November OCS questions of the month will focus on the hip.  Enjoy!

Check out all our questions of the month by clicking here.

 

1) A patient has been diagnosed with borderline hip dysplasia.  Which of the following answer choices describes the lateral center edge angle of a patient with borderline hip dysplasia as visualized on radiographs?

A. 18º

B. 23º

C. 30º

D. 35º

 

 

2) A 35-year-old male office worker is referred to you by a primary care physician for paresthesia in the anterolateral thigh with insidious onset.  His body mass index is 32.  His complaint of numbness in anterior thigh has increased within the last month since he has started training for a half marathon.  What is the most likely diagnosis?

A. L3 Radiculopathy

B. Shingles

C. Greater trochanteric bursitis

D. Meralgia Paresthetica

 

 

 

3) Patient presents to physical therapy with one month history of paresthesia symptoms down the medial aspect of thigh radiating to the medial aspect of his right knee.  You perform a repeated motions examination of the lumbar spine but fail to reproduce his radicular symptoms.  He reports that symptoms are increased with sitting and movements involving active knee extension.  Which nerve is affected?

A. Sciatic nerve

B. Saphenous nerve

C. Tibial nerve

D. Obturator nerve

 

 

4) A 55-year-old male patient is referred to you for non-specific low back pain by a primary care physician.  He complains of morning stiffness lasting 30 minutes in the morning.  While walking in the morning he has an apparent limp, with decreased right hip extension during push off phase of gait.  He has limited lumbar extension, increased lordosis of the lumbar spine, and tight hip flexors.  Which of the following passive range of motion findings from your examination are most suggestive of hip osteoarthritis?

A. Hip internal rotation of 20º

B. Hip flexion of 110º

C. Hip internal rotation of 25º

D. Hip flexion of 115º

 

 

5) A soccer player reports pain during his warm up, apprehension with passive hip abduction, and 4 out of 5 adduction strength with manual muscle testing.  According to the pubic “clock” anatomical concept, if the patient has pain from 6-8 on the pubic clock, what is the most likely diagnosis?

A. External oblique aponeurosis tear

B. Conjoint tendon tear

C. Degenerative pubic symphysis

D. Adductor tendon enthesopathy

 

SCROLL DOWN FOR THE ANSWERS

 

 

1. A patient has been diagnosed with borderline hip dysplasia. Which of the following answer choices describes the lateral center edge angle of a patient with borderline hip dysplasia as visualized on radiographs?

B. 23º

The lateral center edge angle is a measure of coverage of the acetabulum on the femoral head.  Borderline hip dysplasia is defined as a lateral center edge angle between 20º and 25º.  The article below is an excellent resource for clinical application and interpretation of a radiological examination at the hip. 

 Citation: Reis AC, Rabelo ND, Pereira RP, Polesello G, Martin RL, Lucareli PR, Fukuda TY. RADIOLOGICAL EXAMINATION OF THE HIP‐CLINICAL INDICATIONS, METHODS, AND INTERPRETATION: A CLINICAL COMMENTARY. International journal of sports physical therapy. 2014 Apr;9(2):256.

 

 

 

 

 

2) A 35-year-old male office worker is referred to you by a primary care physician for paresthesia in the anterolateral thigh with insidious onset.  His body mass index is 32.  His complaint of numbness in anterior thigh has increased within the last month since he has started training for a half marathon.  What is the most likely diagnosis?

D. Meralgia Paresthetica

This is the best answer choice.  Patient presents with sensory deficits only in the anterolateral thigh which is suggestive of meralgia paresthetica (MP).  Patient’s with MP are commonly between the age of 30 and 40 years old, male, and BMI over 30.   With L3 radiculopathy you would expect potentially sensory and motor deficits. 

Citation: Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. International journal of sports physical therapy. 2013 Dec;8(6):883.

 

 

 

 

 

3) Patient presents to physical therapy with one month history of paresthesia symptoms down the medial aspect of thigh radiating to the medial aspect of his right knee.  You perform a repeated motions examination of the lumbar spine but fail to reproduce his radicular symptoms.  He reports that symptoms are increased with sitting and movements involving active knee extension.  Which nerve is affected?

B. Saphenous nerve

 The two answer choices you should have considered are answer choices B and D.  Since the patient reports paresthesia affecting the medial aspect of thigh and knee, it’s a larger area and extends to the knee, which should make you think saphenous nerve pathology.  It’s a sensory nerve only, whereas the obturator nerve is a motor and sensory nerve, and you’d expect the case to reveal some adductor muscle weakness when the obturator nerve is affected. 

Citation: Reiman MP, Hash 2nd TW, Mather 3rd RC. Acetabular Paralabral Cyst: An Unusual Cause of Lower Extremity Pain and Paresthesia. Journal of Orthopaedic & Sports Physical Therapy. 2016 Jan;46(1):35-.

 

 

 

 

 

4) A 55-year-old male patient is referred to you for non-specific low back pain by a primary care physician.  He complains of morning stiffness lasting 30 minutes in the morning.  While walking in the morning he has an apparent limp, with decreased right hip extension during push off phase of gait.  He has limited lumbar extension, increased lordosis of the lumbar spine, and tight hip flexors.  Which of the following passive range of motion findings from your examination are most suggestive of hip osteoarthritis?

B. Hip flexion of 110º

According to the American College of Rheumatology, pain the hip, hip flexion less than 110º, internal rotation less than 15º, pain with hip internal rotation, less than 60 minutes of morning stiffness, and age greater than 50 years old.

Citation: MacDonald CW, Whitman JM, Cleland JA, Smith M, Hoeksma HL. Clinical outcomes following manual physical therapy and exercise for hip osteoarthritis: a case series. Journal of Orthopaedic & Sports Physical Therapy. 2006 Aug;36(8):588-99.

 

 

 

 

 

5) A soccer player reports pain during his warm up, apprehension with passive hip abduction, and 4 out of 5 adduction strength with manual muscle testing.  According to the pubic “clock” anatomical concept, if the patient has pain from 6-8 on the pubic clock, what is the most likely diagnosis?

D. Adductor tendon enthesopathy

The case is suggestive of answer choice D.  Answer choice A would affect the pubic “clock” at 12-1.  Answer choice B would affect the “clock” at 11.  Answer choice C would affect the “clock” at 3.  The citation below is an excellent resource for groin injuries in athletes with great tables and pictures.

Citation: Falvey EC, Franklyn-Miller A, McCrory P. The groin triangle: a patho-anatomic approach to the diagnosis of chronic groin pain in athletes. British journal of sports medicine. 2008 Nov 19.

 

 

 

 

We’re excited to unveil the new cover of our book coming out this November 27th.

• The book will be released on Amazon this November!
• Focus is on extremity based questions for those taking the OCS or SCS exam.
• Book is complete with short, quick, engaging review sections.
• As well as multiple choice practice questions.
• Scroll down to see details on OCS track and SCS track.

We hope that this book in conjunction with our other study preparation material will be helpful to everyone looking to take the OCS or SCS exam next year.

OCS track:

SCS track:

 

Find our books on Amazon, and download a free sample.