Chapters 17-22
During closed-chain strengthening of the quadriceps, knee ROM in which the greatest amount of patellofemoral compression occurs is: A. At all portions of the ROM (i.e., compressive forces are equal throughout the ROM). B. Between 30° of knee flexion to full extension. C. Between 60° of knee flexion to 30° of knee flexion. D. Between 60° of knee flexion to full knee flexion.
Between 60° of knee flexion to full knee flexion.
Which one of the following ligaments of the ankle is most frequently stressed with an inversion sprain? A. Posterior talofibular B. Anterior talofibular C. Calcaneofibular D. Deltoid
Anterior talofibular
You are educating your patient about returning to functional activities following a radial head resection with an implant. What should you tell her about returning to high-demand, high-impact activities? A. Avoid these activities on a permanent basis. B. Because she had a radial head implant, she may return to these activities after 6 months. C. She may return to heavy lifting after 6 months, but not high-impact (tennis or golf) activities because of the ballistic force these activities create. D. She should have had a TEA if she wanted to return to these activities.
Avoid these activities on a permanent basis.
Tennis elbow may involve all of the following structures except the: A. Extensor carpi radialis brevis. B. Extensor communis. C. Pronator teres. D. Annular ligament.
pronator teres
Which of the following surgical procedures is performed for recurrent anterior instability or dislocation of the glenohumeral joint and involves reattachment and repair of the capsulolabral complex to the anterior rim of the glenoid? A. Anterior capsular shift B. Bankart repair C. Hill-Sachs repair D. SLAP lesion repair
Bankart repair
Each of the following is true about postoperative management after primary TKA except: A. Based on the design of the prosthesis, the use of grade III posterior joint gliding techniques may be an appropriate intervention to increase knee flexion after cruciate-excising TKA but not after cruciate-retaining TKA. B. If the TKA involved cementless fixation, weight-bearing recommendations vary widely from weight bearing as tolerated while using a walker or crutches to touch-down weight bearing for 4 to 6 weeks after surgery. C. Although straight-leg-raising exercises for the operated lower extremity are initiated in supine and prone positions as soon as possible during the early postoperative period, they often are delayed for several weeks in side-lying positions to avoid varus/valgus stresses on the operated knee. D. Participation in high-impact physical activities should be avoided after TKA, as it may contribute to mechanical loosening of the implanted prosthesis over time.
Based on the design of the prosthesis, the use of grade III posterior joint gliding techniques may be an appropriate intervention to increase knee flexion after cruciate-excising TKA but not after cruciate-retaining TKA.
Each of the following is a precaution that should be taken after TEA involving a triceps-reflecting or triceps-splitting approach except: A. Limit assisted elbow flexion to about 90° to 100° for the first 3 to 4 weeks postoperatively. B. For about the first 3 to 4 weeks, perform active elbow flexion/extension only while lying in the supine position. C. Postpone elbow extension against manual resistance or light weights for 6 weeks or longer. D. Avoid pushing motions with the operated upper extremity during functional activities, such as pushing up from a chair, for at least 6 weeks.
For about the first 3 to 4 weeks, perform active elbow flexion/extension only while lying in the supine position.
Hip flexor structural or functional impairment will result in a change in the normal gait cycle. The therapist should suspect hip flexor dysfunction when observing gait and noting a: A. Lengthened stride. B. Posterior lurch of the trunk at foot contact. C. Lateral shift of the trunk over the stance leg when the opposite leg swings. D. Forward flexion of the trunk during weight bearing.
Forward flexion of the trunk during weight bearing
Your patient sustained a fracture of the right calcaneus as the result of a motor vehicle accident 3 months ago. After 10 weeks in a cast followed by a rocker bottom immobilization boot that prevented ankle and foot motion, the fracture shows radiological evidence of bony union. The patient has been ambulating (weight bearing as tolerated) while wearing the boot and is now supposed to discontinue wearing it slowly. Your examination reveals marked limitation of dorsi- and plantarflexion and a high, rigid arch. There is no visible swelling, and pain (2/10) occurs at the end of the day and during passive range of motion (PROM) with overpressure. Which of the following is the most appropriate intervention during the first week of therapy? A. PROM of the ankle (dorsiflexion/plantarflexion and calcaneal inversion/eversion) B. Gentle passive stretching of ankle musculature C. Grade II joint mobilization at the subtalar joint D. Grade III joint mobilization at the midtarsal joint
Grade III joint mobilization at the midtarsal joint
Which of the following functional activities should a patient avoid for the longest period of time after rTSA? A. Reaching overhead B. Hugging with both arms C. Reaching into abduction in the plane of the scapula at a drive-through window D. Fastening a bra behind the back
Fastening a bra behind the back
1. Which of the following most accurately describes the deformities that progressively develop in rheumatoid arthritis (RA) of the foot/ankle? A. Fixed supination of the foot, hallux valgus, hallux rigidus, dorsal subluxation of the proximal phalanges on the metatarsal heads B. Fixed pronation of the foot, hallux valgus, hallux rigidus, plantar subluxation of the proximal phalanges on the metatarsal heads C. Fixed pronation of the foot, hallux valgus, hallux rigidus, dorsal subluxation of the proximal phalanges on the metatarsal heads D. Fixed supination of the foot, hallux valgus, hallux rigidus, plantar subluxation of the proximal phalanges on the metatarsal heads
Fixed pronation of the foot, hallux valgus, hallux rigidus, dorsal subluxation of the proximal phalanges on the metatarsal heads
If a patient stands in a fencer's posture but with the back leg externally rotated and then lunges forward, this self-stretching maneuver primarily stretches which muscle groups of the back leg? A. Hip abductors and external rotators B. Hip flexors C. Hip extensors D. Hip adductors and internal rotators
Hip adductors and internal rotators
The term hybrid total hip arthroplasty refers to a(n): A. Hip replacement with a cemented femoral component and a noncemented acetabular component. B. Total hip replacement that is all metal. C. Alternate term for bipolar hemiarthroplasty of the hip. D. Alternate term for minimally invasive arthroplasty.
