MSK Test 1 review questions

What is the criteria for deferring MLT?

Any capsular restriction in the direction of MLT. Any type of partial tear. Any effusion or edema in the direction of the MLT.

Denotes pain: * PROM C: Limited elbow ext./flex.* w/firm end feel Limited shoulder ext.*/flex. w/firm end feel PROM A: Tight GHJ Capsule, Tight RHJ capsule MSTT: Weak and painful for shoulder and elbow ext. MLT: Tight and painful for biceps PFT: Tenderness over biceps tendon with mod. depth Would you defer MLT, and if so what corresponding TR would you associate for a partial tear in the biceps? A. No, PROM C Low B. Yes, PFT Mod C. Yes, PROM C Mod D. No, PFT Low

B You would defer MLT in this scenario because a capsular restriction would cause a false positive for Biceps MLT. And the answer would be PFT because you cannot use PROM C as a means for assessing TR when there is a capsular restriction. Also, when no direction is given for capsular restriction, we must assume it is in all directions. Due to the tenderness at moderate depth the PFT would be moderate.

Based on the above case what would be a good end of session goal? A. Pt. shows a 1/4 inch decrease in ankle swelling, with an 8 degree increase in ankle ROM, and a one degree decrease in level of pain during walking. B. Pt. will be able to walk up 5 steps once, with a decrease in pain by two levels, and a 6 degree increase in plantar flexion ROM. C. Pt. will demonstrate a 1/4 inch decrease in ankle swelling, with a 6 degree increase in dorsiflexion ROM, and a two minute treadmill walk with one less degree of pain. D. Patient will never walk again

C. This is the best answer because it give a definitive number to each of the relative pieces of data. For choice A, just saying walking doesn't put a time on how to measure the function of their walking. For choice B, the case did not specify stairs, but it had then it would be a good choice. For choice D, if the patient never walks again you're an awful PT

Which of these is not a TSI? A. Tight biceps B. Weak quadriceps C. Swelling across the glenohumeral joint D. Hypermobility of the radiohumeral joint due to laxity E. Weakness of the infraspinatus mms due to partial tear

C. Swelling is not considered a TSI because it does not distinguish between edema and effusion.

Which of these is not a contraindication to thermotherapy? A. Wound healing B. poor circulation C. malignacy D. acute-and-post acute trauma

A. Wound healing is a contraindication to cryotherapy. All the other answers are direct contraindications to thermotherapy.

Patient presents with anterior elbow pain and the following findings :*pain. Palpation for Condition: unremarkable AROM: Limited elbow flexion 110 degrees*, UR elbow PROM Classical: Limited elbow flexion 116 degrees* and firm end-feel, unremarkable elbow extension. Based on the above information, what tissues could be causing symptoms and why? A. Capsule B. Contractile C. Cartilage D. Bone

A. Capsule, this is because AROM and PROM are both painful in the same direction and a firm end feel is established. Why can't it be bone or cartilage?--> No hard EF

Which of these tissue types demonstrates pain in the same direction? A. Inert B. Contractile C. Neural

A. Inert tissue demonstrates pain in the same direction during AROM and PROM. Contractile tissue demonstrates pain in opposite directions during AROM and PROM Neural tissue demonstrates a burning and tingling pain associated with the movements.

denotes pain: * PROM C: limited shoulder IR.* and limited shoulder add. w/ firm end feel PROM A: GHJ- Tight capsule posteriorly MMT: Weak Supraspinatus MLT: Supraspinatus deferred PFT: Tenderness pos./ superior shoulder with mod depth. Based on the above findings, what is the corresponding TR for weak supraspinatus? A. PFT- moderate B. PROM C- moderate C. PFT- low D. PROM C- low

A. PFT moderate If MLT were conducted it would create a false positive due to posterior capsular restriction. Also, it would not be PROM C because, if the ROM for that specific muscle is limited by the capsule, than PROM C cannot be used as a step for tissue reactivity.

Patient presents with wrist pain dorsally and the following findings:*pain. Palpation for Condition: Swelling around the wrist AROM: Limited wrist ext. by 10 degrees*, UR wrist flexion PROM C: Normal wrist flex ROM* and firm EF, UR wrist ext. Given the findings, what tissue would this be associated with? A. Capsule B. Contractile C. Cartilage D. Bursa

B. Contractile, this is because AROM and PROM are painful in opposite directions. Also, pay attention to how the question reads wrist pain dorsally. Because the pain is dorsal, lengthening and contracting the muscle with flexion and extension could elicit pain.

