Questions Review Flashcards
Joint commonly affected by Ankylosing Spondylitis
Sacroiliac joint, shoulders, and hips, and at times the knees
Which phalangeal joints does Rheumatoid Arthritis tend affect?
Proximal interphalangeal joints
What phalangeal joints does Psoriatic Arthritis normally affect?
Distal interphalangeal joints
3 factors that help classify a patient into lumbar traction group.
Peripheralization with extension,
Neurological sensory deficits
Positive crossed straight-leg raise
L5–S1 facet dysfunction referring pattern
Lumbar spine to gluteal region
How should C2 spinal process move with head rotation?
The spinous process of C2 should move immediately in the contralateral direction of head rotation.
Upper cervical ligamentous instability may cause what kind of symptom?
(3 items)
Occipital numbness with occipital headaches,
Significant range of motion limitations in all directions
Signs and symptoms of cervical myelopathy (clumsiness with gait)
For how long should a physical therapist hold a patient in a pre-manipulative hold position?
10 seconds
Are there any special tests is included as a variable in the clinical prediction rule for the diagnosis of carpal tunnel syndrome?
No.
(No special tests ended up being a part of the diagnostic clinical prediction rule for carpal tunnel syndrome, even though they were a part of the comprehensive examination/evaluation to determine those variables)
Which of the following symptoms is possibly found on Cervical Myelopathy?
Blood pressure greater than 160/95
Dizziness or light-headedness related to neck movement
Unexplained weight loss
Urinary retention
Urinary retention
(Bowel and bladder disturbances may be expected in those who have cervical myelopathy.)
Which of the muscles will be weak with anterior interosseous nerve entrapment, but not weak with carpal tunnel syndrome?
Pronator quadratus
(The pronator quadratus, along with the flexor pollicis longus and flexor digitorum profundus (lateral half), would be weak with anterior interosseous syndrome.)
Which of the following special tests is the best at ruling in tears?
Joint line tenderness
McMurray test
Thessaly test at five degrees of flexion
Thessaly test at twenty degrees of flexion
Palpating the lateral joint line has the highest specificity at 97%, per Logerstedt et al.
What tibia tibio-femoral separation is considered abnormal with a medial collateral valgus stress test at 0 degrees?
6-10mm is considered abnormal
Posterolateral corner injury grades by tibial external rotation.
Grade I - less than 5 degrees
Grade II - 5–10 degrees
Grade III - greater than 10 degrees of difference in external rotation
If an isolated posterolateral corner injury occurs, which of the following positions will most successfully assess the injury?
Maximal varus and external rotation will be best assessed at 30 degrees of flexion
3 diseases that are a cause of secondary knee osteoarthritis
Acromegaly
Hyperparathyroidism
Rickets
What is the relationship between weakness in the hands and chronic neck pain?
Those who have weakness in the hands are predisposed to chronic neck pain, according to a study by Bot et al.
What is the expected hold for deep neck flexor endurance test with a patient with weak deep neck flexors and patients with no symptoms?
Weak deep neck flexors - 24 seconds
Patients with no symptoms - 50 seconds
According to the headache CPG.
What are the criteria to diagnose someone with neck pain with headache?
Neck pain with headache includes aggravation or precipitation of symptoms of the headache with sustained positions or certain neck movements.
A sprain or strain of the cervical spine is what ICF diagnosis?
Neck pain with movement coordination impairments
What is a common symptom of Erb’s Palsy?
Weakness of the deltoid muscle
Why does Erb’s palsy affect the deltoid muscle?
Erb’s palsy is a brachial plexus upper trunk injury, and the upper trunk involves the C5–C6 nerve roots.
The deltoid muscle is innervated by the axillary nerve, which includes the C5–C6 nerve roots.
Triceps brachii is inerverted by what nerve?
The triceps is innervated by the radial nerve, which has the nerve roots of C5–T1.
What brachial plexus trunk is affected to cause Klumpke’s palsy?
