Question

Case Study Vignette

A 27-year-old female triathlete presents to your outpatient facility with a chief complaint of left lateral hip pain. She recently began training for an upcoming event after taking a substantial amount of time off from training (approximately 3 months) and drastically increased her training volume. She reports having a history of a left 5^th metatarsal stress fracture in high school.

When screening for the presence of a potential femoral stress fracture, she had negative findings on both the Fulcrum and Patellar-Pubic Percussion tests. In spite of these findings, radiology was performed to confirm the absence of fracture/stress fracture. X-ray imaging showed no evidence of fracture, but did show an increased alpha angle, which is indicative of cam femoroacetabular morphology.

When continuing to consider the likelihood of greater trochanter pain syndrome, what is the most likely structure involved?

A. Trochanteric Bursa

B. Gluteal Tendinopathy

C. Gluteal Tendon Tear

D. Thickened Iliotibial Band

SCROLL DOWN TO SEE CORRECT ANSWER

ANSWERS:

A. Trochanteric Bursa

Based on the study performed by Long and colleagues, only 20.2% of patients presented with trochanteric bursitis.

Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. American Journal of Roentgenology. 2013;201(5):1083-1086. doi:10.2214/AJR.12.10038.

B. Gluteal Tendinopathy (CORRECT ANSWER CHOICE)

 Based on the study performed by Long and colleagues, a majority of patients presented with gluteal tendinopathy (49.9%).

Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. American Journal of Roentgenology. 2013;201(5):1083-1086. doi:10.2214/AJR.12.10038.

C. Gluteal Tendon Tear

Based on the study performed by Long and colleagues, only 0.5% of patients presented with gluteal tendon tear.

Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. American Journal of Roentgenology. 2013;201(5):1083-1086. doi:10.2214/AJR.12.10038.

D. Thickened Iliotibial Band

Based on the study performed by Long and colleagues, only 28.5% of patients presented with a thickened iliotibial band.

Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. American Journal of Roentgenology. 2013;201(5):1083-1086. doi:10.2214/AJR.12.10038.

Happy New Year!

Long over due, but here is an updated practice question of the month!

Good luck studying!

A collegiate football athlete during pre-season camp experienced signs and symptoms associated with exertional heat stroke. You decide to perform complete water immersion immediately and remove the athlete’s equipment. Throughout the complete water immersion, you are monitoring the athlete’s rectal temperature and other vital signs. How often should this occur?

A. Every 1-3 minutes

B. Every 5-10 minutes

C. Every 15 minutes

D. Every 30 minutes

SCROLL DOWN FOR ANSWER…..

A collegiate football athlete during pre-season camp experienced signs and symptoms associated with exertional heat stroke. You decide to perform complete water immersion immediately and remove the athlete’s equipment. Throughout the complete water immersion, you are monitoring the athlete’s rectal temperature and other vital signs. How often should this occur?

A. Every 1-3 minutes

B. Every 5-10 minutes

C. Every 15 minutes

D. Every 30 minutes

During total water immersion for an individual who is suffering from exertional heat stroke, rectal temperature and other vital signs should be monitored every 5-10 minutes unless a continuous monitoring advance is available. If a continuous monitoring advance is available, that device should be used over intermittent measurements.

Casa DJ, DeMartini JK, Bergeron MF et al. National Athletic Trainers’ Association position statement: Exertional heat illness. J Athl Train. 2015;50(9):986-1000.

Check out our other questions of the month here.

Check out the MUST READ ARTICLES FOR THE OCS/SCS.

Check out our PT Ortho Questions book by clicking here.  

Check our our PT Sports Questions book by clicking here.

Check out our PT Ortho and Sports Vol II book by clicking here.

All books available in print on Amazon.

Follow the authors on Twitter:

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@MansfieldCody

@JohnSnyderDPT

Also, follow John on his website by clicking here.

Although we know Clinical Prediction Rules have their weaknesses, understanding them for the OCS and SCS exam is very important.  John does a great job summarizing the strengths and weaknesses of all CPRs.  Click here to learn more.

@cmansfieldDPT

@MattBrancleone

Check out the Must Read Journal Articles for studying for the OCS/SCS exam: https://fasttwitchpress.com/resources/

Study hard!

Deadline for OCS/SCS registration is fast approaching.

Register by July 31st.

Check out some of our other resources:

• Recommended articles to read
• Other practice questions
• OCS study guide
• SCS study guide
• OCS/SCS study guide part II

PRACTICE QUESTION

A 19-year-old male ice hockey player presents to your outpatient facility with a chief complaint of left groin pain. He is a goaltender and notes having increased groin pain during and after competition.

During the subjective interview, he reports a reproducible ‘popping’ sensation during squatting activities in his training program. He denies having any significant previous injuries aside from a high-grade proximal rectus femoris tear when he was 16 years old. He denies having a specific incident that led to his symptoms and describes his pain as a deep ache and he cannot localize it to a specific isolated location. After competition he reports having increased groin pain with prolonged sitting, deep squatting, walking up stairs.

When attempting to make the diagnosis of femoroacetabular impingement syndrome, what three categories need to be satisfied?