Hip replacement with a cemented femoral component and a noncemented acetabular component
Which of the following is true about total knee arthroplasty (TKA)? A. When a cruciate-retaining prosthesis/procedure is used for a TKA, the anterior cruciate ligament (ACL) is not excised, thus providing greater anterior-posterior stability to the knee. B. A tricompartmental TKA involves replacing not only the articulating surfaces of the proximal tibia and distal femur but also the tibiofibular articulation. C. If a semiconstrained or unconstrained prosthetic implant is used, the medial and lateral collateral ligaments (MCL and LCL) must be intact or repairable for adequate postoperative medial-lateral stability of the replaced joint. D. A mobile-bearing prosthesis typically is selected for the elderly, relatively sedentary patient because this design permits full weight bearing immediately.
If a semiconstrained or unconstrained prosthetic implant is used, the medial and lateral collateral ligaments (MCL and LCL) must be intact or repairable for adequate postoperative medial-lateral stability of the replaced joint.
A surgical procedure for a repair of a chondral defect of the medial femoral condyle involves the following: harvesting multiple plugs of intact articular cartilage along with some subchondral bone of the patient's own tissue from a donor site (typically a nonweight-bearing portion of the joint surface) and implanting the plugs (using a press fit) into the site forming a bone-to-bone graft. This procedure is called: A. Autologous chondrocyte implantation. B. Mosaicplasty. C. Microfracture. D. Débridement and lavage.
Mosaicplasty
Following a severe, third-degree (grade 3) inversion sprain, your patient complains of pain just distal and lateral to the knee joint. The pain is likely the result of: A. Subluxation of the proximal tibiofibular joint. B. Tear of the lateral collateral ligament. C. Tear of the lateral head of the gastrocnemius. D. Referred pain from gait deviations due to sore ankle joints and ligaments.
Subluxation of the proximal tibiofibular joint.
Which of the following surgical approaches for conventional total hip arthroplasty is associated with the highest risk of postoperative hip dislocation if the hip flexes (passively or actively) beyond 80° to 90° during the early postoperative weeks? A. Lateral B. Anterolateral C. Posterolateral D. All approaches pose an equally high risk.
posterolateral
Each of the following is an expected outcome of conservative management of osteoarthritis of the knees except: A. Maintaining functional range of motion and strength. B. Relieving pain. C. Regenerating worn articular cartilage. D. Preventing deformity.
regenerating worn articular cartilage
Recent advances in arthroscopy of the hip now allow all of the following procedures to be performed using this less invasive technique except: A. Microfracture to stimulate fibrocartilage growth. B. Acetabular labral repair. C. Resurfacing arthroplasty. D. Capsulorrhaphy for capsular laxity.
resurfacing arthroplasty
Osteoarthritis of the hip is typically characterized by a progressive decrease in range of motion (ROM) of the following movement combinations: A. External rotation and extension. B. Internal rotation and extension. C. External rotation and adduction. D. Equal loss of internal and external rotation.
internal rotation and extension
Results of numerous outcome studies have demonstrated that the most predictable outcome after shoulder arthroplasty is: A. Increased active shoulder ROM. B. Increased shoulder-joint stability. C. Pain relief. D. Improved function of the rotator cuff mechanism.
pain relief
Rotator cuff disease is multifactorial and is associated with both intrinsic and extrinsic factors affecting the structures in the suprahumeral space. Of the following contributing factors, which is classified as an intrinsic factor? A. Vascular changes in the rotator cuff tendons B. Hypertrophic degenerative changes of the acromioclavicular joint C. The shape of the acromion D. Increased thoracic extension
vascular changes in the rotator cuff tendons
Each of the following is true about patellar tendon versus hamstring tendon autografts for ACL reconstruction except: A. A longer healing time and a more slowly progressed rehabilitation program are required with a hamstring tendon graft than with a patellar tendon graft. B. A patellar tendon graft is most appropriate for the skeletally immature patient. C. Anterior knee pain and difficulty kneeling are somewhat frequent complications with a patellar tendon graft but not with a hamstring tendon graft. D. A patellar tendon graft involves bone-to-bone fixation, whereas a hamstring tendon graft involves tendon-to-bone fixation.
A patellar tendon graft is most appropriate for the skeletally immature patient.
Which of the following is a true statement about glenohumeral arthroplasty? A. Hemiarthroplasty is most often performed using an arthroscopic approach. B. The primary indication for glenohumeral arthroplasty is limited mobility of the shoulder. C. A reverse total shoulder arthroplasty (rTSA) is an appropriate procedure for a patient with marked instability of the glenohumeral joint and a rotator cuff that is not repairable. D. For adequate exposure of the joint during surgery, the muscle that routinely must be released (and reattached prior to closure) is the anterior deltoid.
A reverse total shoulder arthroplasty (rTSA) is an appropriate procedure for a patient with marked instability of the glenohumeral joint and a rotator cuff that is not repairable.
During the initial assessment of a patient who complains of a recent onset of "knee pain" when descending stairs and a sense of "giving way" both on the stairs and when walking, you ask several questions about recent knee injuries. Which of the following injuries would lead you to believe the patient might have injured his ACL? A. A forward fall onto his knee directly striking his patella B. A blow to the inside of his knee when his dog was jumping up to greet him C. A twisting injury when he slipped off the curb and his knee buckled inward D. A running injury resulting in pain along the inferior border of the patella and the tibial tubercle
A twisting injury when he slipped off the curb and his knee buckled inward
Your uncle called you last night after playing three games in a softball tournament yesterday. He indicated that late in the third game while trying to stretch a double into a triple, he felt a sudden sharp pain in his calf, which significantly interfered with his ability to continue running. He is able to move his foot "up and down," but both motions are painful. He is also able to walk if he "takes it slow." From the information your uncle gave you and the fact that he is a 42-year-old weekend warrior, your preliminary hypothesis is that your uncle may have sustained a(n): A. Fracture of the tibia. B. Achilles tendon rupture. C. Plantaris rupture. D. Syndesmosis injury.
