MSK2: 2nd Shifting

Question 1

Considering the attachments of the triceps, the passive insufficiency position for this muscle and therefore, the position to fully stretch it is
a. horizontal abduction and elbow flexion
b. shoulder and elbow flexion
c. shoulder and elbow extension
d. horizontal adduction and elbow extension

Answer 1

b. shoulder and elbow flexion

Question 2

To mobilize the humeroradial joint in order to increase flexion, the glide should be towards this direction
a. Posterior
b. Medial
c. Anterior
d. Lateral

Answer 2

c. Anterior

Question 3

To reduce a pulled elbow:
a. apply a quick compressive manipulation to the radius with forearm supination
b. perform a quick distractive manipulation to the radius with forearm pronation
c. use lateral glide to the proximal ulna as the patient extends
d. mobilize the radial head using grade 3 to reposition joint

Answer 3

a. apply a quick compressive manipulation to the radius with forearm supination

Question 4

To mobilize the ulnar nerve, the following motions or positions of joints are included, EXCEPT:
a. shoulder abduction
b. elbow extension
c. wrist extension
d. neck side flexion to the opposite side

Answer 4

b. elbow extension

Question 5

Your patient is presenting with left elbow flexion contracture, if you would like to perform stretching, how will you proceed?
a. stretch the elbow towards flexion
b. stretch the elbow towards extension
c. extend the shoulder as you do passive elbow ROM
d. flex the shoulder as you do passive elbow ROM

Answer 5

b. stretch the elbow towards extension

Question 6

In a patient who had cast removal after an elbow fracture, if a hard endfeel is noted after only 10° of elbow flexion, what are you supposed to do?
a. apply grade 3 joint oscillations to mobilize humeroradial joint
b. strengthen supinators aggressively to treat condition
c. refer patient to the doctor
d. stretch pronators to increase ROM

Answer 6

c. refer patient to the doctor

NOTE: this is due to suspicions of heterotopic ossifications

Question 7

In mobilization with movement (MWM) technique to improve joint tracking in the elbow, the patient is
a. asked to actively flex the elbow as the therapist laterally glides it.
b. passively flexed at the elbow as the therapist laterally glides.
c. asked to actively flex the elbow as the therapist medially glides it.
d. passively flexed at the elbow as the therapist medially glides it.

Answer 7

a. asked to actively flex the elbow as the therapist laterally glides it.

Question 8

True regarding the rehabilitation following total elbow arthroplasty using triceps-reflecting approach EXCEPT:
a. avoid elbow flexion-extension done in supine
b. strength can not be restored to normal
c. provides greater area of exposure during surgery
d. slower rate of progression

Answer 8

b. strength can not be restored to normal

Question 9

The tendon of this muscle is the most commonly affected in Lateral epicondylitis:
a. Extensor digitorum
b. Extensor indicis
c. Extensor carpi radialis brevis
d. Extensor carpi radialis longus

Answer 9

c. Extensor carpi radialis brevis

Question 10

If the goal is to protect the ulnar nerve from further injury in cases when the elbow is swollen, the joint should be immobilized in
a. Full extension
b. 30 DEG of flexion
c. End-range flexion
d. 60 DEG of flexion

Answer 10

b. 30 DEG of flexion

Question 11

Case: YS, a 57 y/o construction worker underwent Total Elbow Arthroplasty using the triceps-reflecting approach 5 days ago due to gross instability of his ® elbow. His surgeon referred him to PT for rehabilitation so that he could return to work ASAP. He presents with pain and gr 3 tenderness, moderate swelling on ® forearm and hand, LOM and weakness around elbow and forearm, and impaired function. Which of the following exercises are appropriate for him at this stage? Type TRUE if the given intervention is correct; otherwise, type FALSE. Do not consider the completeness of parameters yet

1. HOLD-RELAX STRETCHING OF BICEPS AND TRICEPS TO IMPROVE ROM
2. AAROM EXERCISES ON ELBOW FLEXION AND EXTENSION WITHIN PAIN-FREE RANGES TO REGAIN MOTION
3. GR 1 OSCILLATIONS OVER HUMERORADIAL JOINT TO DECREASE PAIN
4. MULTIPLE ISOMETRICS TO MAINTAIN STRENGTH AND MINIMIZE ATROPHY
5. PREs on the shoulder using 10-lb cuff weights above the elbow to improve functional strength

Answer 11

1. False
2. True
3. False
4. False
5. False

Question 12

Buoyancy is the upward force that works opposite to gravity. If a patient is standing and submerged in neck-deep water, buoyancy provides resistive force in all of the following, EXCEPT:
a. knee extension from 90º knee flexion with hip in neutral position
b. shoulder adduction from 90º abduction with elbow extended
c. hip extension from 70º hip flexion with knee extended
d. elbow flexion with the shoulder in 90º flexion

Answer 12

D. elbow flexion with the shoulder in 90º flexion

Rationale: No effect in buoyancy; Flexion happens above the water
Other choices warrant inferior movement which is resisted by buoyancy

Question 13

You are leading an aquatic aerobic class for five middle-aged women. Which of the following procedures should be observed when implementing this program?
a. The water temperature should be maintained in the range of 26-280C.
b. You as their PT instructor should be on land and not in the water with them.
c. There is no need for warm-up and cool-down periods when doing aerobics in
the water.
d. Both A and B are correct.
e. Both A and C are correct.