Which of the steps does not produce a tissue reactivity for muscle or tendon? A. PROM C B. PROM A C. PFT D. MLT

B. PROM A is not a step that maximally stresses the muscle and tendon. Thus, it does not produce TR in the muscle or tendon. MLT->PROM C->PFT = contractile tissue What are the steps for confirming the tissue impairment? --> This concept is different from TR Look it up

Which of these steps does not produce a tissue reactivity for a ligament? A. PROM A B. PROM C C. Special test D. PFT E. They all produce TR

B. PROM C does not maximally stress a ligament. Thus it does not produce TR in the ligament. Special test->PROM A->PFT

Which of these does not demonstrate a procedural principle for MSTT? A. No osteokinematic movement should occur B. Joint maintained in same position for each resistance applied over that joint and the spine C. Maintain a loose pack position D. Gentle pressure to achieve isometric contraction E. When two joint muscles are involved, joint positioning may be individualized for testin

B. The joint should be maintained in same position for each resistance applied over that joint an NEIGHBORING joints

Which if the following mobilization grades are most appropriate in case of a joint capsule effusion? Why? A. I-II distractions B. I-II glides C. I-III glides D. I-III distractions

B. You would not want mechanical changes because there is no true mechanical end feel. Also, glides I-II are the least aggressive, and because laxity causes effusion, you would not want to stretch the tissue further. I-II distractions are joint plays that are used to detect the joints ability to receive and absorb extrinsic forces, which is not the type of intervention we would be aiming at. I-III glides and distractions would incorporate mechanical changes that would not be necessary.

Tissue reactivity for PROM A finding: GHJ capsule adhesion with pain? A. High B. Moderate C. Low

B. The tissue reactivity would be moderate because there is pain associated with the adhesive end feel.

Tutoring Disclaimer If students are confused about any concept, documents or discussions in the tutoring sessions and/or if any of the information (verbal or written) conflicts with the course instructor's class discussions or required text material, please go with what the course instructor states and clarify with the course instructor. As tutors, their responsibility is only to discuss anything that the student may need further help with as the student reviews the course material but not to teach or replace any documents/information provided by the course instructor. Which of these is not an effect of cross friction massage? A. Traumatic hyperemia B. Improved collagen alignment C. Decreased blood flow D. Gaits pain with moving stimulus and pressure

C. With cross friction massage you will encounter all of these effects except decreased blood flow. With CFM blood flow will be increased.

A patient diagnosed with diabetes that began to suffer from peripheral neuropathy rolled his ankle a week ago. Due to the lack of sensation in the area he continued going about his normal daily activities until a day later when he could not put his foot into his shoe. After examining the patient you notice redness, and extreme swelling to the region. The patient also complains that the pain seems like its getting worse. At the time you are seeing this patient what SOC is he in and what is the most important treatment intervention to consider. A. Sub-acute/palliative B. Acute/prepartory C. Acute/palliative D. Chronic/supportive

C. Because of the low amount of time from the injury, the presence of warmth and swell, and that the patient complains of worsening pain, we can conclude that the SOC is acute, and the most appropriate intervention would be palliative.

Based on the findings, which of these is a valid test? Why? A. MSTT: Strong and painless MMT 5/5 with symptoms of pain B. PROM A: GHJ- Tight capsule anteriorly MLT: Shoulder extension limited C. PROM A: GHJ- Tight capsule anteriorly MLT: Shoulder IR excessive D. PROM A: GHJ- Tight capsule posteriorly MLT: Triceps mobility limited

C. The MLT test for shoulder internal rotations would be valid because a tight anterior GHJ capsule would not cause the test to produce a false positive. MMT cannot produce a strength grade if the test is painful. If the capsule is tight anteriorly than an MLT for shoulder extension would produce a false positive. If the capsule was tight posteriorly than an MLT for the limited triceps mobility would also produce a false positive.