Achilles tendon rupture
Each of the following is correct about precautions that should be taken after repair of a full-thickness rotator cuff tear associated with chronic impingement except: A. After a traditional open repair for a massive cuff tear, postpone active ROM exercises until about 2 weeks postoperatively to avoid avulsion of the deltoid that was detached and reattached during the procedure. B. When the patient is lying in the supine position during the early postoperative days, place a folded towel under the humerus to position the arm slightly anterior to the frontal plane of the body to minimize anterior translation of the head of the humerus and the potential for impingement. C. Before initiating active elevation of the arm in the sitting or standing position, restore strength in the rotator cuff muscles, especially the supraspinatus and infraspinatus muscles, to prevent superior translation of the head of the humerus during active elevation of the arm. D. Delay weight-bearing/closed-chain exercises on the operated upper extremity for about 6 weeks.
After a traditional open repair for a massive cuff tear, postpone active ROM exercises until about 2 weeks postoperatively to avoid avulsion of the deltoid that was detached and reattached during the procedure.
Each of the following is a true statement about rehabilitation following dislocation of the glenohumeral joint except: A. After an initial dislocation and a course of nonoperative management, recurrence of a dislocation is higher in older patients (greater than 40 years of age) than in younger patients (less than 30 years of age). B. Anterior dislocation is far more common than posterior dislocation. C. A compression fracture of the posterolateral margin of the humeral head is an associated lesion that may occur as the result of a traumatic anterior dislocation. D. A fall on the arm when it is positioned in flexion, adduction, and internal rotation can result in a posterior dislocation.
After an initial dislocation and a course of nonoperative management, recurrence of a dislocation is higher in older patients (greater than 40 years of age) than in younger patients (less than 30 years of age).
Which of the following is true about managing a tear of the medial or lateral meniscus? A. A tear of the peripheral portion (outer zone) of a meniscus does not lend itself well to surgical repair because this portion of the meniscus is avascular and does not heal well. B. A potential complication of a medial meniscus repair is intraoperative damage to or postoperative entrapment of the saphenous nerve. C. After meniscus repair, initially avoid knee flexion beyond 60° to 70° during weight-bearing exercises for about 2 months because flexion beyond this range can displace the repaired meniscus in a posterior direction. D. After meniscus repair, the knee is immobilized in approximately 45° of flexion.
After meniscus repair, initially avoid knee flexion beyond 60° to 70° during weight-bearing exercises for about 2 months because flexion beyond this range can displace the repaired meniscus in a posterior direction.
When applying mobilization with movement techniques at the hip with the patient lying on a table in the supine position, the primary purpose of the mobilization belt is to: A. Apply a pain-free inferolateral glide of the femur. B. Apply a pain-free inferior glide of the femur. C. Apply a pain-free inferomedial glide of the femur. D. Support the weight of the leg, making it easier for the therapist to perform the mobilization maneuvers.
Apply a pain-free inferolateral glide of the femur.
John is a 25-year-old active athlete and outdoorsman who suffered a severe lateral ankle injury 5 years ago, resulting in progressive subtalar arthritis, pain, and instability of the ankle and hindfoot. His quality of life and ability to work are now restricted owing to the pain and instability despite repeated sessions in therapy. The surgical procedure of choice for John is most likely: A. Arthrodesis (fusion). B. Total ankle arthroplasty. C. Brostrom procedure. D. Watson-Jones procedure.
Arthrodesis (fusion)
Pendulum (Codman's) exercises are used most effectively: A. As a grade II oscillation technique to inhibit pain and maintain mobility. B. As a strengthening exercise when a weight is held in the hand or placed around the wrist. C. To stretch the shoulder musculature and increase range of motion (ROM) when a patient does not have antigravity control of shoulder movement. D. As a grade III distraction technique to increase ROM when mobility of the scapula is normal but there is chronic stiffness of the glenohumeral joint.
As a grade II oscillation technique to inhibit pain and maintain mobility
You are treating a patient with a painful shoulder as the result of supraspinatus tendonitis from chronic impingement. There is no evidence of tendon rupture or joint instability. Acute symptoms have subsided. Each of the following is appropriate to improve active elevation of the arm at this stage of rehabilitation except: A. Reinforce the importance of maintaining an erect trunk during elevation of the arm. B. Teach the patient to apply cross-fiber massage to the supraspinatus tendon while it is on a stretch, followed by isometric contractions of the muscle. C. As the patient actively elevates the arm within the pain-free range, apply an anterior glide of the head of the humerus (mobilization with movement technique). D. Strengthen key scapular stabilizers, such as the serratus anterior, middle trapezius, and lower trapezius, in closed-chain and open-chain positions.
As the patient actively elevates the arm within the pain-free range, apply an anterior glide of the head of the humerus (mobilization with movement technique).
Each of the following principles is important when designing a therapeutic exercise program to correct hip muscle length/strength imbalances except: A. When stretching the hip musculature, the spine and pelvis must be stabilized against the force. B. Contraction of the muscle opposite the range-limiting muscle (i.e., contracting the antagonist of the tight muscle) to assist with the stretching maneuver has the benefit of training the antagonist muscle to function in any newly gained range. C. Because of the functional demands placed on the lower extremities, it is more important to have full hip ROM than to have "normal" strength of hip musculature. D. Strengthening exercises should include closed-chain exercises to prepare for functional activities in weight-bearing postures.
Because of the functional demands placed on the lower extremities, it is more important to have full hip ROM than to have "normal" strength of hip musculature.
To strengthen the elbow extensors in a closed chain, you have the patient perform push-ups, using body weight as the source of resistance. Which of the following variations of push-ups provides the greatest amount of resistance to the elbow extensors? A. Bilateral push-ups while in a fully prone position on the floor with weight on the hands and toes B. Bilateral wall push-ups while in a standing position and leaning into and pushing away from the wall C. Bilateral push-ups while standing and leaning on the hands on a kitchen countertop D. Bilateral push-ups in a prone position with weight on the hands and knees
Bilateral push-ups while in a fully prone position on the floor with weight on the hands and toes
When a period of continuous immobilization of the elbow is required after trauma or surgery, the elbow often is positioned in only a moderate amount of flexion (20° to 30°) rather than 90° of flexion. This position is selected to: A. Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the cubital tunnel. B. Decrease the risk of radial neuropathy from compression of the radial nerve in the cubital tunnel. C. Decrease the risk of median nerve neuropathy from compression in the cubital tunnel. D. Decrease the risk of overstretching the lateral collateral ligament complex of the elbow that could cause posterior translation of the radial head.
Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the cubital tunnel.
In an elderly patient, which of the following types of hip fracture is managed most often with hemireplacement of the hip (hemiarthroplasty)? A. Noncomminuted intertrochanteric fracture B. Displaced subcapital (intracapsular) fracture C. Unstable subtrochanteric fracture D. Hemiarthroplasty is equally indicated for intracapsular and extracapsular fractures.
Displaced subcapital (intracapsular) fracture
Your patient has RA and is complaining of pain in her ankles and feet when walking. You observe her gait and notice short steps and poor push-off. This is consistent with what deformity in RA? A. Everted calcaneus and pronated forefoot B. Inverted calcaneus and pronated forefoot C. Everted calcaneus and supinated forefoot D. Inverted calcaneus and supinated forefoot
Everted calcaneus and pronated forefoot
You are modifying a home exercise program for a patient recovering from an episode of medial epicondylitis. Although pain has subsided, there is evidence of mild limitation of motion and pain when the involved muscle-tendon unit is placed on a stretch and overpressure is applied at the end of the available ROM. To fully lengthen the muscle-tendon unit typically involved in medial epicondylitis, have the patient perform a self-stretch by using the opposite hand to: A. Flex and ulnarly deviate the wrist and flex the fingers while the elbow is extended and the forearm is pronated. B. Flex and radially deviate the wrist and flex the fingers while the elbow is extended and the forearm is supinated. C. Extend and ulnarly deviate the wrist and extend the fingers while the elbow is extended and the forearm is pronated. D. Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated.
Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated.
A patient underwent a triple arthrodesis of the hindfoot 12 weeks ago and is now allowed to ambulate without the rigid boot. The patient has been referred to you for exercises to improve ROM and strength of the operated lower extremity and to re-establish a normal gait pattern. Which of the following interventions is inappropriate to include in your treatment plan to restore this patient's function? A. Passive stretching of the plantar flexors B. Grade III medial and lateral sustained glides to increase inversion and eversion C. Grade III sustained posterior glides of the talus on the tibia to increase dorsiflexion D. Closed-chain training to improve lower extremity control
Grade III medial and lateral sustained glides to increase inversion and eversion
You are developing an exercise program for a patient who has adhesive capsulitis of the right shoulder. You have determined that the signs and symptoms identified during your examination are consistent with stage 2, the "freezing" stage, of this disorder. In addition to maintaining mobility of joints distal to the shoulder, which of the following interventions for the shoulder is most appropriate at this time? A. Low-intensity progressive resistance exercise, mobilization with movement techniques, and manual stretching of the shoulder and scapular stabilization exercises with progressive weight bearing through the upper extremity B. Grade III joint-mobilization techniques, self-stretching, and strengthening exercises C. Gentle weight bearing on the involved upper extremity to develop scapular control and active ROM of the shoulder (e.g., wand and wall-climbing exercises) D. Grades I and II joint distraction and gliding techniques, pendulum exercises, passive or active-assistive ROM within pain-free ranges, and muscle setting exercises for shoulder musculature
Grades I and II joint distraction and gliding techniques, pendulum exercises, passive or active-assistive ROM within pain-free ranges, and muscle setting exercises for shoulder musculature
Current research shows that the "survival rate" for TEA is: A. 30% over a 10-year period. B. Greater for patients with rheumatoid arthritis than for those with traumatic arthritis or osteoarthritis. C. Highly correlated with the type of implant (prosthesis). D. Greater for young, active adults who provide consistent stress to the fixation, encouraging increased bone formation and less loosening of the implant.
Greater for patients with rheumatoid arthritis than for those with traumatic arthritis or osteoarthritis.
For effective shoulder function, each of the following is necessary except: A. Appropriate movement and stability of the scapula. B. Greater mobility in the external rotators than the internal rotators. C. A balance in strength of the external and internal rotators. D. Thoracic extension and axial extension of the cervical spine.
Greater mobility in the external rotators than the internal rotators.
Of the following activities, which is the most appropriate choice for developing stability of the scapulothoracic joint? A. While in the supine position, have the patient perform repeated concentric contractions of the scapular protractors against manual resistance applied to the anterior aspect of the shoulder. B. While standing, have the patient place the arms in a reverse-T position while holding a piece of elastic tubing between the hands. Then have the patient attempt to "pinch the shoulder blades together" repeatedly against the elastic resistance. C. Have the patient stand, face a wall, place the hands on the wall, and lean into the wall as the therapist applies alternating resistance against the shoulders. D. Have the patient hold the arms in various positions in space (perform isometric contractions) as the therapist applies resistance in various directions.
Have the patient stand, face a wall, place the hands on the wall, and lean into the wall as the therapist applies alternating resistance against the shoulders.
You place your patient's wrist in a splint because he is experiencing an acute episode of lateral epicondylitis. Which of the following is the least appropriate intervention while the inflamed soft tissue is healing? A. Have the patient wear a splint to immobilize the wrist continuously for at least 2 weeks or until there is no pain. B. Have the patient remove the splint several times each day and perform active or self-assisted ROM of the wrist within pain-free ranges. C. Have the patient remove the splint several times a day and perform gentle muscle-setting exercises, elongating the involved muscle-tendon unit slightly after each contraction but not beyond the pain-free ranges. D. Apply cross-fiber massage at the site of the lesion.
Have the patient wear a splint to immobilize the wrist continuously for at least 2 weeks or until there is no pain.
You are seeing a patient to initiate exercises 5 days after reconstruction of the ACL with a patellar tendon autograft. During the first phase of the postoperative exercise program, your primary concern is: A. Preventing contractures at the knee. B. Preventing atrophy and reflex inhibition of the quadriceps. C. Imposing controlled loads on the knee while protecting the graft from excessive stresses. D. Preventing joint swelling.
Imposing controlled loads on the knee while protecting the graft from excessive stresses.
The most common fracture in the elbow region is a fracture of the head and neck of the radius. All of the following are true about medical management of this injury except: A. Improved ROM is the primary indication for surgery and the primary goal of postoperative rehabilitation following a radial head fracture. B. Open reduction and internal fixation is the preferred technique if stable fixation can be achieved and the patient is a young, active adult. C. Closed reduction is preferred for radial head fractures in children. D. Biomechanical studies demonstrate that implant arthroplasty after a severely comminuted fracture restores stability and kinematics similar to the native radial head.