Answer 13

D. Both A and B are correct.

Rationale: Water should be between 26-28 for aerobic exercises & instructor should be on land to see the LE movements. Middle-aged women do not need close assistance, no condition indicated also.

Question 14

Your patient was referred for underwater gait training with 40% weight-bearing.
The water depth should be
a. at the level of the sternum
b. at C7 level
c. at the xiphisternal junction
d. at the level of the ASIS
e. above the ASIS

Answer 14

e. Above the ASIS

Question 15

Which of the following documentation for the use of aquatic exercise as a PT intervention is correct?

a. Endurance training with water at shoulder level at 36ºC X 80% HRmax for 20 mins to increase aerobic capacity.
b. Strengthening exercise in waist-deep water at 28ºC using hydro-tone boots X 10 reps X 2 sets each on (B) shoulder flexors, extensors, abductors, and adductors to increase strength.
c. Underwater bicycling on water noodle in chest-high deep at 28ºC X 20 mins with RPE of 13-14 to increase endurance.
d. Both A and B are correct.
e. Both A and C are correct

Answer 15

c. Underwater bicycling on water noodle in chest-high deep at 28ºC X 20 mins with RPE of 13-14 to increase endurance.

Rationale: Endurance training is wrong bc of too high temperature.
Strengthening training is wrong bc hydrotone boots were used but for UE muscles

Question 16

Which of the following documentation for the use of massage as a PT intervention is correct?
a. Massage using effleurage and petrissage on the (L) UE X 10 mins in supine to reduce lymphedema.
b. Massage using effleurage and cupping over hypoventilated segments of the (L) lung X 5 mins each in postural drainage position to mobilize excessive secretions
c. Whole body massage in supine and prone using effleurage, shingles, kneading, rolling X 20 minutes to induce relaxation
d. Only A and B are correct
e. All are correct

Answer 16

d. Only A and B are correct

Rationale: Wrong duration for C.

Question 17

Your patient who is a bank teller has low back pain due to strain. Which of the following should be included in the Patient Education/Environmental Modification for this patient?
a. Proper lifting techniques
b. Home modification: use of handrails on both sides of the stairs
c. Work modification: use of a stool rater than an office chair
d. Both A and B are correct
e. Both A and C are correct

Answer 17

a. Proper lifting techniques

Rationale: LBP is not that debilitating that pt needs handrails on both sides. Stool is not recommended bc it has no back support

Question 18

Your patient who is an office clerk complains of pain on the posterior aspect of the neck. Upon palpation, you noted muscle spasms and taut bands on bilateral upper traps. You decided to apply massage. Which of the following massage variation/s should you use?
I. deep friction massage
II. effleurage
III. wringing
IV. cupping

a. Only I is correct
b. Only II and IV are correct
c. Only I, II, III are correct
d. All are correct

Answer 18

c. Only I, II, III are correct

Rationale: Cupping is not included bc it’s for excessive mucous in the lungs

Question 19

Your patient has back pain due to scoliosis. Which of the following should be included in the Patient Education/Environmental Modification for this patient?
a. Using only one shoulder (the higher one) to carry a backpack
b. Modification: use of firm mattress to sleep on
c. School modification: placing the armrest on the side of convexity of the scoliosis
d. Both A and B are correct
e. Both A and C are correct

Answer 19

b. Modification: use of firm mattress to sleep on

Rationale: Scoliosis pts should carry backpack on both shoulders. Arm rest should depend on the hand dominance of pt

Question 20

All of the following are correct about the use of taping, EXCEPT:
a. Limit unwanted movement
b. Hold dressings and pads in place
c. Protect a fractured structure during treatment and rehabilitation
d. Protect supporting ligaments, tendons, and muscle from further injury
e. None of these

Answer 20

c. Protect a fractured structure during treatment and rehabilitation

Rationale: Splint should be used for fx, taping cannot protect a fractured bone

Question 21

In modifying the environment to facilitate function of patients, the following are considered, EXCEPT:
a. mode of transportation
b. financial capability of the patient
c. beliefs and customs of the patient
d. patient’s ROM and strength
e. none of these

Answer 21

e. none of these

Question 22

Case profile: A 13 y/o baseball pitcher developed (R) medial elbow tendinopathy. The following muscles could be affected in this case, EXCEPT:
a. Flexor carpi ulnaris
b. Pronator teres
c. Palmaris longus
d. Extensor carpi radialis brevis

Answer 22

D. ECRB

Rationale: It is an extensor, found laterally, and is most commonly affected in lateral tendinopathy

Question 23

Case: A 13 y/o baseball pitcher developed (R) medial elbow tendinopathy. He has been playing baseball for 1 year now. He was referred to you for functional training. He reports very minimal pain (1/10) on the area. He has no tenderness or muscle spasm, and his wrist flexors are graded 4/5. What is the MOST appropriate Long-Term Goal (LTG) for your patient?
a. Pt will report dec in pain from 1/10 to 0/10 on the medial aspect of R elbow p 4 wks of PT sessions to be able to resume play.
b. Pt will demonstrate inc in R wrist flexors strength from 4/5 to 5/5 p 6 wks of PT sessions to be able to pitch ball properly.
c. Pt will be able to pitch ball as often as needed in a baseball game s any pain and c 5/5 strength of R wrist flexors p 6 wks of PT sessions.
d. All of these
e. None of these

Answer 23

c. Pt will be able to pitch ball as often as needed in a baseball game s any pain and c 5/5 strength of R wrist flexors p 6 wks of PT sessions.

