skiing.

d. Engage in upper extremity plyometrics to improve power: Plyometrics are more focused on power, not endurance.

Question 46

A patient is five weeks S/P rotator cuff repair. The protocol states that glenohumeral AROM and sub-maximal isometrics can be performed at six weeks. The patient is making excellent progress, has prior habits of exercise, is in excellent health, and is very motivated. The patient asks if he can start to actively move his shoulder. Your best response is?

A. Allow the patient to begin gentle glenohumeral AROM based on the patient’s current status
B. Progress to glenohumeral isometrics and gentle resistive exercise per tolerance
C. Encourage the patient to resume functional activities but stay within tolerance
D. Continue to progress per the surgeon’s protocol

Answer 46

D. Continue to progress per the surgeon’s protocol

Correct Answer: d. Continue to progress per the surgeon’s protocol

Explanation:

a. Allow the patient to begin gentle glenohumeral AROM based on the patient’s current status: Premature movement can jeopardize the repair.

b. Progress to glenohumeral isometrics and gentle resistive exercise per tolerance: This goes against the protocol timeline.

c. Encourage the patient to resume functional activities but stay within tolerance: This can still risk the integrity of the surgical repair.

d. Continue to progress per the surgeon’s protocol: Correct. Adhering to the protocol is crucial to ensure proper healing.

Question 47

A 16-year-old female softball player (third baseman) reports pain in the right shoulder. She reports that throwing increases her shoulder pain and that she is unable to lie on her right shoulder at night. She states that most of her pain is located over the anterior aspect of her shoulder and that she can pinpoint the exact location.

Observation: Very thin and tall stature, increased valgus at the elbows bilaterally, genu recurvatum noted.
ROM: WNL
MMT: 4+/5 supraspinatus (painful), all other rotator cuff muscles 5/5
Reflex/sensation: intact
Palpation: Tenderness noted over the shoulder’s anterior lateral aspect, inferior to the acromion.
Special tests: Load and Shift = positive, Sulcus sign = positive.

What anatomical structure do you believe is involved?

A. Long head of biceps tendon
B. AC joint
C. Suprascapularis tendon
D. Supraspinatus tendon

Answer 47

A. Long head of biceps tendon

Correct Answer: a. Long head of biceps tendon

Explanation:

a. Long head of biceps tendon: Correct. The location of tenderness and pain, especially with overhead activity, indicates biceps tendinitis.

b. AC joint: This would present with point tenderness directly over the AC joint and pain with horizontal adduction.

c. Suprascapularis tendon: This muscle does not exist. Likely a confusion with the supraspinatus tendon.

d. Supraspinatus tendon: While painful with MMT, the pinpoint anterior pain and tenderness indicate biceps involvement.

Question 48

A 19-year-old female swimmer reports to physical therapy complaining of right shoulder pain during and after swimming. The pain is diffuse about the shoulder; however, she does have one specific focal point just below the anterior/lateral aspect of the acromion that is extremely tender. She reports her pain as a “7” on a 1-10 scale during swimming and 1-2 after swimming. She does report recurrent ankle sprains and a history of a subluxing patella. She denies neck pain.

Observation: Forward flexed head, rounded shoulders, elbow hyperextension, and genu recurvatum bilaterally.
ROM: AROM & PROM of the bilateral upper limbs are all WNL. Many of the upper limb joint ROMs are greater than normal.
MMT: The right supraspinatus, infraspinatus, teres minor, and subscapularis are 4/5.
Reflex/Sensation: +1 Biceps/Brachioradialis/Triceps-bilateral, Sensation is WNL bilateral.

Based on this patient’s subjective and objective history, which of the below exercise regimes would most benefit this patient?

A. Glenohumeral joints mobilizations (grade 3), glenohumeral stretching, rotator cuff program
B. Tricep press downs, biceps curls, rhomboid exercises
C. Scapular stabilizer program, rotator cuff program, dynamic stability exercises
D. Patient education, posture instruction, and glenohumeral joints mobilizations (grade 2)

Answer 48

C. Scapular stabilizer program, rotator cuff program, dynamic stability exercises

Correct Answer: c. Scapular stabilizer program, rotator cuff program, dynamic stability exercises

Explanation:

a. Glenohumeral joints mobilizations (grade 3), glenohumeral stretching, rotator cuff program: Mobilizations and stretching may not address the underlying instability.

b. Tricep press downs, biceps curls, rhomboid exercises: These exercises do not specifically target the needed stabilizers.

c. Scapular stabilizer program, rotator cuff program, dynamic stability exercises: Correct. These exercises address the underlying instability and muscle imbalances.

d. Patient education, posture instruction, and glenohumeral joints mobilizations (grade 2): While beneficial, it is less targeted than option C.

Question 49

A 16-year-old female softball player (third baseman) reports pain in the right shoulder. She reports that throwing increases her shoulder pain and that she is unable to lie on her right shoulder at night. She states that most of her pain is located over the anterior aspect of her shoulder and that she can pinpoint the exact location.

Observation: Very thin and tall stature, increased valgus at the elbows bilaterally, genu recurvatum noted.
ROM: WNL
MMT: 4+/5 supraspinatus (painful), all other rotator cuff muscles 5/5.
Reflex/sensation: intact
Palpation: Tenderness noted over the shoulder’s anterior lateral aspect, inferior to the acromion.
Special tests: Load and Shift = positive, Sulcus sign = positive.

What is the BEST intervention for this patient?

A. Rotator cuff and scapula-thoracic stability exercises
B. Glenohumeral joint mobilizations to increase capsular mobility
C. Iontophoresis over biceps tendon
D. Immobilize in a sling 6-8 weeks

Answer 49

A. Rotator cuff and scapula-thoracic stability exercises

Correct Answer: a. Rotator cuff and scapula-thoracic stability exercises

Explanation:

a. Rotator cuff and scapula-thoracic stability exercises: Correct. These exercises address muscle imbalances and instability.

b. Glenohumeral joint mobilizations to increase capsular mobility: Mobilizations are not the primary need given the instability.

c. Iontophoresis over biceps tendon: This may help with pain but does not address the underlying instability.

d. Immobilize in a sling 6-8 weeks: Immobilization is not indicated and would lead to further muscle weakness and stiffness.

Question 50

A patient presents with complaints of upper rib and posterior shoulder pain, along with intermittent upper extremity paresthesia. The patient has a history of smoking, diabetes, and a sedentary lifestyle. Examination of the cervical spine and upper limb do not demonstrate any impairments or reproduce the patient’s pain. The patient describes the pain as deep in the shoulder and shoulder blade area. Based on this information, what is a possible diagnosis and your action?

A. Pancoast tumor, refer to a medical doctor
B. Cervical radiculopathy, treat the patient
C. Non-displaced third rib fracture, treat the patient
D. Gastroesophageal reflux disease, refer to a medical doctor

Answer 50

A. Pancoast tumor, refer to a medical doctor

Correct Answer: a. Pancoast tumor, refer to a medical doctor

Explanation:

a. Pancoast tumor, refer to a medical doctor: Correct. The symptoms, especially with the history of smoking and deep shoulder pain, suggest a Pancoast tumor, requiring immediate medical referral.

b. Cervical radiculopathy, treat the patient: The cervical exam did not reproduce symptoms, making this diagnosis less likely.

c. Non-displaced third rib fracture, treat the patient: There is no history or mechanism of injury suggesting a rib fracture.

d. Gastroesophageal reflux disease, refer to a medical doctor: While GERD can cause referred pain, the deep shoulder pain and history of smoking point more towards a Pancoast tumor.