Improved ROM is the primary indication for surgery and the primary goal of postoperative rehabilitation following a radial head fracture.
Each of the following is an expected improvement after TAA for advanced arthritis except: A. Increased mediolateral stability of the ankle. B. Alleviation of pain. C. Sufficient range of motion (ROM) of the ankle for functional activities. D. Decreased joint deformity.
Increased medilateral stability of the ankle.
Which of the following is a correct statement about arthrodesis of the hip? A. It is the surgery of choice for the elderly (greater than 75 years old) patient with an intertrochanteric fracture. B. It is commonly performed arthroscopically in young, active individuals. C. It is the procedure of choice for treating severe osteoarthritis that affects both the acetabular and femoral components of the hip. D. It is considered a salvage procedure when revision arthroplasty is not an option.
It is considered a salvage procedure when revision arthroplasty is not an option.
Which of the following is true about myositis ossificans (heterotopic bone formation) in the elbow region? A. The muscle most often affected in the elbow region is the biceps brachii. B. It is distinguished from traumatic arthritis of the humeroulnar joint in that passive extension is more limited than flexion. C. After the acute inflammatory period, heterotopic bone is laid down within muscle fibers and within the joint. D. Before the bony mass in the muscle has matured, the muscle should be stretched and massaged regularly to prevent a contracture.
It is distinguished from traumatic arthritis of the humeroulnar joint in that passive extension is more limited than flexion.
The "minimally invasive knee arthroplasty" is one type of surgical approach for performing TKA. When the surgeon chooses this approach, it is because: A. It is easier to perform and therefore is the choice of the less-experienced surgeon. B. The incidence of intraoperative complications is lower. C. It is an arthroscopic procedure, so the rehabilitation is shorter. D. It is less disruptive to the soft tissue, with increased rate of postoperative recovery and less postoperative pain.
It is less disruptive to the soft tissue, with increased rate of postoperative recovery and less postoperative pain
Which of the following is a true statement about an arthroscopic subacromial decompression procedure? A. It is indicated for a patient who sustains a full-thickness, traumatic tear of the rotator cuff if coupled with a repair of torn cuff tissues. B. It may or may not involve resection of the anterior acromial protuberance and contouring of the undersurface of the remaining acromion. C. It is indicated for a patient with secondary impingement syndrome due to glenohumeral joint hypermobility/instability. D. During surgery, the deltoid must be detached for adequate exposure of the suprahumeral space.
It may or may not involve resection of the anterior acromial protuberance and contouring of the undersurface of the remaining acromion.
Your patient, a 19-year-old college student, sustained a nondisplaced fracture of the distal humerus, which was managed by closed reduction and 6 weeks of immobilization in a cast. Yesterday the cast was removed and the patient is to begin exercises to improve range of motion (ROM) and strength of the elbow. Your examination reveals significant limitation of elbow flexion/extension and forearm pronation/supination as well as reduced joint play at the elbow. The patient describes her elbow as feeling "very stiff," but pain occurs only when overpressure is applied at the end of the available ranges. One of the goals in this patient's treatment plan is to increase elbow ROM. With which of the following techniques should you begin to increase ROM? A. Cross-fiber massage of the tendons inserting at the elbow B. Joint-mobilization techniques to stretch the restricted joints (grade III sustained glide or grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with grade II sustained glides C. Manual passive stretching to lengthen muscles that cross the elbow D. Passive ROM within pain-free ranges
Joint-mobilization techniques to stretch the restricted joints (grade III sustained glide or grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with grade II sustained glides
A patient with a history of recurrent dislocation of the patella underwent a surgical procedure for realignment of the extensor mechanism. Considering the position of immobilization postoperatively, you would expect to find each of the following impairments when it is permissible to begin exercises except: A. Lack of full or almost full passive knee extension. B. Quadriceps (extensor) lag. C. Lack of full knee flexion. D. Weakness of the quadriceps and hamstrings.
Lack of full or almost full passive knee extension.
Which of the following is true about ligament injuries of the knee and post-injury management? A. The most common mechanism of injury of the ACL is forceful internal rotation of the tibia while the foot is planted. B. Under similar noncontact conditions, a man is far more likely to injure the ACL than a woman. C. MCL injuries are managed nonoperatively more often than are ACL, posterior cruciate ligament (PCL), or LCL injuries. D. Forceful hyperextension of the knee is the most common mechanism of injury of the PCL.
MCL injuries are managed nonoperatively more often than are ACL, posterior cruciate ligament (PCL), or LCL injuries.
The primary value of a patient performing quadriceps setting exercises when the knee is immobilized in a long leg cast for an extended period of time is to: A. Strengthen the quadriceps muscle. B. Maintain mobility of the patella. C. Stretch the anterior portion of the knee capsule. D. Prevent a knee extension contracture.
Maintain mobility of the patella.
Which of the following is true about total elbow arthroplasty (TEA)? A. A semiconstrained, linked prosthesis allows flexion and extension of the elbow but not varus, valgus, or rotational motions. B. The typical method of fixation of the implants is all-cementless (all-biological) fixation. C. The surgical approach most often used leaves the triceps tendon intact. D. One of the more common, long-term complications after TEA is joint instability, particularly with unlinked implants or in patients who previously underwent excision of the radial head.
One of the more common, long-term complications after TEA is joint instability, particularly with unlinked implants or in patients who previously underwent excision of the radial head.