Which of these is a good end of session goal? A. Pt will be able to run 30 mins on treadmill w/out stopping. B. Pt. will be able to perform a sit to stand x10 to increase quadriceps strength C. Pt will reach first shelf in pantry, and increase shoulder ROM 6 degrees w/ 2 degrees less pain D. Pt. will decrease pain by 2 levels, and improve 7 degrees in shoulder ROM

C. This is a good end of session goal because it is functional, realistic, objective, and measurable. F-functional R-realistic O-objective M-measurable

Based on the previous case scenario, what would be the best therapeutic modality to start with and why? A. Thermotherapy, because it increases permeability and has the potential to aid in oxygen and nutrient delivery. B. Electrical stimulation, because it assists with the re-education of the muscle and promotes strength recovery. C. Soft tissue massage, because it mobilizes the tissue and can help to reduce inflammation. D. Hit their ankle with a hammer because your tired of trying to think of things. E. Cryotherapy, because cold just works

C. I'm going to go with soft tissue massage on this one because it can help to alleviate pain and reduce swelling, and the explanation for cryotherapy wasn't good enough. However, thermotherapy is out because a tissue experiencing acute trauma is contraindicated. It wouldn't be electrotherapy because with the associate acute flair up you would not be trying to reeducate the muscle or promote strength.

Which PROM C motions will provide TR if MLT is defered or false positive for Elbow extensors? A. PROM C: limited shoulder extension w/firm EF B. PROM C: limited elbow extension w/hard EF C. PROM C: limited elbow flexion w/ firm EF D. PROM C: Limited shoulder extension w/firm EF

C. PROM C for limited elbow flexion would be the step used to determine corresponding TR for elbow extensors. This is because elbow extension MLT requires elbow flexion

PROM findings: shoulder internal rotation limited 10 degrees with tight capsule. Pick the best option? A.Tight internal rotators B. Tight external rotators C. Defer ER MLT D. Defer IR MLT

C. You would defer ER MLT because the tight capsule for IR would create a false positive when trying to determine MLT for ER's.

Which of these is not necessary to look for during the scanning examination? A. When trauma with radicular signs are present B. To determine the level of the spine that is affected. C. To rule out a serious pathology D. When abnormal signs and symptoms are present E. Presence of altered sensation in the limb

C. You would rule in or rule out a serious pathology during the systems review.

When performing a structural inspection, how do we differentiate a functional impairment from a structural impairment? A. Evaluate the primary peripheral joint after accessing the joint above and below. B. Determine the patients active physiological range of motion. C. Positional relationships are altered due to soft tissue impairments D. Deformation of the bony elements within the framework of the body.

C. - You can differentiate a structural problem from a functional problem by assessing whether or not the structural impairment is due to soft tissue or a deformed bony segment. If it is a deformed bony segment there is nothing the PT can do to treat the dysfunction. However, if the impairment is due to a tight muscle, weakness or fascial restrictions, this can be corrected by a PT.

Which of these is not a contraindication to CFM? A. Bursitis B. Traumatic arthritis C. Ossification of soft tissue D. Hematoma E. Over neural tissue

D. According to the note packet hematoma is not a direct contraindication to performing cross friction massage.

Which finding would you use as an indicator to defer MLT? A. MSTT-strong and painful B. Pt. presents with osteoarthritis C. PROM A- normal capsular EF D. TSI- GHJ effusion E. B & D

D. The best answer to this question would be GHJ effusion, because you do not want to perform an MLT on a joint that has effusion. The answer would not be E or B because you can't be sure if the osteoarthritis would effect the muscle you are trying to perform an MLT on.

Which of these would be associated with a soft endfeel? A. meniscal injury B. torn muscle C. elbow flexor contracture D. tenosynovitis E. capsular adhesion

D. - It would be tenosynovitis because that is inflammation within the tendon sheath associated with a build up of synovial fluid, and a swelling end feel is a type of soft end feel. Why would none of the others fit?

Which of these steps produces a tissue reactivity for the capsule? A. PROM C B. PROM A C. Special test D. All of these steps produce TR

D. All of these steps produce tissue reactivity and they are listed in the order of: PROM A-> Special Test-> PROM C

For tight biceps, which sequence of interventions would be most appropriate. A. Prep- moist pack, Corr-biceps strengthening, Supp- biceps stretching B. Prep- thermal US, Corr-biceps stretching, Supp- Cold pack C. Prep-Cold pack, Corr-biceps stretching, Supp- STM D. Prep- STM, Corr- biceps stretching, Supp- Moist pack

D. Go through the different interventions required for different TSI's

Which of these is most appropriate for tight capsules? A. Grade I glides B. Grade I distraction C. Grade II glides D. Grade III distractions

D. Grade III distractions because there are mechanical effects. None of the other interventions cause mechanical effects.