Rationale: Other 2 are impairment level only, for STG

Question 24

A 13 y/o baseball pitcher developed (R) medial elbow tendinopathy. He has been playing baseball for 1 year now. He was referred to you for functional training. He reports very minimal pain (1/10) on the area. He has no tenderness or muscle spasm, and his wrist flexors are graded 4/5. For him to return to competitive play, which of the following interventions should be part of your treatment plan? Type TRUE if intervention is correct; otherwise type FALSE. Do not consider completeness of parameters yet
a. Grip strengthening using hand-held dynamometer
b. Self-stretching of wrist flexors with the elbow extended and dorsum of hand against the wall
c. Simulate pitching to be done against theraband resistance
d. Ice massage on the medial aspect of the ® elbow until numbness
e. Multiple-angle muscle sets for wrist flexors and extensors
f. Gr. 1 joint oscillations on ® humeroulnar joint
g. With the supinated forearm supported and hand over the edge of the table, flex wrist 10x while holding a 5-lb dumbbell

Answer 24

a. TRUE: Strong grip on the ball
b. FALSE: Wrist extensors would be stretched
c. TRUE
d. FALSE: Not an acute case, no tenderness, 1/10 pain only
e. FALSE: Functional training, no need for muscle sets, only for very acute and weak pts, to retard atrophy
f. FALSE: Pain doesn’t originate from the joint, it’s on the tendon
g. TRUE: Strengthening exercise

Question 25

The following activities or etiologic factors may predispose an individual to develop medial elbow tendinopathy, EXCEPT:
a. repetitive shuffling of book pages of librarians or accountants
b. pitching baseball for 3 years for the teenager
c. pulling weeds in the palace garden by hand
d. swinging golf club many times per game daily
e. None of these

Answer 25

c. pulling weeds in the palace garden by hand

Rationale: It’s more for lateral elbow tendinopathy

Question 26

Case: A 13 y/o baseball pitcher developed (R) medial elbow tendinopathy. He has been playing baseball for 1 year now. He was referred to you for functional training. He reports very minimal pain (1/10) on the area. He has no tenderness or muscle spasm, and his wrist flexors are graded 4/5. What is the correct intervention scenario?
a. Restore
b. Compensate
c. Prevent
d. Patient does not need any intervention

Answer 26

a. Restore

Rationale: Already in functional training c minimal pain, (-) tenderness/spasm, ⅘ strength

Question 27

To avoid ulnar deviation deformity after MCP arthroplasty, the PT must be careful NOT to apply:
A. Traction on the fingers
B. Valgus stress on the fingers
C. Prolonged immobilization
D. Tendon glide

Answer 27

B. Valgus stress on the fingers

Question 28

A patient came to you with a referral form saying that he had Zone IV extensor tendon rupture. Even without seeing the patient yet
you would think that this is at the
A. PIP joint region
B. Apex of MCP joint
C. Proximal phalanx
D. Dorsum of the hand

Answer 28

C. Proximal phalanx

Question 29

In performing “place and hold” exercises, a therapist:
A. Asks the patient to place the fingers in a variety of positions then the patient holds this position
B. Passively places the patient’s fingers in a variety of positions then the patient holds this position
C. Passively places the patient’s fingers in a variety of positions then the patient contracts muscle concentrically
D. Passively places the patient’s fingers in a variety of positions then the patient contracts muscle eccentrically

Answer 29

B. Passively places the patient’s fingers in
a variety of positions then the patient holds this position

Question 30

To strengthen the interossei, which exercise below is BEST?
A. Long horn exercise with the wrist in neutral
B. Tip-to-tip exercise as tolerated
C. Kneading yellow theraputty for 5 mins
D. Towel crumpling with fingers spread apart

Answer 30

D. Towel crumpling with fingers spread apart

Question 31

Laceration at the volar zone II of the hand pose a particular challenge for therapist because of
A. Frequent occurrence of Dupuytren’s contracture
B. Limited blood supply
C. Opposition of flexor and extensor muscles
D. Development of nodules

Answer 31

B. Limited blood supply

Question 32

The best tendon-gliding position to facilitate contraction of the lumbricals
A. Straight fist
B. Intrinsic minus
C. Table top
D. Full fist

Answer 32

C. Table top

Question 33

During the maximum protection phase post finger flexor repair, what motions are avoided
A. Wrist flexion and full fist
B. Claw hand with wrist in neutral position
C. Straight hand with wrist extension
D. Wrist flexion and table top position

Answer 33

C. Straight hand with wrist extension

Question 34

To increase flexion of the wrist at the radiocarpal joint, if the proximal carpal row is to be mobilized, the glide should be
A. Volar
B. Dorsal
C. Radial
D. Ulnar

Answer 34

B. Dorsal

Question 35

What should be the post-operative position of the finger in Boutonniere’s deformity?
A. DIP extension
B. PIP flexion and DIP extension
C. MCP extension
D. PIP extension and DIP flexion

Answer 35

D. PIP extension and DIP flexion

NOTE:

Boutonniere presents with PIP flexion and DIP hyperextension; thus, we need to counteract this deformity.