You are initiating postoperative treatment for a 78-year-old woman who sustained an intertrochanteric fracture of the proximal femur 3 days ago and immediately underwent open reduction with internal fixation (screw-plate fixation). She has been referred to physical therapy for postoperative exercise and gait/functional training (initially with minimal weight bearing on the operated side). A decision has not yet been made about whether this patient will be discharged directly to home where she lives with her husband or to a subacute skilled nursing facility. Prior to discharge from the hospital during the next few days, which of the following is the lowest priority intervention? A. Gait training with a walker and transfer/bed mobility training B. Active-assistive range of motion (A-AROM), progressing to active range of motion (AROM) of the operated hip C. Open-chain, resistance exercises for the operated lower extremity D. Closed-chain, resisted exercises for the upper extremities and sound lower extremity, emphasizing extension in functional patterns
Open-chain, resistance exercises for the operated lower extremity
Which of the following signs and symptoms in the hip region and/or lower extremity is most consistent with the finding associated with trochanteric bursitis? A. Pain along the lateral aspect of the hip joint and possibly along the lateral thigh and knee to the insertion of the iliotibial band; pain typically worsens during long periods of asymmetrical standing with more weight shifted to the involved side B. Pain that becomes evident during extended periods of sitting, with most pain experienced in the buttock region over the ischial tuberosities C. Groin and anterior thigh pain that becomes evident or is aggravated during activities that require repetitive hip flexion D. Groin pain at rest that increases with weight bearing coupled with a positive Trendelenburg sign and pain with hip abduction
Pain along the lateral aspect of the hip joint and possibly along the lateral thigh and knee to the insertion of the iliotibial band; pain typically worsens during long periods of asymmetrical standing with more weight shifted to the involved side
Your patient reports a sudden onset of severe pain yesterday in the (L) posterior thigh while sprinting. Today he is unable to fully extend his (L) knee while walking because of pain. Which of the following interventions is most appropriate to use when initiating therapy today? A. Passive knee flexion/extension within the pain-free range with the hip flexed to 90° B. Passive knee flexion/extension within the pain-free range with the hip positioned in 0° extension C. Active knee flexion but no passive or active extension D. Submaximal resisted knee flexion in the prone-lying position
Passive knee flexion/extension within the pain-free range with the hip positioned in 0° extension
A quadriceps lag may be described as: A. Patient has full active knee extension but exhibits increased time to peak torque when knee extensors are evaluated on an isokinetic dynamometer. B. Patient has full passive knee flexion but limited passive knee extension. C. Patient cannot actively extend the knee to full extension even though there is full passive knee extension. D. Another term for knee extension contracture.
Patient cannot actively extend the knee to full extension even though there is full passive knee extension.
Which of the following exercises, designed to self-stretch the hamstrings, is the safest and utilizes the most effective stabilization? A. Patient stands, bends forward, keeping both knees straight, and attempts to touch the nose to the thighs. B. Patient stands on one leg, places the other leg on a table, bends forward with the back straight, and reaches toward the foot of the elevated leg. C. Patient sits on the floor in a hurdler's position, keeps the back straight, and reaches toward the foot of the straight leg. D. Patient sits on the floor in a long-sitting position with the knees straight and does a bilateral toe touch.
Patient stands on one leg, places the other leg on a table, bends forward with the back straight, and reaches toward the foot of the elevated leg.
Muscles that typically are shortened in patients with increased thoracic kyphosis; forward head; and protracted, forward tilted scapula are the: A. Teres major and minor, subscapularis, infraspinatus, and triceps. B. Pectoralis major and minor, latissimus dorsi, infraspinatus, and teres minor. C. Pectoralis major, teres major and minor, and serratus anterior. D. Pectoralis minor, subscapularis, and levator scapulae.
Pectoralis minor, subscapularis, and levator scapulae.
Your patient has regained normal strength (5/5) and ROM during rehabilitation following a traumatic injury that severely stressed several ligaments and joints of the ankle. He continues to have poor control while walking on gravel or other uneven surfaces. To address this problem, your exercise program should focus on: A. Strengthening exercises for the invertor and evertor muscles of the ankle using elastic resistance. B. Stretching the invertor and evertor muscles of the ankle. C. Performing progressive balance training with closed-chain disturbed balance activities on a rocker/balance board. D. Practicing walking on uneven surfaces while wearing a custom-made ankle/foot orthosis that controls inversion and eversion.
Performing progressive balance training with closed-chain disturbed balance activities on a rocker/balance board.
A patient who underwent a right cemented total hip arthroplasty through a posterolateral conventional incision 3 to 4 weeks ago is permitted to do each of the following except: A. Flexion of the operated hip to 80° or 90°. B. Pivot to the right while bearing weight on the operated lower extremity. C. Ambulation with crutches or a walker, bearing weight on the operated lower extremity as tolerated. D. Active abduction of the operated hip while standing on the sound lower extremity.
Pivot to the right while bearing weight on the operated lower extremity.
A 40-year-old teacher who has been referred to you has experienced pain along the plantar aspect of the heel for more than 6 months. It is most noticeable when getting out of bed in the morning, upon standing after sitting for longer than 1 hour, and after playing racquetball. During walking, pain is most noticeable at the terminal stance/pre-swing phase of gait. The mostly likely disorder causing these symptoms is: A. Plantar fasciitis. B. Calcaneal bursitis. C. Achilles tendinitis. D. Posterior tibialis tendinitis.
Plantar fasciitis
Your patient has a capsular pattern, decreased joint play in the knee, and restricted mobility of the patella after a prolonged period of immobilization following a fracture. Which of the following mobilization techniques can be used to increase knee flexion? A. Posterior glide of the tibia on the femur with the tibia positioned in lateral rotation; caudal glide of the patella B. Posterior glide of the tibia on the femur with the tibia positioned in lateral rotation; superior glide of the patella C. Posterior glide of the tibia on the femur with the tibia positioned in medial rotation; superior glide of the patella D. Posterior glide of the tibia on the femur with the tibia positioned in medial rotation; caudal glide of the patella
Posterior glide of the tibia on the femur with the tibia positioned in medial rotation; caudal glide of the patella
Which of the following is true about postoperative precautions and the rate of progression of rehabilitation after surgery for glenohumeral instability? A. Progress upper extremity weight-bearing exercises more slowly/cautiously after surgery for posterior instability than for anterior instability. B. Progress exercises more slowly/cautiously if the origin of the instability was traumatic versus atraumatic. C. Progress exercises more slowly/cautiously after an arthroscopic capsular shift involving imbrication and suturing the capsule than after an arthroscopic thermally assisted capsular shift. D. Progress ROM into internal rotation more slowly/cautiously after surgery for anterior instability than for posterior instability.
Progress upper extremity weight-bearing exercises more slowly/cautiously after surgery for posterior instability than for anterior instability.