A lower trunk injury of the brachial plexus causes Klumpke’s palsy, and C8–T1 are involved.
The flexor carpi ulnaris is innervated by these nerve root segments.
What condition could Parsonage–Turner syndrome cause?
Erb’s palsy since Parsonage–Turner syndrome is a neuritis of the brachial plexus and the upper trunk could be impacted.
Pronator teres syndrome symptoms
(3 items)
Pain on the radial side of the palm
Paresthesia in the thumb, index, and middle finger
Feeling that forearm is “heavy” at times, and this is not dependent on activity
Does the Flexor carpi radialis run through the carpal tunnel?
No!
Among other things, injury to the Musculocutaneous nerve could cause what symptoms?
Sensory deficits to the lateral forearm region
Weak forearm supination and elbow flexion
What acromion type is this?
Type I
What type of acromion is this?
Type II
What type of acromion is this?
Type III
What type of acromion is this?
Type IV
What are the three types of shoulder impingement?
Primary
Secondary
Internal
In the case of coracoid impingement, symptoms with what movements are expected?
Shoulder flexion, adduction, and internal rotation
How is causalgic pain described?
Burning pain
(Causalgic pain is described as burning, and patients with causalgia have very significant amounts of pain. This is commonly seen in patients who have certain types of preganglionic brachial plexus injuries.)
What is a common presentation of preganglionic brachial plexus pain?
Causalgic pain
Angina pectoris can present as shoulder pain with activity.
True or False
True
In women, a symptom of neck and left posterior shoulder pain, but also anterior breast pain with normal muscle testing which does not elicit symptoms could indicate what?
Breast cancer
What is the common presentation for Hodgkin’s lymphoma?
(3 items)
Typically age 15–35
Neck pain of a prolonged duration
Swollen lymph nodes in the neck, axilla, and groin
Is brusing presentation for glenohumeral joint dislocation?
No
Complete severing of the nerve is known as what?
Neurotmesis
What is the best long-axis hip manipulation?
In open-pack and moving gradually into closed pack where the patient is most restricted.
What is the course of treatment for swan-neck?
Splinting initially.
If problem does not resolve, surgical intervention may be warranted.
Is hypermobilty a precaution or a contraindication for thrust manipulation?
It is a precaution as some patients may still benefit from thrust manipulation even in the presence of hypermobility.
According to Fritz et al. (2007), what should be the parameters for lumbar traction?
Prone for a maximum of 12 minutes with 40% to 60% of body weight.
What exercise is commonly used after lumbar traction?
Prone press ups.
For carpal tunnel, are cortisone injections more useful short-term or long term?
here has been no demonstrated impact of corticosteroid injections after one month, so they are effective in the short term, but that is all that is known at this point.
Which muscle assists the PCL in preventing posterior tibial translation?
The popliteus muscle.
What exercises are best in improving knee flexion and overall lower extremity strength in a patient who has undergone an anterior cruciate ligament reconstruction?
Balance and proprioceptive exercises plus lower extremity strengthening
What is currently known in regard to stretching for patients with adhesive capsulitis?
Patients should not be stretched beyond the limit of their pain.
It may worsen the overall outcomes.
What are the grades of Kaltenborn joint traction?
Grades 1-3.
What is a common autonomic response to joint manipulation?
Change in skin temperature
Which muscles are important to be added to a stretching program for neck pain?
- Anterior, medial, and posterior scalene
- Upper trapezius
- Levator scapulae
- Pectoralis muscles
In relation to WAD, what is the relationship between wearing a soft collar and time off work?
Individuals who wear a soft collar after a motor vehicle accident are more likely to take prolonged time off work
In the cases of peripheral ulnar nerve injuries in which splinting is needed, what is the advantage of splinting the metacarpophalangeal joints in flexion?
(3 items)
- It prevents overstretching of the volar surface soft tissues
- Forces the extrinsic finger extensors to provide interphalangeal joint extension
- Allow for finger extension.