In Swan Neck Deformity, there is PIP hyperextension and DIP flexion: thus, PIP flexion and DIP extension will be used to counteract the deformity

Question 36

True about tendon-gliding exercises EXCEPT:
A. Used to maintain mobility between multijoint musculotendinous unit
B. Are also stretching exercises for extrinsic finger muscles
C. Starting position is observed with wrist in neutral
D. Straight fist positions MCP and PIP joints in flexion and DIP joints in extension

Answer 36

B. Are also stretching exercises for extrinsic finger muscles

Because there is no hold, it is not considered as stretching.

In B, extrinsic are the ones being stretched.

Question 37

Case: A patient is referred to you early in the development of symptoms that stem from RA. He is currently in the remission phase after his first serious flare of the disease and desires a home exercise program to safely improve the use of his hands. He is a salesman who travels frequently. He keeps his records on computer. His grip strength is reduced 50%; he has 25% loss of joint ROM and decreased joint play in the wrist; MCP and IP joints. Detectable synovial hypertrophy is minimal and there are no joint subluxations. Establish a program of exercise intervention for this patient. Type TRUE if the given intervention is correct; otherwise, type FALSE. Do not consider the completeness of parameters yet

1. Crumple scratch papers and throw them in a trash bin
2. Differential tendon gliding exercises for various finger and wrist muscles
3. Grade III sustained joint traction on affected joints
4. Full stretching of muscles crossing multiple joints
5. PRE’s for ulnar deviators and wrist extensors

Answer 37

1. TRUE
2. TRUE
3. TRUE
4. FALSE
5. FALSE

Question 38

Position of immobilization for flexor zone IV laceration
a. 10-45º of wrist and 40-70º MCP flexion with PIP and DIP extension
b. PIP and DIP extension
c. 30º wrist extension and 30-45º MCP flexion
d. 70º MCP flexion, neutral wrist

Answer 38

d. 70º MCP flexion, neutral wrist

a is for flexor zone I, II, and III
b is for extensor zone III and IV
c is for extensor zone V and VI

Question 39

The best position to stretch the lumbricals
a. Straight fist
b. Table top
c. intrinsic minus
d. Full fist

Answer 39

c. intrinsic minus

Contraction of lumbricals: PIP DIP in ext, MCP in flexion (table top or intrinsic plus position). To stretch, position joint on opposite manner MCP ext, PIP DIP flex (intrinsic minus position). Contraction / activate lumbricals is not its position to stretch.

Question 40

You would suggest the delayed motion approach in the rehabilitation of patients post tendon laceration and surgery with any of the following characteristics, except
a. 13 yo c Down’s syndrome
b. Depressed individual
c. Grade 1 elementary pupil
d. Pt is ordered to stay in bed
e. None of these

Answer 40

d. Pt is ordered to stay in bed

Rationale:
a is Pedia + cognitive impairment
b is Pt might be more depressed / unmotivated
c is Too young, pt could be too hyperactive

Question 41

To mobilize the CMC of the thumb to increase flexion, the proximal end of the 1st metacarpal should be glided towards
a. Ulnar
b. Radial
c. Volar
d. Dorsal

Answer 41

a. Ulnar

Question 42

You have a 9 7/0 R-handed male pt a grade 3 pupil, who sustained a L flexor zone II laceration of the index and middle fingers while carving a pumpkin 3 wks ago. Immediate primary repair was done for the FDP and FDS tendons. Which post-op management approach is appropriate in this case?
a. Delayed motion approach
b. Early controlled passive motion approach
c. Early controlled active motion approach

Answer 42

a. Delayed motion approach

Since pt is still a kid

Question 43

A 9 yo R-handed male pt, a grade 3 pupil, sustained L flexor zone II laceration. The FDS of the index and middle fingers are affected. Where is the FDS inserted?
a. Palmar aspect of the middle phalanges of digits 2-5
b. Dorsal aspect of the middle phalanges of digits 2-5
c. Palmar aspect of the distal phalanges of digits 2-5
d. Dorsal aspect of the distal phalanges of digits 2-5

Answer 43

a. Palmar aspect of the middle phalanges of digits 2-5

Supercificalis: middle phalanx
Profundus: distal phalanx

Question 44

A pt with CTS is performing median nerve mobilization in the hand. The current position of her wrist is neutral with the fingers and thumb extended. What is the next
position?
a. Wrist neutral with DIP and PIP joints flexed
b. Wrist extension with fingers extended and thumb neutral
c. Intrinsic plus position
d. Straight fist position
e. None, this is the last position

Answer 44

b. Wrist extension with fingers extended and thumb neutral

Question 45

To mobilize the ulnar nerve, the following upper extremity positions are introduced one by one in the technique, except:
a. Shoulder ER
b. Wrist flex
c. Elbow flex
d. Forearm supination

Answer 45

b. Wrist flex

Question 46

You have a 9 7/0 R-handed male pt a grade 3 pupil, who sustained a L flexor zone II laceration of the index and middle fingers while carving a pumpkin 3 wks ago. What should be the position of the wrist and hand of your pt during the period of
immobilization?
a. The wrist is kept in neutral position but the MCPs are in 70 flex
b. The wrist is extended to 30 while MCPs flexed to 30-45
c. The wrist should be in 10-45 flexed, the MCPs are flexed also in 40-70 but IPs are extended
d. No wrist restrictions but the Ips are kept in extension