Your patient has degenerative joint disease of the knees. Although currently her left knee is asymptomatic, she has been experiencing pain and periodic "giving way" of her right knee for the past week. Her physician prescribed anti-inflammatory medication to reduce joint swelling and pain and has referred the patient to you for evaluation and treatment. The patient is experiencing significant stiffness of the knee, especially in the morning and after sitting for an extended period of time. Although she indicates that pain and swelling have decreased during the past few days since she began taking the prescribed medication, pain is still notable during walking and with movement toward the end of the range of motion (ROM) (more so in flexion than extension). Knee ROM is limited (active and passive knee flexion 100°; passive knee extension lacks 10°; active knee extension lacks 20°). Strength of knee musculature is 4/5. She exhibits an antalgic gait pattern. Which of the following interventions is most appropriate for this patient at this time? A. Quadriceps setting exercises, active ROM within pain-free ranges, resisted multiple-angle isometrics, dynamic control of the knee with bilateral closed-chain exercises, activity modification, and use of a cane during ambulation B. Ice, rest, active-assistive ROM through the pain-free range, quads and hamstring setting exercises, ambulation with crutches until pain and swelling subside C. Low-intensity stretching to increase knee flexion, static and dynamic strengthening with unilateral closed-chain exercises, stationary cycling D. Activity modification and use for an assistive device during ambulation, vigorous resistance exercises of the asymptomatic knee to improve strength, isometric resistance exercise, eccentric but no concentric resisted exercises of the involved knee, low-intensity stretching
Quadriceps setting exercises, active ROM within pain-free ranges, resisted multiple-angle isometrics, dynamic control of the knee with bilateral closed-chain exercises, activity modification, and use of a cane during ambulation
Which of the following is a true statement about surgical repair of the rotator cuff and postoperative management? A. Regardless of the size of the cuff tear, the shoulder is immobilized in an abduction splint for a period of time after surgery. B. If the size and severity of the tears are similar, rehabilitation after repair of an acute, traumatic cuff tear typically progresses more rapidly than after repair of an atraumatic tear associated with chronic impingement. C. Detachment of the deltoid from its proximal insertion is a necessary component of a traditional open repair or an arthroscopically assisted repair (mini-open). D. The quality of the patient's tissues (tendon and bone) has little to no impact on the progression of rehabilitation.
Regardless of the size of the cuff tear, the shoulder is immobilized in an abduction splint for a period of time after surgery.
Your goal is to increase end-range elbow flexion using joint-mobilization techniques. Which of the following techniques is appropriate? A. Stabilize the distal humerus and apply a proximal glide of the ulna B. Apply a valgus stress at the elbow C. Stabilize the humerus and apply a dorsal glide to the head of the radius D. Stabilize the distal humerus and apply an ulnar (lateral) glide of the ulna
Stabilize the distal humerus and apply an ulnar (lateral) glide of the ulna
Your patient has a diagnosis of RA and is developing a capsular pattern in the foot and ankle. Which joint-mobilization technique could perpetuate or worsen the impairment/deformity typically associated with RA of the foot and ankle? A. Stabilize the mortise and glide the talus in an anterior direction B. Stabilize the calcaneus and glide the cuboid in a plantar direction C. Stabilize the talus and glide the navicular in a dorsal direction D. Stabilize the talus and glide the calcaneus in a lateral direction
Stabilize the talus and glide the navicular in a dorsal direction
According to Neer's classification of rotator cuff disease, which of the following stages is seen most often in patients 25 to 40 years of age and characterized by tendonitis or bursitis but not a rotator cuff tendon rupture? A. Stage I B. Stage II C. Stage III D. Stage IV
Stage II
You are evaluating a patient with rheumatoid arthritis (RA) of the hand and wrist. You notice several deformities, including hyperextension of the proximal interphalangeal (PIP) joints and flexion of the distal interphalangeal (DIP) joints of digits 2, 3, and 4. This deformity is called: A. Swan-neck deformity. B. Heberden's deformity. C. Boutonnière deformity. D. Saddleback deformity.
Swan-neck deformity.
Each of the following is true about guidelines for rehabilitation after a procedure to repair an articular cartilage defect except: A. ROM exercises (within a protected range) typically are begun a few days postoperatively. B. Protective bracing is worn during early weight bearing and exercises. C. The larger the articular defect is, the slower the progression of postoperative rehabilitation will be. D. Swimming and cycling are allowed and encouraged within 2 weeks to stimulate circulation and healing with limited weight bearing.
Swimming and cycling are allowed and encouraged within 2 weeks to stimulate circulation and healing with limited weight bearing.
Each of the following is a true statement about total ankle arthroplasty (TAA) and postoperative rehabilitation except: A. At the close of surgery, the foot and ankle typically are immobilized in a neutral position in a well-padded compression dressing and short-leg posterior splint. B. A patient with peripheral arterial disease of the lower extremities in addition to advanced arthritis of the ankle is not an appropriate candidate for TAA. C. After a TAA that involved biological fixation, weight bearing on the operated lower extremity during ambulation with a walker initially is permissible only while wearing an ankle immobilizer and may need to be partially restricted for several weeks to allow time for some degree of bio-ingrowth to occur. D. TAA is an appropriate procedure for a patient with advanced arthritis combined with marked instability of the ankle.
TAA is an appropriate procedure for a patient with advanced arthritis combined with marked instability of the ankle.
Each of the following is true about surgical repair/reconstruction of the lateral ligament complex of the ankle and postoperative management except: A. The most common procedure is a direct repair and imbrication of the torn ligaments through an open surgical approach. B. After reconstruction of the lateral ligaments that includes a tendon autograft and tendon transposition (often the peroneus brevis tendon) to reinforce the lateral aspect of the ankle, there may be some permanent loss of full ankle inversion postoperatively. C. The ankle is immobilized in plantarflexion and slight eversion for 4 to 6 weeks postoperatively; therefore, the patient must remain nonweight bearing on the operated lower extremity during the period of immobilization to prevent rupture of the repair site. D. It is usually permissible to remove the ankle immobilizer by about 4 to 6 weeks postoperatively to begin active ROM exercises of the ankle.