Which manipulations have been shown to improve heel pain symptoms in patients with plantar fasciitis?
(3 items)
- Cuboid thrust manipulation
- Distal tibiofibular joint posterior nonthrust manipulation
- Proximal tibiofibular joint thrust manipulation
What is the correct information regarding the use of iontophoresis in heel pain?
Iontophoresis may or may not provide two to four weeks of pain relief and improved function in those with heel pain.
What is the recommendation for the use of US calcific tendinitis?
For short-term improvement, Ebenbichler et al. found ultrasound therapy to be beneficial for calcific tendinitis.
What position is a patient placed in during a Stimson’s shoulder relocation technique?
Prone.
Why is he medial meniscus easier to injure than the lateral meniscus?
Because the medial meniscus has a strong capsular attachment.
What systemic pathology is possible to occur due to rheumatoid arthritis?
Pericarditis is a possible systemic pathology that can occur due to rheumatoid arthritis
(cardiac complications)
After a grade 3 posterior cruciate ligament injury, what is recommended regarding weight-bearing status?
Partial weight-bearing for 2–4 weeks after injury
What is predictor of poor outcome post arthroscopy for medial compartment osteoarthritis of the knee?
History of knee osteoarthritis for longer than 24 months.
The use of which muscle prior to 6-8 weeks post for open repair for a rotator cuff tear could result in need for revision.
Deltoid
(During an open rotator cuff repair, there is splitting and detachment of the deltoid, and reattachment of this muscle to the acromion is a significant part of the surgical procedure. Because of the extent of involvement of the deltoid, it is imperative to not use this muscle actively for a relatively long period of time after surgery. If used, it could lead to a failure of the procedure.)
A sprain or strain of the cervical spine is what ICF diagnosis?
Neck pain with movement coordination impairments.
The median nerve terminal branches is created from which cords?
The median nerve terminal branch is created from the lateral and medial cords
What women’s health procedure is associated with a higher risk of carpal tunnel syndrome?
Hysterectomy.
How sensitive is the wrist ratio index greater than 0.67 for the development of carpal tunnel syndrome?
93% sensitivity.
With ulnar nerve damage in the Guyon’s canal, what are the expected presentation? How will the hand be resting?
(3 items - Intrinsic minus position)
The hand will be resting in
1) wrist flexion, 2) MCP extension, and 3) PIP/DIP flexion
What is a common presentation for an anterior interosseous nerve entrapment?
(4 items)
Weakness:
In the anterior forearm,
In the flexor pollicis longus,
In the the lateral half of the flexor digitorum profundus,
and at the pronator quadratus
When differentiating middle lumbar spine pain accompanied by lower abdomen and radiating pain to the buttock between MSK LBP and large intestine pain what should you consider?
Involvement of the large intestine will exhibit most of their symptoms in the buttock, middle lumbar spine, and lower abdomen, with the symptoms located in the region of T11–L1.
A patient with weak plantar flexion is likely to present issues with what nerve root?
S1 nerve root.
Pectineus weakness is common with the lesion to which nerve?
Femoral nerve.
With a posterolateral corner injury what is common to happen during the push-off phase of gait?
Sharp pain during terminal stance and push-off as being a finding common to posterolateral corner injuries.
Which of the following two tests is more specific to identify a posterior cruciate ligament injury: posterior drawer test or posterior sag sign?
Posterior sag sign is 100% specific while the posterior drawer test is 99% specific.
(per 2010 CPGs)
Which combination of tests is most accurate in determining the presence a SLAP lesion?
Active compression test and Jobe relocation test
Which test is being performed in the following picture?
Active compression test.
Which test is being performed in this picture?
What ranges should it be tested on?
Jobe’s relocation test.
90º, 100º, and 110º of abduction with maximum external rotation.
What imaging finding is associated with joint stiffness?