Answer 46

c. The wrist should be in 10-45 flexed, the MCPs are flexed also in
40-70 but IPs are extended

Question 47

You have a 9 7/0 R-handed male pt a grade 3 pupil, who sustained a L flexor zone II laceration of the index and middle fingers while carving a pumpkin 3 wks ago. Immediate primary repair was done for the FDP and FDS tendons. After 3 wks of immobilization, he is now referred to PT for further evaluation and treatment. The child’s active and passive wrist and finger extensions are now significantly limited; his L handgrip is also weaker compared to the R; states he enjoys riding his bike and playing basketball after class and on weekends. What is the most appropriate STG for your pt?
a. Pt will be able to hold the bike handle c firm grp and s pain & difficulty on L hand while riding the bike p 10 wks of PT sessions
b. Pt will be able to dribble basketball using L s pain and difficulty in order to return to leisure basketball games p 12 wks of PT sessions
c. Pt will demonstrate AROM within allowable and pain-free range on L finger joints p 6 wks of PT session in preparation for more functional activities
d. All of these
e. None of these

Answer 47

c. Pt will demonstrate AROM within allowable and pain-free range on L finger joints p 6 wks of PT session in preparation for more functional activities

Question 48

You have a 9 7/0 R-handed male pt a grade 3 pupil, who sustained a L flexor zone II laceration of the index and middle fingers while carving a pumpkin 3 wks ago. Immediate primary repair was done for the FDP and FDS tendons. After 3 wks of immobilization, he is now referred to PT for further evaluation and treatment. The child’s active and passive wrist and finger extensions are now significantly limited; his L handgrip is also weaker compared to the R; states he enjoys riding his bike and playing basketball after class and on weekends. At the current stage of rehabilitation, which of the following PT interventions should be part of your treatment plan for this pt? Do not consider the completeness of parameters yet. Type TRUE if the given intervention is correct; otherwise type FALSE

a. With fingers flexed, do active wrist extension within the pain-free range
b. Differential stretching of FDS and FDP
c. Place and hold exercises
d. To passively flex only the DIP of the index finger, the proximal phalange must be stabilized
e. Ice massage on the surgical wound to promote healing
f. Tendon blocking exercises to isolate contraction of the two muscles
g. Patient education on the proper use of the prescribed dorsal hand splint

Answer 48

a. TRUE = active > passive bc flexor tendon is affected. When the wrist moves, it is not the flexor tendons contracting, so it’s okay. And it’s within the pain
free range so it’s okay
b. FALSE = not yet pwede to stretch
c. TRUE = not end range naman
d. FALSE = stabilization is incorrect, if you want to mobilize DIP stabilize middle phalanx
e. FALSE = 3 wks immobilized, cold modality/cryotherapy is not required
f. FALSE = blocking exercises are more advanced exercises, thus not suitable since pt was just referred. Place and hold muna to see if pt can maintain a certain position when passively positioned
g. TRUE = patient education included in PT intervention

Question 49

The following are true about idiopathic frozen shoulder EXCEPT
a. formation of dense adhesions in the dependent folds of the capsule
b. also known as periarthritis
c. arthritic changes in the cartilage
d. appears normal in radiographs

Answer 49

c. arthritic changes in the cartilage

This is common for OA

Question 50

Possible sites of pain in frozen shoulder EXCEPT
a. axilla
b. deltoid insertion
c. C5-C6 distribution
d. anterosuperior shoulder

Answer 50

a. axilla

Question 51

At this stage of adhesive capsulitis atrophy of the deltoid, rotator cuff, biceps, and triceps brachii muscles occurs:
a. freezing
b. frozen
c. thawing
d. all of the above

Answer 51

b. frozen

Question 52

Which of the capsular ligament/s of the glenohumeral joint serves as the main stabilizer of the abducted shoulder?
a. superior glenohumeral ligament
b. middle glenohumeral ligament
c. inferior glenohumeral ligament
d. all of the above

Answer 52

c. inferior glenohumeral ligament

Question 53

The following are interventions to minimize muscle inhibition, guarding & atrophy for shoulder post-operative in a maximum protection phase EXCEPT
a. muscle settings
b. light isometrics 4-6 weeks post op
c. scapular stabilization in non-weight bearing
d. progressive exercise using 3 lbs weights

Answer 53

d. progressive exercise using 3 lbs weights

Too aggressive for maximum protection phase

Question 54

Faulty posture of forward head and protracted shoulders as seen in patients with frozen shoulder results in the following shoulder girdle positions EXCEPT
a. forward tilt of the scapula
b. downward rotation of the scapula
c. internal rotation of the humerus in a dependent position
d. relative adduction of the humerus in a dependent position

Answer 54

d. relative adduction of the humerus in a dependent position

Question 55

The following activity limitation is consistent with a patient having adhesive capsulitis EXCEPT
a. difficulty in reaching back pocket of pants
b. difficulty in hooking/unhooking a front clasped bra
c. difficulty in donning/doffing upper extremity clothes such as shirts
d. difficulty lifting weighted objects

Answer 55

b. difficulty in hooking/unhooking a front clasped bra

Question 56

Consider the following goal you set for this patient. Criticize each goal and identify the missing component. Patient will demonstrate absence of pain on (L) shoulder after one week of PT session.
a. behavior
b. condition
c. functional carryover
d. degree

