February 2019 OCS Question of the Month

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 5th 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

screen-shot-2017-01-15-at-3-30-54-pm

screen shot 2019-01-11 at 9.36.48 am

 

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.

fast-twitch-press-logo

 

screen shot 2019-01-11 at 9.36.48 am

 

 

 

 

January 2019 SCS/OCS Question of the Month

skeleton

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…..

fast-twitch-press-logo

 

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.

Screen Shot 2019-01-11 at 9.36.48 AM.png

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:

 

 

 

This slideshow requires JavaScript.

@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

OCS/SCS Practice Question

Deadline for OCS/SCS registration is fast approaching.

Register by July 31st.

Check out some of our other resources:

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.

fast-twitch-press-logo

 

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.

 

  1. 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.

 

  1. 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.

 

  1. 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

Vol_2

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:

screen-shot-2017-02-01-at-9-21-31-am

March Question of the Month

Just want to say good luck to everyone taking the OCS/SCS exam this month!  We hope our questions of the month and resources have been useful.

This will be the last question of the month till we start up again in November.  All the best!

A patient presents to you with bilateral numbness in the anterior and posterior thighs that worsens with prolonged sitting.

SEE THE CORRECT ANSWER BELOW

The correct answer is lumbar stenosis.  Although lumbar stenosis can cause bilateral symptoms into the legs, you would expect this patient to have a relief of symptoms when they sit down.

Cervical myelopathy often presents initially in the lower extremities and can worsen symptoms with prolonged sitting.

Cauda equina syndrome and a large central disc herniation in the lumbar spine are essentially the same pathology, and cause bilateral symptoms.  So you can essentially rule these answer choices out.

Tough question this week, and definitely debatable, but all good OCS questions are.

Check out the recent case report published on Cervical Myelopathy in Physiotherapy Theory and Practice by clicking here.

 

GOOD LUCK AND STUDY HARD!

OCS/SCS Questions of the Month-CSM edition

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

Check out last months QUESTION OF THE MONTHthe first question tricked the majority that tried to answer it.

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

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

Lastly, if you’re going to CSM in New Orleans, check out the sessions we recommend for those who are going prior to taking the OCS/SCS exam this year.

QUESTION # 1

While the patient is sidelying on their left side, you elicit their concordant pain as you move their right hip into extension while keeping the hip adducted and externally rotated.

SCROLL DOWN FOR QUESTION 2 AND ANSWERS.

 

QUESTION # 2

 

SCROLL DOWN FOR ANSWERS.

QUESTION # 1

The correct answer choice is ischiofemoral impingement.  When the clinician moves the hip into extension when the hip is already in an adducted and externally rotated position, this causes ischiofemoral impingement as the lesser trochanter impinges on the ischium, and could be a cause of posterior hip pain.

Check out the excellent article below that was published recently in IJSPT.  This is an excellent article to review prior to taking the OCS or SCS.  Especially for the OCS, a knowledge of the spine, brachial plexus, and lumbosacral plexus is crucial to passing the test!

Click on picture to link to the article.

QUESTION # 2

All pathologies listed are specific to children for hip pathology except for Reiter’s Syndrome.  Understanding pediatric conditions at the hip are extremely important.  Read the reference to learn more.

Click on picture to link to the article.

 

If you liked these questions, check out are other OCS/SCS questions of the month:

Holiday 2017 QoM– The Grinch

December 2017 QoM– 5 Question OCS/SCS mini quiz

November 2017 QoM– 5 hip OCS/SCS questions

October 2017 QoM-Smash the OCS/SCS; Elbow Questions

September 2017 QoM– Shoulder Questions

August 2017 QoM– Thoracic Questions

July 2017 QoM-New Book and Knee Questions

June 2017 QoM– Harper Baseball Punch and Muscle Stretch Reflexes

May 2017 QoM– Tingling Toes Differential Diagnosis and Treatment

February 2017 QoM– Super Bowl Edition: Peyton Manning + Cervical radiculopathy

February 2017 QoM– 5 Question Mini-OCS/SCS quiz

January 2017 QoM – Discovery Channel and Deadliest Catch

January 2017 QoM – Tiger Woods and Lumbar Disc Herniation

January 2017 QoM – Harry Potter

CSM in New Orleans

Going to CSM?  Taking the OCS or SCS?

