MSK Prac Exam

Question 1

What special tests can assist in diagnosing achilles tendinopathy and an achilles rupture?

Answer 1

For tendinopathy:
1. Royal London Hospital Test (looking for pain in tendon during plantarflexion, a positive test will reduce the pain when maximally dorsiflexed)
2. The Arc test (palpate to find tenderness, then patient plantar and dorsiflexes, a positive test moves the swelling point with the flexion)

To assess the integrity of the tendon (rupture/tear)
1. Thompson’s test (squeeze the calf)
2. Gap palpation test (palpate the tendon)
3. Matles test (the foot drop when in prone)

Question 2

What special tests would you use for an ankle sprain?

Answer 2

1. Anterior drawer test (ATFL laxity)
2. Talar tilt test (inversion/eversion stress test) - assesses ATFL, CFL, deltoid ligament
3. Figure of 8 swelling test (mark the points with a pen first and then measure)
4. Rule out fracture with Ottawa Ankle Rules

Question 3

What are the Ottawa Ankle Rules?

Answer 3

1. Bony tenderness along distal 6 cm of the posterior edge of fibula or tip of lateral malleolus
2. Bony tenderness along distal 6 cm of the posterior edge of tibia/tip of medial malleolus
3. Bony tenderness at the base of the 5th metatarsal
4. Bony tenderness at the navicular
5. Inability to bear weight both immediately after injury and for 4 steps during initial evaluation

Question 4

What is the special test can diagnose plantarfasciopathy?

Answer 4

Windlass test - 2 positions; weight bearing and non-weight bearing (passively lift toes to stretch plantarfascia, in NWB therapist can palpate the foot too)

Question 5

What special test would be used to diagnose a syndesmosis injury?

Answer 5

Squeeze test - squeeze tib and fib together (if pain is anterior then the test is positive and suggests syndesmosis, if pain is locally along fibula it suggests a fracture)

Note: pain during PAMs and PROM can also be an indicator of a syndesmosis injury

Question 6

What special test could you use to identify tarsal tunnel syndrome?

Answer 6

Tinel’s sign ankle (note: sensitivity is low and there is no specificity)
- deep peroneal nerve by tapping anterior to the medial malleolus
- posterior tibial nerve by tapping behind the medial malleolus

Question 7

What ROM movements of the foot/ankle could you assess?

Answer 7

Ankle movements
- plantarflexion
- dorsiflexion =- with goniometer or knee to wall test
- inversion
- eversion

1st MTPJ movements
- flexion
- extension
- abduction

Question 8

What PAMs could you do to assess the ankle (talocrurual)? (4)

Answer 8

1. longitudinal traction
2. compression
3. Internal/external rotation
4. AP and PA glide

Question 9

What PAMs could you do to assess the foot?

Answer 9

1. Mid-tarsal glide (stabilise proximal, glide distal)
2. Tarsal-metatarsal glide
3. Inter metatarsal glide

Question 10

What PAMs could you do to assess the 1st MTPJ?

Answer 10

1. Longitudinal traction
2. Rotation
3. AP glide

Question 11

What should you remember when performing a PAM?

Answer 11

Rate the quality of stiffness - hypermobility or hypomobility?

What movement could this improve if used as a treatment?

Question 12

What are the stages during the gait cycle?

Answer 12

Stance phase:
- Initial contact
- loading response
- mid-stance
- terminal stance

Swing phase:
- mid-terminal swing
- foot clearance