Answer 56

c. functional carryover

Question 57

Consider the following goal you set for this patient. Criticize each goal and identify the missing component. Patient will independently don and doff front-buttoned upper extremity garment.
a. behavior
b. condition
c. functional carryover
d. degree

Answer 57

d. degree

No need for functional carryover bc it’s already an activity limitation

Question 58

Consider the following goal you set for this patient. Criticize each goal and identify the missing component. Patient will demonstrate increased shoulder by at least 10 degrees on all planes after 3 weeks of PT session to facilitate overhead activities.
a. behavior
b. condition
c. functional carryover
d. degree

Answer 58

b. condition

10 degrees - condition does not have a baseline

Question 59

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. What is the phase of recovery of the patient?
a. protection phase
b. maximum protection phase
c. controlled motion phase
d. return to function phase

Answer 59

a. protection phase

Question 60

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. Which of the following is the appropriate PT Diagnosis?
a. moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills d/t pain, tenderness, (+) empty can test, muscle spasm, and LOM.
b. moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills d/t pain, tenderness, muscle spasm, and LOM.
c. moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills with Medical Diagnosis of (L) supraspinatus tendinitis d/t pain, tenderness, muscle spasm, and LOM.
d. Mod difficulty in BADLs and IADLs d/t pain, tenderness, muscle spasm, and LOM

Answer 60

b. moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills d/t pain, tenderness, muscle spasm, and LOM.

Question 61

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. What is the Prognosis for this case?
a. excellent
b. good
c. fair
d. poor

Answer 61

a. excellent

Question 62

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. Identify the abnormal findings based on ICF model. Pain on (L) shoulder
a. direct impairment
b. indirect impairment
c. activity limitation
d. participation restriction

Answer 62

a. direct impairment

Question 63

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. Identify the abnormal findings based on ICF model. LOM of (L) shoulder
a. direct impairment
b. indirect impairment
c. activity limitation
d. participation restriction

Answer 63

b. indirect impairment

Question 64

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. Identify the abnormal findings based on ICF model. Severe difficulty in performing volleyball skills
a. direct impairment
b. indirect impairment
c. activity limitation
d. participation restriction

Answer 64

d. participation restriction

Question 65

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. Considering a restorative intervention scenario, which of the following is an appropriate rehabilitative long term goal for the pt?
a. Pt will be able to return to playing volleyball s difficulty and pain p 6 wks of PT session
b. Pt will be able to return to playing volleyball c use of kinesiotape during game p 6 wks of PT session
c. Pt will be able to demonstrate proper warm up and cool down p 6 wks of PT session
d. Pt will be able to demonstrate decrease difficulty from severe to moderate in playing volleyball p 6 wks of PT session

Answer 65

a. Pt will be able to return to playing volleyball s difficulty and pain p 6 wks of PT session

B is a compensatory type of intervention scenario
C is a preventive type of LTG
D is not attainable/realistic in six weeks, it’s a STG

Question 66

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills.
Which of the ff is an appropriate short-term goal for pain?
a. Pt will demonstrate decrease pain from 8/10 to 4/10 on L shoulder p 2 wks of PT session to be able to perform overhead activities
b. Pt will demonstrate decrease pain from 8/10 to 4/10 on L shoulder using VAS p 2 wks of PT session to be able to perform overhead activities
c. Pt will report decrease pain from 8/10 to 4/10 on L shoulder p 2 wks of PT session to be able to perform overhead activities
d. Pt will exhibit decrease pain from 8/10 to 4/10 on L shoulder p 2 wks of PT session

Answer 66

c. Pt will report decrease pain from 8/10 to 4/10 on L shoulder p 2 wks of PT session to be able to perform overhead activities

If pain is the impairment, the right verb is report not demonstrate

Question 67

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills.
The following can be used to treat your patient:
a. PREs on L shoulder
b. PROM on L shoulder
c. Manual stretching on L shoulder
d. Closed chain exercises on L shoulder

Answer 67

b. PROM on L shoulder

Pt is in protection phase so PROM bc of high pain scale of pt. The other options are too aggressive

Question 68

You have a 23 y/o female patient, (-) DM/Htn, was referred for PT evaluation and management c/o sharp pain graded as 8/10 on SPS on (L) shoulder. Patient experience this pain 2 days ago after a competitive volleyball game. Persistence of pain prompted for MD consultation and was diagnosed to have (L) supraspinatus tendinitis.Upon physical examination: grade 2 tenderness on (L) supraspinatus area.(+) muscle spasm on (L) shoulder, ( +) empty can test on (L) shoulder, LOM of (L) shoulder abduction : AROM 0-150, PROM 0-165, with moderate difficulty in accessing overhead cabinets and severe difficulty in performing volleyball skills. Which of the following correctly documents the HMP treatment to be given to your patient?
a. HMP x 20 mins on L shoulder to increase tissue extensibility
b. HMP x 20 mins on L shoulder to decrease pain
c. HMP x 10 mins on L shoulder to decrease pain
d. HMP x 35 mins on L shoulder to decrease pain

Answer 68

b. HMP x 20 mins on L shoulder to decrease pain

Question 69

It is important to correct flat neck posture because it leads to mandibular
a. Protraction
b. Retraction
c. Depression
d. Elevation

Answer 69

a. Protraction

Question 70

Your advice to a pt with TMJ dysfunction will include all the following, except:
a. Avoid biting fingernails
b. Do not tear open packages of potato chips using teeth
c. Choose hard solid food more than soft food to strengthen mastication
muscles
d. Chop or cut food to small bit sizes before eating
e. None of these

Answer 70

c. Choose hard solid food more than soft food to strengthen mastication
muscles

Question 71

Which of the following are considered cardinal signs of TMJ impairment
I. clicking sound during movement
II. decreased jaw movements
III. pain with jaw motions
IV. inability to chew food
a. I and III
b. I II and III
c. II and IV
d. All

Answer 71

b. I II and III

Question 72

You would like to teach your pt with TMJ dysfunction the correct resting position
of the jaw. How is this achieved?
a. Lips are slightly apart, teeth are approximated, and the tongue is resting
lightly on the hard palate behind the front teeth
b. Lips and teeth are slightly apart, and the tongue is resting lightly on the hard palate behind the front teeth
c. Lips are closed, teeth are slightly apart, and the tongue is resting lightly on the soft palate behind the front teeth
d. Lips are closed, teeth are slightly apart and the tongue is resting lightly
on the hard palate behind the front teeth
e. Any of these

Answer 72

d. Lips are closed, teeth are slightly apart and the tongue is resting lightly
on the hard palate behind the front teeth

Question 73

A 43 y/o office clerk is experiencing posterior neck pain graded 7/10 that seems to spread to the lateral aspect of the left elbow. Condition started one week ago
physical exam results reveals muscle spasms on paracervical muscles (L>R), LOM on active lateral flexion on both directions. She is currently on-leave because of her situation. What is the most appropriate LTG for this pt?
a. Pt will report dec pain from 7/10 to 5/10 on post neck p 2 wks of PT sessions to be able to bend head side-to-side with more ease
b. Pt will demonstrate inc in AROM on lateral flexion on B sides by at least 10 degrees p 3 wks of PT sessions to promote better sleeping position of the head
c. Pt will be able to work s pain & normal bilat lateral flexion of neck p 4
wks of PT sessions

Answer 73

c. Pt will be able to work s pain & normal bilat lateral flexion of neck p 4
wks of PT sessions

Question 74

To stretch the right SCM in a pt with torticollis, you would
a. Extend the neck, laterally flex the neck towards the L and rotate neck towards the R
b. Perform chin tuck, laterally flex the neck towards the L and rotate neck towards the R
c. Perform chin tuck, laterally flex the neck towards the R and rotate neck towards the L
d. Extend the neck, laterally flex the neck towards the R and rotate neck towards the L

Answer 74

b. Perform chin tuck, laterally flex the neck towards the L and rotate neck towards the R

Question 75

Proper way to document calliet neck exercises
a. Calliet neck exercises on all planes X 10 reps c 6 sec hold X 1 set in sitting to increase neck muscle strength
b. Calliet neck exercises on all planes X 10 reps c 15 sec hold X 1 set in sitting to increase neck ROM
c. Calliet neck exercises on all planes X 10 reps X 1 set in sitting to promote
kinesthetic awareness
d. Calliet neck exercises on all planes X 10 reps X 1 set in sitting to maintain joint integrity

Answer 75

a. Calliet neck exercises on all planes X 10 reps c 6 sec hold X 1 set in sitting to increase neck muscle strength

Question 76

You decided that your pt with MPS will benefit from the application of massage which of the following techniques is most appropriate to use for taut bands and
nodules?
a. Effleurage
b. Shaking
c. Raindrop
d. Deep friction
e. All of these

Answer 76

d. Deep friction

Question 77

A 65 y/o diagnosed with rheumatoid arthritis (exacerbation phase) of the cervical spine was referred for PT management due to paracervical pain. All of the following are CI, except
a. Joint mobilization
b. Cervical collar
c. Gentle passive stretching
d. Manual controlled traction

Answer 77

b. Cervical collar

Question 78

A pt presents with flat neck posture. Which of the following muscles are expected to be tight and weak muscle in this pt?
a. Levator scapulae
b. SCM
c. Anterior neck muscles
d. All of the above

Answer 78

c. Anterior neck muscles

Question 79

You would like to stretch the right upper trapezius of your pt diagnosed with MPS. You would move the neck of the pt towards flexion in combination with
a. R side flexion and rotation to the L
b. L side flexion and rotation to the L
c. L side flexion and rotation to the R
d. R side flexion and rotation to the R

Answer 79

c. L side flexion and rotation to the R

Question 80

Pt will report dec pain on posterior neck from 5/10 to 2/10 p 3 wks PT sessions to be able to work c ease. The underlined statement is
a. Behavior
b. Condition
c. Degree
d. Functional carry over

Answer 80

a. Behavior

Question 81

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

You want to teach SO proper posture of the neck and upper back. Which of the following is an appropriate STG for this pt?
a. Pt will demonstrate dec forward head posture p 2 wks of PT sessions to be
bale to tolerate prolonged sitting
b. Pt will demonstrate dec forward head posture as manifested by ability to align head and shoulders c tactile cues p 2 wks of PT sessions to be able to tolerate prolonged sitting
c. Pt will demonstrate dec forward head posture p 2 wks of PT sessions to
improve posture
d. Pt will demonstrate dec forward head posture as manifested by ability to align head and shoulders c tactile cues p 2 wks of PT sessions to improve posture