Here is the programming we recommend:

Make sure you pick programming in your weakest topics, and have a great time at the conference!

UPPER EXTREMITY:

Taking the Gloves Off: Evidence-Informed Manual Therapy for UE Conditions, Part 1
Section: Academy of Hand and Upper Extremity PT
Co-Section: Orthopaedics Section
Session Code: HR-1A-8607
Date: Thursday, February 22, 2018
Time: 8:00 AM – 10:00 AM
Location: Hilton Riverside
Room: Grand Salon D

 

Shoulder Pathomechanics in the Throwing Athlete: Causes, Surgery, Outcomes, and Rehab
Section: Sports PT Section
Session Code: SP-2B-7097
Date: Friday, February 23, 2018
Time: 11:00 AM – 1:00 PM
Location: New Orleans Ernest N. Morial Convention Center
Room: The Great Hall A

Speaker(s):   James Andrews, MD
Rafael Escamilla, P.T., Ph.D.
Mike Reinold, PT, DPT, SCS, ATC, CSCS
Kevin Wilk, PT, DPT, FAPTA
Kyle Yamashiro, DPT

 

Evidence in Practice for Shoulder Pain: Optimizing Diagnosis and Treatment
Section: Orthopaedics Section
Session Code: OR-2B-0520
Date: Friday, February 23, 2018
Time: 11:00 AM – 1:00 PM
Location: Hilton Riverside
Room: Grand Salon A

Speaker(s):   Lori Michener, PT, PhD, ATC, SCS, FAPTA
Amee Seitz, PT PhD DPT OCS
Charles Thigpen, PhD

Shoulder Instability:

Science Meets Practice: Innovative Changes With Treating Shoulder Instabilities
Section: Sports PT Section
Session Code: SP-2A-4100
Date: Friday, February 23, 2018
Time: 8:00 AM – 10:00 AM
Location: New Orleans Ernest N. Morial Convention Center
Room: The Great Hall A

ELBOW:

Tommy John Surgery: Surgical Intervention, Rehabilitation, and Return to Throwing
Section: Sports PT Section
Session Code: SP-3A-0370
Date: Saturday, February 24, 2018
Time: 8:00 AM – 10:00 AM
Location: New Orleans Ernest N. Morial Convention Center
Room: The Great Hall B

Speaker(s):   Lyle Cain, MD
Daniel Lorenz, DPT, PT, ATC/L, CSCS, USAW
Leonard Macrina, MSPT, SCS, CSCS
Mike Reinold, PT, DPT, SCS, ATC, CSCS

 

HIP:

Femoroacetabular Impingement: A Theoretical Frpmework to Guide Clinical Practice
Section: Orthopaedics Section
Session Code: OR-2C-6009
Date: Friday, February 23, 2018
Time: 3:00 PM – 5:00 PM
Location: Hilton Riverside
Room: Grand Salon A

Speaker(s):   Jennifer Bagwell, PT, PhD, DPT
Christopher Powers, PT, PhD, FACSM, FAPTA
Alexander Weber, MD
Not Your Mama’s Hip Replacement: The Evolution of THA and Rehabilitation
Section: Orthopaedics Section
Session Code: OR-3C-4504
Date: Saturday, February 24, 2018
Time: 3:00 PM – 5:00 PM
Location: Hilton Riverside
Room: Grand Ballroom A

Speaker(s):   Erica Fritz, DPT, OCS
Sharlynn Tuohy, PT, DPT, MBA

KNEE:

Training Load Monitoring to Enhance Return to Sport Following Knee Injury
Section: Section on Research
Co-Section: Sports PT Section
Session Code: RE-2B-5989
Date: Friday, February 23, 2018
Time: 11:00 AM – 1:00 PM
Location: New Orleans Ernest N. Morial Convention Center
Room: 228

Speaker(s):   David Bell, PhD, ATC
Darin Padua, PhD, ATC
Susan Sigward, PT, ATC, PhD
Laura Stanley, PT, DPT, SCS
John Willson, PT, Ph.D.
Neuromuscular Training After ACLR to Decrease ACL Reinjuries and Risk in Young Female Athletes
Section: Sports PT Section
Session Code: SP-2C-7111
Date: Friday, February 23, 2018
Time: 3:00 PM – 5:00 PM
Location: New Orleans Ernest N. Morial Convention Center
Room: The Great Hall A