Large joint effusion
(In a study from Kornaat et al., a large joint effusion was associated with joint pain and stiffness)
Paresthesia to the thumb alone without radiation to any other region is generally connected to what nerve root?
C6 nerve root.
In the diagnosis of neck pain with radiating pain in what direction is most uncommon for the radiation to happen?
Neck pain that radiates during cervical flexion
Scapular winging in abduction, but not in flexion is commonly found in the lesion to what nerve?
Spinal accessory nerve.
Paresthesia to the thenar eminence of the hand is most likely to injury to which nerve?
Median nerve.
With anterior interosseous nerve syndrome, is there any sensory deficit?
No - It is only motor.
What are the three muscles innervated by the AIN (Anterior interosseous nerve)?
Flexor pollicis longus (FPL),
Pronator quadratus (PQ),
Radial half of flexor digitorum profundus (FDP)
Painful cervical rotation of less than how many degrees could indicate cervical radiculopathy?
60º (CPR by Wainner)
C7 dermatome corresponde to the dorsum of which finger?
Middle finger.
Pancoast tumor is likely to mimic which nerve root pathology?
C8 pathology.
Backing a loser corresponds to what type of error?
Type I - Saying there is a difference when there isn’t.
High quality diagnostic studies, prospective studies, or randomized controlled trials correspond to what level of evidence?
Type I
Lesser qualities diagnostic studies, prospective studies, or randomized controlled trials (e.g. weak diagnostic criteria or reference standards, improper randomization, no blinding or less than 80% follow up) corresponds to what level of evidence?
Level II
Case-controlled studies or retrospective studies correspond to what level of evidence?
Level III
Case series corresponds to what level of evidence?
Level IV
Expert opinion corresponds to what level of evidence?
Level V
The variable being manipulated is the __________ variable.
Independent
The variable being measured (outcome) is the ______________ variable.
Dependent variable.
What greek letter corresponds to the level of statistical significance of a study?
Alpha
Missing a winner is equivalent to what kind of research error type?
Type II - Saying there is not difference when there is a difference.
What value is considered a large effect size?
Greater than 0.8
What value is considered a moderate effect size?
0.5 - to 0.79
What value is considered a small effect size?
0.2 to 0.49
What is a trivial effect size?
Less than 0.2
A Cohen capa score of 0 represents what level of reliability?
No better than a toss of a coin (no reliability)
A Kappa score of less than 0.4 is considered ____________ reliability.
Poor
A kappa score of 0.4 to 0.6 is considered ______________ reliability.
fair
A kappa score of 0.6 to 0.75 is considered _____________ reliability.
Good
A capa of greater than 0.75 indicates _____________ reliability.
Excellent.
A kappa score of 1 indicates _________________ reliability.
Perfect.
What are the cut-off values for positive likelihood ratios?
Greater than 10 =- Large likelihood
5 - 10 = Moderate likelihood
Less than 5 = Small likelihood
1 = No difference
What are the negative likelihood ratio cut-off scores?
Less than 0.1 - Large shift in probability away from a diagnosis
0.1 - 0.2 - Moderate shift in probability away from a diagnosis
Greater than 0.2 a small shift in probability away from a diagnosis
1 - No change
What is the placebo effect?
Positive effect of a treatment/intervention due to belief something will work.
Placebo have the greatest effect on outcomes which are mediated by _______.
An example would be ________.
The brain.
Pain, Fear, and Functional Ability.
Nocebo effect is when a _______ belief results in negative effect of the intervention.
Negative.
What is the Hawthorne effect?
Knowledge of being observed increases participants’ engagement.
What is the observer effect?
Participants perform better when they perceived they are being observed.
Those who get more attention get better.
John Henry effect corresponds to what?
(Steam drill)
When the control group works harder due to the belief of disadvantage.
They try to get better in other ways.
Blinding helps
Pygmalion effect - what is it?
(Sculptor)
Expectation of those in authority shape the response of the subjects.
Rosenthal effect - School IQ.