The ankle is immobilized in plantarflexion and slight eversion for 4 to 6 weeks postoperatively; therefore, the patient must remain nonweight bearing on the operated lower extremity during the period of immobilization to prevent rupture of the repair site.
Your patient has only 50° of passive and active knee flexion (but full passive extension) 2 weeks after removal of a cast for a fracture of the tibia. The bone is now radiologically healed. Each of the following techniques will be of value to increase the range of knee flexion except: A. The hold-relax technique, with isometric contraction of the hamstrings with the knee at 45°, followed by relaxation, then passive movement into more flexion. B. Low-load, long-duration self-stretching of the quadriceps. C. Posterior glide of the tibia. D. Caudal glide of the patella.
The hold-relax technique, with isometric contraction of the hamstrings with the knee at 45°, followed by relaxation, then passive movement into more flexion.
Which of the following special tests may be used to confirm or rule out a rupture of the Achilles tendon during a patient's physical examination? A. Thompson test B. Anterior drawer of the ankle C. Talar tilt test D. Test for Homan's sign
Thompson Test
A person with a long history of polyarticular rheumatoid arthritis is experiencing severe, dominant-side elbow pain that is interfering with personal grooming, light housework, and work-related responsibilities as a computer programmer. In addition to pain, physical findings include persistent synovitis despite ongoing medical management, limited elbow ROM, and complete loss of the joint space of the humeroulnar and humeroradial joints. Given these findings, this person is most likely a candidate for which of the following surgical procedures to relieve pain and improve daily function? A. Synovectomy B. Excision of the radial head coupled with prosthetic implant C. Total elbow arthroplasty D. Arthrodesis of the elbow
Total elbow arthroplasty
Your patient exhibits a forward head posture and excessive thoracic kyphosis. Considering the muscles that typically are weak with this faulty posture, which of the following muscles of the shoulder girdle are most important to strengthen? A. Pectoralis minor and levator scapulae B. Serratus anterior and levator scapulae C. Upper and lower trapezius and serratus anterior D. Upper and lower trapezius and pectoralis minor
Upper and lower trapezius and serratus anterior
The clinical prediction rule for the diagnosis of osteoarthritis of the hip developed by Sutlive and colleagues includes consideration of all of the following variables except: A. Self-reported squatting aggravates symptoms. B. Walking more than one block causes groin and anterior thigh pain. C. Passive internal rotation is less than or equal to 25°. D. Scour test with adduction causes lateral hip or groin pain
Walking more than one block causes groin and anterior thigh pain
Which of the following is an inappropriate component of an exercise program 1 to 3 weeks postoperatively for a patient without preoperative rotator cuff deficiency who underwent total shoulder replacement? A. Wand exercises for active-assistive external rotation to neutral with the arm positioned near the side of the chest B. Wand exercises for active-assistive shoulder extension (combined with internal rotation) by placing the wand behind the back and sliding it up the back C. Pendulum exercises D. Wand exercises for active-assistive elevation of the arm in the plane of the scapula to approximately 90° while in a supine or sitting position
Wand exercises for active-assistive shoulder extension (combined with internal rotation) by placing the wand behind the back and sliding it up the back
Which of the following correctly identifies biomechanical abnormalities that contribute to patellofemoral pain or patellar instability? A. Genu varum, overstretched lateral retinaculum, weakness of the vastus medialis obliques (VMO) muscle, excessive supination of the feet, weakness of the hip adductors and internal rotators B. Weakness of the VMO, tight lateral retinaculum, genu valgum, excessive external tibial torsion, excessive pronation of the feet, weakness of the hip abductors and external rotators C. Excessive internal tibial rotation, genu varum, weakness vastus lateralis muscle, tight lateral retinaculum, excessive supination of the feet, weakness of the hip adductors and internal rotators D. Excessive external tibial torsion, genu valgum, weak vastus lateralis muscle, overstretched lateral retinaculum, excessive pronation of the feet, weakness of the hip abductors and external rotators
Weakness of the VMO, tight lateral retinaculum, genu valgum, excessive external tibial torsion, excessive pronation of the feet, weakness of the hip abductors and external rotators
Your patient had a total hip replacement 3 days ago and will be discharged from the hospital tomorrow. Your home instructions should include, but are not limited to, each of the following except: A. Avoid moving the hip past midline when moving in bed; do not cross your legs. B. Perform ankle-pumping exercises on a regular basis throughout the day with the legs elevated. C. Perform assisted, progressing to active, ROM exercises of the hip and knee within protected ranges. D. Whenever possible, perform transfers toward the operated side.
Whenever possible, perform transfers toward the operated side.
Using a handheld weight as the source of resistance, which of the following positions to strengthen the elbow extensors begins with the long head of the triceps brachii fully lengthened? A. Have the patient assume a prone-lying position with the shoulder in 90° abduction, the upper arm supported on the table, and the elbow flexed to 90°. B. Have the patient assume the supine position with the shoulder flexed to 90° and the elbow flexed so the handheld weight touches the opposite shoulder. C. With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain the shoulder in as much flexion as possible. D. While the patient is in a standing position and the hips are flexed to 90°, begin with the shoulder in hyperextension.
With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain the shoulder in as much flexion as possible.
After closed reduction of an anterior dislocation of the glenohumeral joint, which of the following is the safest and most effective procedure to increase mobility of the joint for external rotation of the shoulder? A. With the shoulder in the resting position, apply a grade II distraction of the humerus. B. With the shoulder in the resting position, apply a grade III anterior glide of the humerus. C. With the shoulder placed at the end of the available range of external rotation, apply a grade III anterior glide of the humerus. D. With the shoulder in the resting position, externally rotate the shoulder and apply a grade III distraction of the humerus.
With the shoulder in the resting position, externally rotate the shoulder and apply a grade III distraction of the humerus.
Although interventions used to manage patellofemoral pain syndrome are based on an examination of each patient on an individual basis, each of the following interventions is commonly employed except: A. Strengthening the knee and hip extensors in weight-bearing and non-weight-bearing positions. B. Lateral gliding of the patella. C. Stretching the tensor fasciae latae (TFL) and iliotibial (IT) band. D. Using an insert (orthotic device) in a patient's shoe to correct excessive foot pronation.
lateral gliding of patella