Answer 81

b. Pt will demonstrate dec forward head posture as manifested by ability to align head and shoulders c tactile cues p 2 wks of PT sessions to be able to tolerate prolonged sitting

Question 82

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

What is the best intervention for pt SO
a. Chin tucking exercises X 6SH X 10 reps
b. Calliet’s neck exercises on all panes X 10 reps/plane
c. Conventional TENS using TENS MED 931 X 110 Hz X 50 us X 20 mins to dec mm spasm
d. AROM of neck on all planes x 10 reps/plane to maintain joint & muscle
integrity

Answer 82

d. AROM of neck on all planes x 10 reps/plane to maintain joint & muscle
integrity

Question 83

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

SO has difficulty maintaining prolonged posture as in sitting or standing for 30
minutes. All of the following impairments contribute to this difficulty, except
a. + jump sign
b. Pain on B upper traps & posterior neck graded 4-5/10
c. + grade 2 tenderness on L upper traps
d. Weakness of cervical mms graded ⅗

Answer 83

a. + jump sign

Question 84

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

SO presents c protracted shoulders. Which of the following is not consistent with
this finding?
a. There is possible tightness of latissimus dorsi
b. There is possible stretch weakness of the rhomboid major
c. There is possible tightness of serratus anterior
d. None of the above

Answer 84

d. None of the above

Question 85

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

SO presents with excessive thoracic kyphosis. Which of the following is
consistent with this finding
a. The degree of thoracic kyphosis is evaluated during postural assessment in
posterior view
b. There is possible tightness of the pectoral muscles
c. This finding is concomitant with scapular retraction
d. All of the above

Answer 85

b. There is possible tightness of the pectoral muscles

Question 86

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

Which of the following is not a direct impairment resulting from MPS
a. Pain on B upper traps & posterior neck graded 4-5/10
b. Trigger points on medial border of B scapula
c. Grade 2 tenderness on L upper traps
d. Postural deviation

Answer 86

d. Postural deviation

Question 87

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

Given a restorative scenario, which of the following is the most apt rehabilitative LTG
a. PT will be able to tolerate 30 mins of sitting c proper posture, s pain & difficulty p 6 wks of PT sessions
b. Pt will report dec pain on upper traps and posterior neck as manifested by ability to maintain correct sitting posture p 6 wks of PT sessions
c. Pt will be able to tolerate 30 mins of sitting c proper posture, s pain and difficulty p 6 wks of PT sessions to be able to perform work c ease
d. Pt will report dec pain on upper traps and posterior neck as manifested by ability to maintain correct sitting posture p 6 wks of PT sessions to be able to
perform work c ease

Answer 87

a. PT will be able to tolerate 30 mins of sitting c proper posture, s pain & difficulty p 6 wks of PT sessions

Question 88

S:> SO, a 26 yo R handed, (-) Htn/DM, female pt ℅ constant, diffused aching pain on
B upper traps and posterior neck graded 4-5/10 (L>R) on SPS. Condition started 3
mos ago when pt started to feel aching pain on her L upper back p an 9-hr class. No
mx was done since then, pt consulted MD 2 days PTC and was dxed c MPS, and was
advised to undergo PT. unremarkable PMHx. Pt is a college instructor who provides
lectures for ~4hrs/day and 3-6 hrs/day of skills demonstration on average. Work
involves standing for most hours. Carrles backpack (~4kgs)
O:> OI > + postural deviations (see PA)
Palpation > + grade 2 tenderness on L upper traps
● + grade 1 tenderness on R upper traps
● + mm spasm on B upper traps & posterior neck
● + taut bands and nodules on B upper traps
● + trigger points on medial border of B scapula
ROM > All ROM of B UE and LE are WNL c N endfeels. Cervical flexion, extension,
lateral flexion, and rotation are WNL, c pain at end range
MMT > All mms of B UE and LE are grossly graded 5/5; cervical muscles graded ⅗
PA > + forward head posture
+ Scapular protraction B
+ Inc thoracic kyphosis
+ Dec lumbar lordosis
Special test > + jump sign
- Spruling’s (B)
FA > Neck disability index = 22
Min difficult in prolonged sitting or standing ~20-30 mins
Mod difficulty in carrying of ~4kg backpack d/t pain

What is the most appropriate PT DX for this pt
a. Min difficulty in prolonged sitting or standing, mod difficult in carrying backpack, and NDI score of 22 2º to pain, tenderness, weakness and postural deviation
b. MD Dx of MPS on B upper traps & posterior neck further defined by diffused aching pain, tenderness, taut bands, trigger points, and weakness of the
cervical muscles as manifested by difficulty in prolonged sitting or standing, carrying of backpack, and NDI score of 22
c. Min difficult in prolonged sitting or standing and carrying backpack 2º to nodules, taut bands, and trigger points
d. MD dx of MPS on B upper traps & posterior neck further defined by NDI score of 22 2º to pain and tenderness

Answer 88

a. Min difficulty in prolonged sitting or standing, mod difficult in carrying backpack, and NDI score of 22 2º to pain, tenderness, weakness and postural deviation