Prevalence of Back pain is Increasing, Decreasing or Staying the same?
Increasing.
History of activity limiting LBP and a recurrence:
Should I refer this patient?
Unless other sinister symptoms are present, this is a normal presentation of LBP
Is LBP more common in women or men?
Women
Lower education status is associated with what in regards to back pain?
Increased prevalence, longer duration and worse outcomes.
What is a physical work related risk factor for low back pain?
Operating heavy equipment
What are risk factors for sciatica?
Cardiovascular risk factos
(Obesity, Hypertension, Smoking)
Are degenerative changes in MRI and other imaging modalities associated with risk factors for LBP?
No.
What is the evidence for trunk strength and lumbar spine mobility in relation to low back pain?
There is inconclusive evidence.
Psychosocial or physical factors play a larger roll in low back pain?
Psychosocial factors
Should clinicians focus on factors such as fear, depression and destress in early stages of low back pain?
Yes per CPGs.
Expectation of recovery affects return to work?
Yes.
Is active coping strategies positive or negative for recovery?
Positive.
Do co-morbidities have any association of LBP prognosis?
No - Patient expectations are more important.
Risk factors to develop recurring low back pain.
History of previous episode
Excessive spine mobility
Excessive mobility in other joints
Prognostic factors for development of chronic pain.
Presence of symptoms below the knee
Psychological distress or depression
Fear of pain, movement and re-injury or low expectations of recovery
Pain of high intensity
Passive coping style
Red flags associated with a back related tumor.
Constant pain not affected by position or activity
Age over 50
Hx of cancer
Failure to improve with 30 days of conservative management
Unexplained weight loss
No relief with bed rest
What is the red flag with the highest positive likelihood ratio for back tumor?
Previous history of cancer (23.7)
What are the most common types of cancers to metastasize to the spine?
“PT Barnon Loves Kids”
Prostate
Thyroid
Breast
Lung
Kidney
After previous history of cancer, what are the other red flags with the highest positive likelihood ratios?
Unexplained weight loss
Failure to improve with 30 days of treatment
Age over 50
What is the most sensitive finding for red flag screening for cancer of the spine?
No relief with bed rest.
When referring a patient with low back pain to screen for cancer what ESR values should be considered?
ESR greater than 20 (Increases +LR)
ESR greater than 50 = +LR of 19.2
Roland Morris disability questionnaire - What is the MCID?
Change of 5 points (30%).
ODI - Oswestry Disability Index:
What are the cut-offs?
And MCID?
20 percentage points.
0-20% = Minimal
21-40% = Moderate
41-60 = Severe disability
MCID = 10 percentage points.
What are the most significant red flags for cauda equina syndrome?
Bowel and bladder changes (Urinary Retention most sensitive/specific)
Saddle anesthesia
Neurologic (sensory/motor) deficits L4-L5-S1 area
Back related infection most important red flags:
Recent infection
IV drug use
Concurrent immunosuppressive disorder
Deep constant pain that increases with WB
Fever, malaise (most useful) or swelling, or spine rigidity (rigidity: least useful)
Red flags for spinal fractures.
(5 items)
Hx of major trauma (vehicular accident/Fall/Direct blow to the spine)
Age over 50 (age over 75 higher risk factor)
Prolonged use of steroids (3 month)
Point tenderness over the side of the fracture
Increased pain with WB
In regards to spine fractures:
Besides the risk factors of the CPGs for back pain what are other two important risk factors?
History of osteoporosis
History of spinal fracture (trauma into spine flexion)
Female sex
Thoracic compression fracture (70% of non-traumatic)
Abdominal aneurysm (red flags)
Back, abdominal or groin pain
Presence of PVD or CAD (associated cardiovascular risk factors)
Smoking history
Family history
Age over 70
Non-caucasian
Female
Symptoms of LBP not related to movement stresses
Presence of a bruit central epigastric area
Palpable aortic pulse 4cm or greater
Since structural diagnosis is so difficulty what does the LBP CPG suggests?