1. Clinical signs
2. Symptoms
3. Blood Testing
4. Radiology

Scroll down for correct answer choices.

Answer Choices

1. Clinical Signs

According to the Warwick Agreement published by Griffin and colleagues, the diagnosis of Femoroacetabular Impingement Syndrome (FAIS) should be utilized when appropriate clinical signs, symptoms, and radiology have been satisified.

Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine. 2016; 50(19): 1169-1176. doi:10.1136/bjsports-2016-096743.

2. Symptoms

 According to the Warwick Agreement published by Griffin and colleagues, the diagnosis of Femoroacetabular Impingement Syndrome (FAIS) should be utilized when appropriate clinical signs, symptoms, and radiology have been satisified.

Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine. 2016; 50(19): 1169-1176. doi:10.1136/bjsports-2016-096743.

3. Blood testing

Presently, blood testing is not a beneficial measure in determining the presence of FAIS.

According to the Warwick Agreement published by Griffin and colleagues, the diagnosis of Femoroacetabular Impingement Syndrome (FAIS) should be utilized when appropriate clinical signs, symptoms, and radiology have been satisified.

Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine. 2016; 50(19): 1169-1176. doi:10.1136/bjsports-2016-096743.

4. Radiology

According to the Warwick Agreement published by Griffin and colleagues, the diagnosis of Femoroacetabular Impingement Syndrome (FAIS) should be utilized when appropriate clinical signs, symptoms, and radiology have been satisified.

Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine. 2016; 50(19): 1169-1176. doi:10.1136/bjsports-2016-096743.

This practice question was written by John Snyder, primary author of our latest book:

PT Ortho and Sports Questions Volume II

Check out his website here.

He has a great resource on clinical predictions rules, which are important to know for the OCS/SCS exam.

Check out our other books on Amazon:

Below are the 3 January questions of the month.

Check out our other OCS/SCS Questions of the Month by clicking here.

Here are some of our top Questions of the Month.

1. Tiger Woods and Lumbar Disc Herniation
2. Harry Potter hurts his arm
3. Discovery Channel- Deadliest Catch

Also, check out the blog post “Three Testing Taking Strategies” to Ace the OCS/SCS Exam.

Lastly, check out the Must Read Articles for the OCS/SCS we recommend reading, and our resources on Amazon.

Question #1

Scroll down for answer.

Sling use for 6 weeks and then physical therapy for range of motion exercises is the best answer.  This will minimize the risk of a tear after rotator cuff repair.

Question #2

Scroll down for answer.

Coxa vara of the hip with angle of inclination of 115° is the correct answer.  This will lead to the highest compressive forces at the hip.

Question #3

Scroll down for the answers.

Click here to view books on Amazon for more practice questions.

Zone II is known as no man’s land in the hand and is the most difficult to repair.

Check out our new book, now available on Amazon.

• Practice OCS/SCS questions based on the joints/extremities
• Review sections written by John Snyder; check his blog out here

If taking the OCS, also check out our first book which contains over 200 spine specific questions:

View the first several pages on Amazon by clicking here.

If taking the SCS, check out our SCS specific book with 100 sports physical therapy questions, answers, rationale and citations to articles you must read:

View the first several pages on Amazon by clicking here.

For those interested in residency and fellowships, performing research as a PT, or how we got our start with our books.  Check out the latest article from the Columbus Orthopedic Therapy Group, where Paul Tadak asked me to answer a few questions.

FEATURED PHYSICAL THERAPIST OF THE MONTH
(Columbus Orthopedic Therapy Group)

Dr. Cody James Mansfield is our featured physical therapist of the month!

Cody is a physical therapist at The Ohio State University Wexner Medical Center-Sports Medicine. He is a Fellow of the American Academy of Orthopaedic Manual Physical Therapists, Board Certified Orthopedic Specialist, and an ATC. Cody is the president of Fast Twitch Press and has authored 3 books on how to pass the OCS and SCS exams. He has also published articles in JMMT and IJSPT.

Cody has taken the time to answer a few questions below regarding the residencies and fellowships, research, authoring books, starting his own company, and his favorite coffee.

Cody, you have completed both the orthopedic residency and the OMPT Fellowship programs, how would you describe the difference between the 2 programs? Would you recommend both programs and why?

• Every program is different, and you have to pick and choose a program based on what you’re looking for in your career.
• I chose the Ohio State University (OSU) Sports Med Orthopaedic residency because it was a triple threat: (1) Research (2) Mentorship (3) Teaching.
• My research project involved working with a PT PhD, two radiologists, and two hip surgeons and resulted in presentations at the Ohio PT Scientific Symposium and at the Combined Sections Meeting.
• I helped teach the MSK lab in the Doctor of Physical Therapy program at OSU. I received quality mentoring from highly skilled clinicians that had a variety of expertise and niche practices and had achieved their OCS.
• To find out more about our residencies at OSU follow this link: https://wexnermedical.osu.edu/…/residencies/orthopedic-phys…
• The OMPT Fellowship afforded me mentorship from master clinicians with over 10 years of experience, and both had their OCS and FAAOMPT credentials. The program didn’t just emphasize manual therapy techniques, but rather advanced orthopedics. My mentors cultivated my clinical reasoning and helped foster my skills when it came to the implementation of pain science to patients with complicated spine pain. The fellowship also lead to more opportunities for me professionally afterwards.
• In clinic, I sat between both my mentors at all time throughout the fellowship, which was beneficial because I got to know them better, and we had great discussions outside of patient care which advanced my thinking.
• I chose the Fellowship because I wanted to improve by ability to treat complicated spine cases, and the organization AAOMPT has had a profound effect on my career both in PT school and afterwards. It was my goal to become a Fellow of AAOMPT.
• https://aaompt.org
• Find out more about our fellowship by following this link: https://wexnermedical.osu.edu/…/orthopaedic-manual-physical…