PROM C: shoulder flexion. limited 20 degrees with firm end feel PROM A: GHJ-Normal capsular mobility MMT: Weak biceps MLT: Limited with pain Based on the above findings, what is the step and corresponding TR for weak biceps? A. PROM C- moderate B. PROM C- Low C. MMT- moderate D. MLT- moderate

D. The answer is MLT because that is the first step in determining TR for a contractile tissue. And their is no criteria for deferring MLT.

Pt. suffered from a fall on an outstretched arm after flying over the handle bars of their bicycle. They have come to see you one week after the accident, and report that their symptoms are getting better. Upon examining the tissue you note swelling and redness around the shoulder. Upon palpation of the affected area you noticed that the tissue was still warm. You continue conducting your examination and these are your findings: Denotes pain * PROM C: shoulder flexion/extension limited* PROM A: GHJ effusion* MSTT: Strong and painless MMT: Weak anterior deltoid with pain MLT: Patient guarded with pain PFT: Tenderness over the shoulder with moderate depth Based on the above findings what would be your TSI, TR with the corresponding tissue, and what SOC would the patient be in? A.Weak ant. deltoid/GHJ effusion, MLT-high, acute SOC B. Ant. deltoid tendonopathy, MLT- high, sub-acute SOC C. GHJ effusion, PFT-mod, acute SOC D. GHJ effusion, PROM A-mod, acute SOC E. Weak ant. deltoid/GHJ effusion, PFT-mod, acute SOC

D. The answer to this question would be GHJ effusion as the TSI, PROM A-mod, and the patient would be in the acute SOC. GHJ effusion would be your TSI because the findings for MMT would produce a false positive based on the pain associated with the test. The MLT would be a false finding because you defer MLT with effusion of the joint. Their SOC would be acute because even though the pt. reports feeling better they are presenting with warmth, redness, and swelling. Also, it has only been one week since the accident, which falls under the acute SOC time line.

Pt. came in after a nasty car accident that occurred six months prior. They broke their femur and had multiple contusions on their head and neck. They also suffered from a broken ankle. The pt. was in a long leg cast for 5 and a half months. Cast came off two weeks ago, and they came to see you to help them overcome the muscular weakness associated with the immobility. Upon coming in for today's session you noticed that their ankle was showing signs of redness, warmth, and swelling. The patient also reported that they have been experiencing worsening symptoms of pain in the ankle. Pt. began walking, but with pain during the walking. . What is their SOC, appropriate associated intervention category, and subject reactivity? A. Chronic/ acute flair up- Corrective, SR-low B. Chronic- Supportive, SR-mod C. Chronic- Palliative, SR-high D. Chronic/ acute flair up- Palliative, SR-mod

D. This patient would be in the chronic stage, yet because of the symptoms associated with their ankle, they would be experiencing an acute flair up. Because this patient is experiencing an acute flair up it would be necessary to take a palliative course of action

How do the signs of instability/laxity present? A. Capsular ligamentous laxity may present with normal osteokinematic motions. B. Capsular ligamentous laxity may present with excessive osteokinematic motions. C. Capsular ligamentous laxity may present with limited osteokinematic motions. D. These are all possible signs that may be demonstrated with capsular ligamentous laxity.

D. When an individual is suffering from capsular ligamentous laxity, it is possible for them to experience any of these signs.

Which of the following glides are most appropriate for decreased functional ROM? A. Grade I oscillation B. Grade II oscillations C. Grade II sustained stretch D. Grade III sustained stretch

D. You can use Grade III sustained stretch because you are assuming the tissue reactivity is low, and it has mechanical effects for improving range of motion. It would not be C because a grade II sustained stretch would not bring the muscle through enough ROM to have a mechanical effect.

If anterior glide at the radio humeral joint is limited due to tight capsule, which MLT's would you defer and why? A. Elbow extensors- involves elbow extension MLT, which is involved in radio humeral anterior glide. B. Elbow flexors- involves elbow extension MLT, which is necessary to radio humeral anterior glide C. Shoulder extensors- involved in elbow flexion MLT, which corresponds with radio humeral anterior glide D. Elbow extensors- involves elbow flexion MLT, which is necessary to radio humeral anterior glide.

D. Because Elbow extensors MLT involves elbow flexion. Elbow flexion requires anterior radial head glide (RHJ-concave on convex) and if that glide is limited by capsule, we would defer all elbow extensors MLT so that we do not get a false positive tightness of those muscles.