A classification system:
MDT
TBC
What are the 5 elements from the manipulation CPR for the lumbar spine?
No symptoms distal to the knee
A recent onset of symptoms (<16 days)
FABQ - Work <19
At least 1 hypomobile segment in the lumbar spine
At least 35º of internal rotation in at least one hip
(This group had greater than 51% on the ODI with one week of treatment)
In both manipulation studies for the CPR, a Chicago/Million-Dollar Roll was performed and was followed up by what exercise?
Pelvic tilts.
Criteria to fit stabilization group on the TCB for back.
Younger age (<40 years old)
Greater flexibility (post-partum* or SLR >91º)
Instability catch/aberrant movement during lumbar flexion/extension
Positive prone instability test
3/8 = 80% chance of success
*Positive active painful SLR
TBC criteria for specific exercises.
Symptoms distal to the buttock
Older age
Directional preference for flexion or extension
Traction group classification (least evidence based)
Signs and symptoms of nerve root compression
Peripheralization of symptoms with flexion and extension
What are considered signs and symptoms of nerve root compression for the traction group on the TBC on the LBP CPG?
Pain and sensory disturbances in dermatomal patterns
Diminished deep tendon reflexes
Myotomal weakness
Positive nerve tension tests
Positive cross-SLR
What are the 3 stages of treatment for patient with LBP for the most recent CPG for LBP?
Symptoms modulation - High disability
Movement control - Moderate disability
Functional optimization - Low disability
What treatment approaches fit into the pain modulation of the 2016 CPG for LBP?
Specific exercise
Manipulation/Mobilization
Traction
Active rest
What treatments are involved in the movement control group?
Sensory motor exercises (nerve glides)
Stabilization exercises / Motor control
Mobility exercises
What treatment should patient in the functional optimization group of the 2016 CPG receive?
Strength and conditioning exercises
Work/Sport specific tasks
Aerobic exercises
General fitness exercises
What are the A level recommendation interventions for low back pain?
Manual therapy
Trunk coordination, strength and endurance exercises (stabilization)
Directional preference
Progressive endurance exercise or fitness activities for chronic back pain
Is manipulation a high level evidence?
Yes it is level A.
Besides general strengthening and TBC movement control group, what surgical intervention benefits from stabilization exercises?
Microdiscectomy
In what cases are specific exercises indicated besides those patients with radicular signs?
Acute, sub-acute or chronic back pain with mobility deficits.
For chronic low back pain without chronic generalized pain, what level A exercises are indicated?
Moderate to high intensity exercises.
For chronic low back pain with generalized pain, what type of exercise is recommended?
Progressive low intensity submaximal fitness and endurance activities.
Flexion exercises for lumbar stenosis receives what level of recommendation?
C level
What are the recommendations for low back pain with stenosis?
Manual therapy
Nerve mobilization
Progressive walking
What kind of treatment is better for lumbar stenosis?
Manual therapy and exercises
(body-weight supported walking)
What Ankle Brachial Index values indicates possible presence of arterial disease?
< 1 - Possible presence
< 0.9 - abnormal value
< 0.8 Possible PAD (peripheral artery disease)
< 0.25 Limb threatening
What level of evidence is given to nerve mobilization procedures?
Level C
Subacute and chronic stage
Nerve testing to isolate: Sciatic nerve
Hip flexion with knee in extension +
Ankle dorsiflexion + hip add/IR
Nerve testing to isolate: Posterior tibial nerve
Hip flexion knee extension +
Ankle dorsiflexion + eversion + great toe extension
Nerve testing to isolate: Sural nerve
Hip flexion knee extension +
Ankle dorsiflexion + inversion
Nerve testing to isolate: Common peroneal nerve
Hip flexion with knee extension +
hip internal rotation + ankle plantar flexion + inversion
What level recommendation is traction given?
D level.
