MSK Test Questions

Question 1

A patient is referred to a physical therapist for treatment of chronic neck pain. During the examination, the therapist notices that the patient has a marked ulnar drift in both hands at the MCP joints. Which of the following treatments should the therapist perform?

1.Cervical stabilization exercises with the patient in good postural alignment

2.Gentle cervical mobilization for 8 minutes

3.Intermittent cervical traction at 8% of the patient’s body weight for 10 minutes

4.Moist hot pack on the patient’s cervical spine with the patient in sitting position for 15 minutes

Answer 1

1. Marked ulnar drift is a hallmark sign of rheumatoid arthritis. Because cervical spine ligaments can be affected in this population, cervical stabilization exercises in neutral are appropriate for managing neck pain in patients who have rheumatoid arthritis.

Incorrect Answers:
2. Cervical spine ligaments can be affected in patients who have rheumatoid arthritis, placing the patient at high risk for subluxation and significant complications from cervical mobilization.

3. Cervical traction is contraindicated in patients who have rheumatoid arthritis.
4. Although thermal agents can provide some local pain relief, application of heating modalities to an area with potential ligamentous laxity or acute inflammation is not recommended for patients who have rheumatoid arthritis

Question 2

After undergoing a reverse total shoulder arthroplasty, a patient is MOST likely to dislocate the shoulder in which of the following positions?

1.Lateral (external) rotation and abduction with flexion

2.Medial (internal) rotation and abduction with flexion

3.Lateral (external) rotation and adduction with extension

4.Medial (internal) rotation and adduction with extension

Answer 2

4. Patients are most likely to dislocate a reverse total shoulder arthroplasty by performing medial (internal) rotation and adduction in conjunction with extension. This position allows the prosthesis to escape anteriorly and inferiorly.

Incorrect Answers:
1. Lateral (external) rotation and abduction with flexion is not the most likely position to dislocate the reverse total shoulder arthroplasty. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation.

2. Abduction and flexion are not most likely to cause dislocation. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation.
3. Lateral (external) rotation is not most likely to cause dislocation. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation.