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NMSK 2 > OSCE Station 4 and 5 practice > Flashcards

OSCE Station 4 and 5 practice Flashcards

1
Q

35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.

o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1

Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1

What is the most appropriate manual technique for treatment today?

A

quads effleurage

consider location of the pain - instead of location of action involved

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2
Q

35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.

o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1

Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1

Why would dynamic hamstring massage be unhelpful?

A

The location of pain (anterior thigh) and resisted tests (pain on engaging quads for knee extension) point to a Quads STI

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3
Q

35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.

o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1

Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1

Why would AP Tib-Fem joint Grade II?

A

The location of pain (anterior thigh) and resisted tests (pain on engaging quads for knee extension) point to a Quads STI.

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4
Q

A 66 year old retired GP complaining of functional stiffness due to osteoarthritis.

Physical exam reveals hip flexion = 105degs, limited by stiffness
what is the most appropriate MT technique?

A

Lateral distraction Hip joint at 90 degrees flexion x Grade IV

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5
Q

A 58 year old office worker complaining of functional stiffness due to osteoarthritis.

Physical exam reveals hip abduction = 20degs, limited by stiffness

A

Longitudinal caudad Hip joint at 90 degrees flexion x Grade IV

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6
Q

45 year old woman presents with residual complaints of stiffness 6/12 after sustaining a conservatively managed undisplaced tibial plateau fracture. She reports moderate EOR knee pain P1 (0-4/10) that is non-irritable.

o/e
Knee ROM: Active = Passive
Extension: (-) 10˚ limited by stiffness & EOR P1
Flexion: WNL

Resisted tests:
Knee extension = (-) P1
Knee flex = (-) P1

Identify all of the possibly appropriate manual techniques for treatment?

A

PFJ - Superior glide x Gr II-III
Tibio-femoral joint - PA glide x Gr II-III
Quads tapotement
Quads effleurage

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7
Q

45 year old woman presents with residual complaints of stiffness 6/12 after sustaining a conservatively managed undisplaced tibial plateau fracture. She reports moderate EOR knee pain P1 (0-4/10) that is non-irritable.

o/e
Knee ROM: Active = Passive
Extension: (-) 10˚ limited by stiffness & EOR P1
Flexion: WNL

Resisted tests:
Knee extension = (-) P1
Knee flex = (-) P1

Accessory exam:
PFJ = NAD
Tibiofemoral joint = hypomobile glide (accompanying knee extension), otherwise NAD
With the addition of the accessory exam, now identify the most appropriate manual technique(s) for treatment?

A

Tibio-femoral joint - PA glide x Gr II-III

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8
Q

19 year old ballet dancer presents 3/12 post Grade II ATFL ligament sprain (R) with residual complaints of stiffness, making it difficult to get back ‘en pointe’ i.e. on her toes to dance.

o/e
Ankle ROM:
Dorsiflexion - WNL, L = R
Plantarflexion - L = 60degs, R 40degs

Resisted tests: NAD

Identify all of the possibly appropriate manual techniques for treatment?

A

Talocrural joint - PA glide x Gr IV
DTF ATFL
Talocrural joint - Physiological plantarflexion x Gr IV

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9
Q

19 year old ballet dancer presents 3/12 post Grade II ATFL ligament sprain (R) with residual complaints of stiffness, making it difficult to get back ‘en pointe’ i.e. on her toes to dance.

o/e
Ankle ROM:
Dorsiflexion - WNL, L = R
Plantarflexion - L = 60degs, R 40degs

Accessory glides: NAD talocrural joint.

Resisted tests: NAD

Now identify the most appropriate manual technique for treatment?

A

DTF ATFL

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10
Q

A 40 year old male recreational runner presents for treatment for chronic Achilles tendinopathy. This will include addressing known risk factors for tendinopathy. Which of the following is NOT a risk factor for Achilles tendinopathy?

A

Reduced ankle plantarflexion

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11
Q

accessory glide of hip flexion

A

AP

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12
Q

Accessory glide of hip abduction

A

lateral distraction

longitudinal caudad

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13
Q

Accessory glide of hip lateral rotation

A

PA (extension and lateral rot go together)

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14
Q

Accessory glide of hip medial rotation

A

(flexion and medial rot go together)

Lateral distraction

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15
Q

Accessory glide of hip extension

A

PA

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16
Q

Accessory glide of knee flexion

A

AP

longitudinal caudad

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17
Q

Accessory glide of knee extension

A

PA

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18
Q

What types of accessory movement can be performed on the hip joint?

A
  • AP
  • PA
  • Lateral distraction
  • Caudad / Longitudinal
19
Q

Pain in the anterior of thigh after 1 week means

A

quads effleurage

20
Q

Pain in the posterior of thigh after 1 week means

A

hamstrings effleurage

21
Q

pain in the posterior of calf muscle after 1 week means

A

calf effleurage

22
Q

benefits of effleurage

A

movement of; lymph, venous blood, oedema, lung secretions
mobilisation of; muscle fibres, muscle belly, tendons, scar tissue tissue layers
reduce muscle tension

23
Q

list 4 absolute contraindications of massage

A 
cancer
48-72 hours post injury
open wound/burn
foreign body/bone fragment
circulatory disease
24
Q

list 4 potential contraindications of massage

A

Cancer – Malignant disease
Fragile skin
Collagenous weakening e.g. diabetes, advanced RA(rheumatoid arthritis), long-term steroid use
Cardiac pathology – increase BP, reflex fx (neck, chest, mid-thoracic)

25
Q

MT for limited hip flexion

A

lateral distraction

26
Q

MT for limited hip extension

A

anterior glide /PA

27
Q

MT for limited hip abduction

A

longitudinal caudad

28
Q

MT for limited hip adduction

A

lateral distraction

29
Q

MT for limited hip external rotation

A 
anterior glide 
for patient in prone 
90 degree knee flexion
towel in ant. of pelvis
one hand in distal of posterior hip and other hand ankle
push hand downward on posterior hip
30
Q

MT for internal rotation

A

posterior glide

31
Q

list movements hip are in when they are in a closed packed position

A

Extension
Abduction
Internal Rotation

32
Q

patient is suffering from anterior groin pain or upper thigh pain pain on passive abduction and resisted or isometric hip adduction. what manual therapy treatment do you give them

A

adductor longus DTF treatment
knee flexed
hip partially abducted
place thigh against their thigh and ask them to apply resisted abduction to find adductor longus

33
Q 
patient feels pain in back of thigh 
(+) pain on hamstring flexibility test
(90:90 test)
(+) pain on resisted prone knee
flexion (worse in IR for medial hams
and in ER for BF).
A 
Hamstring knee flexed
prone with knee flexion to relax muscle. 
Reinforced
fingers or elbow exert transverse
friction
34
Q

Deep transverse frictions are suitable for which type of injuries. give frequency and time duration of massage.

A 
tendinopathy
muscle strains
ligament strains
scar healing
2-3 times a week for 3 weeks
never twice in a row
for 5-10 minutes
35
Q

patient feels pain on medial side of knee after GAA game
pain on knee extension
(+) pain on Valgus ligamentous stress test. - MCL
what manual therapy prescription is applied

A

MCL injury
DTF in maximum comfortable extension in supine.
May have to start in flexion – in flexion the
ligament is in line with tibia and so direction of DTF
is more diagonal than vertical. In extension, the
direction of DTF is horizontal. Technique is
performed with reinforced finger - week 5

36
Q

kneading and box kneading massage - petrissage is conducted in what muscle group

A

quads

calf

37
Q

wringing petrissage can be conducted in what muscle group

A

hamstring
quads
achilles tendon

38
Q

picking up petrissage can be conducted in what muscle group

A

quads

calf

39
Q

clapping and hacking tapotement can only occur in what muscle group

A

hamstrings

40
Q

constituents of deltoid ligament

A

deep - posterior and anterior tibiotalar ligament

superficial - tibiocalcaneal and tibionavicular ligament

41
Q

constituents of lateral ligament

A

posterior talofibular
anterior talofibular
calcaneofibular

42
Q

origin and insertion of tibialis anterior

A 
O = lateral surface of tibia
I = Medial cuneiform
43
Q

movements in tibialis anterior

A

inversion

dorsiflexion

44
Q

patient is recovering from achilles tendinopathy 3/12
pain during dorsiflexion or plantarflexion
Ankle ROM:
Plantarflexion - WNL, L = R
Dorsiflexion - L = 60degs, R 40degs
pain during resisted dorsiflexion
what is the appropriate manual therapy prescription?

A

achilles tendon wringing

achilles DTF

NMSK 2 (8 decks)

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