You have been published a number of times and have a passion for doing research. What would you recommend to a physical therapist seeking to go down the research path without a Phd?

• It’s not easy for physical therapists to participate in research, and often times requires a significant effort outside of your 40 hour a week clinic time.
• I’m fortunate to work at an Academic Hospital where clinicians can interact with researchers, and help with ongoing randomized control trials or prospective studies.
• Some clinicians at OSU actually have protected time from the clinic to help with research projects.
• Also, there are several types of projects that clinicians can initiate without having a PhD, such as a case report (often required by many residencies and fellowships), case series (requires IRB approval, but can be done in clinic), systematic reviews (requires a minimum of 3 authors), and clinical commentaries.
• APTA has some excellent resources to help clinicians publish a case reports: http://www.apta.org/crmanual/

Cody, you also have started your own publishing company and co-authored 3 books that are study guides for the OCS and SCS. Can you tell us what inspired you to do this? Can you tell us a little more about the books and how it can help a clinician study for the OCS or SCS?
• After my wife and I took the OCS exam we realized that there weren’t a lot of study materials available to PTs looking to take specialty exams.
• Both of us completed residencies and were under a lot of pressure to pass the OCS exam the first time.
• At OSU, both ortho and sports residencies boast a 100% pass rate for all residents, and I didn’t want to be the first one to tarnish the record.
• We created these books to be helpful to PTs like us that had a lot of pressure to pass these exams.
• More information about the books can be found on www.FastTwitchPress.com
• Or on Twitter: @MansfieldCody
• Our first book, PT Ortho Questions, focuses on the spine with over 200 practice questions.
• Our second book, PT Sports Questions, written by my former co-sports resident, has a 100 specific SCS practice questions.
• Our latest release, PT Ortho & Sports Questions Vol. II, focuses on the joints and extremities, has practice questions and review sections, and is meant to complement our other OCS/SCS books.
• If you’re taking the OCS we recommend reading PT Ortho Questions and PT Ortho & Sports Questions Vol. II.
• And if you’re taking the SCS, we recommend reading PT Sports Questions and PT Ortho & Sports Questions Vol. II.
• The overall mission of the books is to help PTs pass the test without breaking the bank.
• The books can be view on Amazon:

i. https://www.amazon.com/PT-Ortho-Questions-wit…/…/ref=sr_1_1…

ii. https://www.amazon.com/PT-Sports-Questio…/…/ref=pd_sim_14_3…

iii. https://www.amazon.com/PT-Ortho-Sports-Q…/…/ref=pd_sim_14_1…

It is known you are a connoisseur of coffee, what is your favorite coffee and your preferred style of brewing?

• Pour over coffee is my favorite. I also like to use the AeroPress.
• I love to buy beans from Intelligentsia, a coffee roaster based in Chicago, or locally from Stauf’s.
• I usually like beans from Central American and prefer a medium to light roast.

This OCS/SCS question is based on one of the most famous doctors of them all, Dr. Seuss.

After the Grinch stole Christmas, and his heart grew 3 sizes, he started to notice a tickle in his feet, that would worsen with walking up or down Mount Crumpet.  So he saw a physical therapist (PT) in Whoville that suspected peripheral artery disease.  After ankle-brachial index (ABI) testing, the PT suspected moderate peripheral artery disease.

Citation:

Walsworth MK, de Bie R, Figoni S, O’Connell J. Peripheral artery disease: what you need to know. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(12).

SCROLL ALL THE WAY DOWN TO SEE THE ANSWER.

Check out our new book, now available on Amazon.

• Practice OCS/SCS questions based on the joints/extremities
• Review sections written by John Snyder; check his blog out here

If taking the OCS, also check out our first book which contains 300 spine specific questions:

View the first several pages on Amazon by clicking here.

If taking the SCS, check out our SCS specific book with 100 sports physical therapy questions, answers, rationale and citations to articles you must read:

View the first several pages on Amazon by clicking here.

ANSWER:

Score                                          Severity

>1.4                                              Noncompressible arteries

1.00-1.40                                      Normal

0.91-0.99                                     Borderline

0.41-0.90                                    Mild to Moderate Peripheral Artery Disease

0.00-0.40                                  Severe Peripheral Artery Disease

Citation:

Walsworth MK, de Bie R, Figoni S, O’Connell J. Peripheral artery disease: what you need to know. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(12).