What is the relevance of a PT examination? A. To make a clinical judgement based on the data from the tests and measures. B. To organize information into defined clusters, syndromes and categories for intervention strategies. C. To determine the level of improvement that might be attained through physical therapy. D. To determine if a patient needs physical therapy. E. To measure improvement or lack of improvement the patient gained.

D. Evaluation- to make a clinical judgement based on the data obtained during the examination. Diagnosis- is both the process of evaluating and and the result of evaluating information obtained during an examination, which then helps the PT to organize the information into clusters, syndromes, and categories to help formulate an intervention strategy. Prognosis- determine the level of optimal improvement that a patient might gain from PT. Outcome- measures improvements or lack of improvement.

What do you identify for when palpating for condition? A. Redness B. Pain C. Loss function D. Swelling

D. Identifying the presence of redness is done during the structural inspection. Identifying pain is conducted during PFT. And loss of function is determined during the movement analysis.

What PROM C motions will provide TR if MLT is deferred or false positive for shoulder flexors? A. PROM C: limited shoulder flexion w/ firm EF B. PROM C: limited elbow extension w/ hard EF C. PROM C: limited elbow flexion w/ soft EF D. PROM C: limited shoulder extension w/ firm EF

D. PROM C for limited shoulder flexion would be the step used to determine corresponding TR for shoulder flexors. This is because shoulder flexion MLT will require shoulder extension.

What is not a possible reason for excessive arthrokinematic motions due to capsular laxity? A. Biomechanical B. Neurophysiological C. Pain D. Reflexive E. Muscle length/tension

D. Reflexes have more to do with signals coming for the CNS, and are not heavily involved with effecting arthrokinematic motions at the joint.

Which of these is not characteristic of Joint Play? A. Tibiofemoral distraction B. Not under voluntary control C. Does not follow the convex concave rule D. Detects interference with AROM E. the force is perpendicular to the treatment plane

D.- Detecting joint dysfunctions that may be interfering with AROM is characteristic of component motion. Joint plays are not under voluntary control and do not follow the convex concave rule. When performing a joint play motion like tibiofemoral distraction the direction of force is perpendicular to the treatment plane.

Which of these is not a TSI? A. Subacromial bursitis in the left shoulder B. Partial tear of the right biceps brachii C. Adhesion of the MCP joint capsule in the posterior direction. D. Hypermobility in the radiohumeral joint capsule due to laxity E. These are all tissue specific impairments.

E. These are all tissue specific impairments because the impairment, the tissue, and what is wrong with the tissue is determined.

Pick the best intervention for the finding below. PROM A: GHJ joint capsule tightness in anterior direction. A. Grade III distraction B. Grade I-II anterior humeral glide C. Grade I-III oscillations D. Grade III-IV posterior humeral glide E. Grade IV anterior humeral glide w/sustained stretch

E. You would use a Grade IV anterior humeral glide with sustained stretch due to the low tissue reactivity, which would allow you to place more stress on the tight capsule.

Which of these does not relate to how you would treat an impairment? A. Determine tissue reactivity B. Determine subject reactivity C. Determine SOC D. Ascertain a functional goal E. These all relate

E. All of these components are considered when determining how to treat a functional impairment.

If PFT is the best step for the impairment how do you determine whether it is high-mod-low?

High- pain at superficial depth Mod-pain at deep/mod deep Low- No pain associated

Would hypomobility of the GH joint capsule in the anterior direction be considered a TSI?

No, hypomobility is not specific enough. In order for this to be considered a TSI, the specific distinction for hypomobility must be specified. Ex. Hypomobility of the GH joint capsule in the anterior direction due to adhesion When determining hypomobility of a joint capsule you look for TIGHTNESS, ADHESION, AND EFFUSION.

Would you defer MLT if capsular laxity is present?

No, you would not defer MLT because of capsular laxity. This is because it would not effect the maximal lengthening of the muscle. In other words, it would not produce a false positive.

True or False If a submaximal test (MSTT) is not enough to elicit symptoms you would perform an MMT.

True Because MSTT is a submaximal test, it may not be enough force to aggravate the pts. symptoms.

True or False Edema is a reason to defer MLT.

True- when you have edema around a joint you do not want to maximally stress the tissue with an MLT. Also, you should not use PROM C as your step for tissue reactivity if it is a one joint muscle.--> Use PFT However, if it is a two joint muscle, and there is no impairment to the second joint you can still you PROM C as your step for TR. Ex: Shoulder has anterolateral swelling. You would defer MLT b/c you can't bring the arm into full extension, but you can extend the elbow and use PROM C as your step.