Speaker(s):   James Andrews, MD
Rafael Escamilla, P.T., Ph.D.
Kevin Wilk, PT, DPT, FAPTA
Kyle Yamashiro, DPT
Knee Injury Prevention Clinical Practice Guidelines
Section: Orthopaedics Section
Session Code: OR-3C-3176
Date: Saturday, February 24, 2018
Time: 3:00 PM – 5:00 PM
Location: Hilton Riverside
Room: Grand Salon A

Speaker(s):   Amelia Arundale, PT, DPT, SCS
Mario Bizzini, PT, PhD
Airelle Giordano, PT, DPT, SCS, OCS
Timothy Hewett, PhD
David Logerstedt, PT, PhD, SCS
Bert Mandelbaum, MD
David Scalzitti, PT, PhD
Lynn Snyder-Mackler, PT, ScD, FAPTA

NERVES:

Peripheral Nerve Injuries:

Section: Academy of Clinical Electrophysiology and Wound Management
Co-Section: Federal PT Section,Orthopaedics Section
Session Code: CE-1A-6548
Date: Thursday, February 22, 2018
Time: 8:00 AM – 10:00 AM
Location: Hilton Riverside
Room: Magazine

 

Neurodynamics 2.0: Pain, Plasticity and Desensitizing the Nervous System
Section: Academy of Hand and Upper Extremity PT
Session Code: HR-2C-7922
Date: Friday, February 23, 2018
Time: 3:00 PM – 5:00 PM
Location: Hilton Riverside
Room: Jefferson Ballroom

Speaker(s):   Adriaan Louw, PT, PhD
Stephen Schmidt, OCS, FAAOMPT
Diagnosis, Treatment, and Outcomes of 3 Common Lower Extremity Nerve Injuries
Section: Academy of Clinical Electrophysiology and Wound Management
Session Code: CE-3B-4097
Date: Saturday, February 24, 2018
Time: 11:00 AM – 1:00 PM
Location: Hilton Riverside
Room: Jackson

Speaker(s):   Mark E. Brooks, PT, DSc, ECS, OCS
Dimitrios Kostopoulos, DPT, MD, PhD, DSc, ECS
Quinn Millington, PT, DPT, ECS, OCS
Darin White, PT, DPT, ECS

SPINE:

Spinal Radiographic Measures: What Is Their Significance to Physical Therapists?
Section: Orthopaedics Section
Session Code: OR-1B-2692
Date: Thursday, February 22, 2018
Time: 11:00 AM – 1:00 PM
Location: Hilton Riverside
Room: St. James Ballroom

CHRONIC PAIN

The Chronic Pain Epidemic: National Research, Education, and Practice Initiatives (PMSIG Programming)
Section: Orthopaedics Section
Co-Section: Section on Research
Session Code: OR-1B-4405
Date: Thursday, February 22, 2018
Time: 11:00 AM – 1:00 PM
Location: Hilton Riverside
Room: Grand Salon A

 

Spotlight on Research: Let’s Talk About Pain Studies and Clinical Implications
Section: Orthopaedics Section
Session Code: OR-2C-6813
Date: Friday, February 23, 2018
Time: 3:00 PM – 5:00 PM
Location: Hilton Riverside
Room: St. James Ballroom

Speaker(s):   Steven George, PT, PhD, FAPTA
Daniel White, PT, ScD, MSc

PELVIC FLOOR:

Management of Pelvic Floor Dysfunction in Female Runners
Section: Sports PT Section
Session Code: SP-2A-4733
Date: Friday, February 23, 2018
Time: 8:00 AM – 10:00 AM
Location: New Orleans Ernest N. Morial Convention Center
Room: R08

 

DIRECT ACCESS:

Referral for Imaging in Physical Therapist Practice: A Pragmatic Vision (Imaging SIG Programming)
Section: Orthopaedics Section
Session Code: OR-1A-4354
Date: Thursday, February 22, 2018
Time: 8:00 AM – 10:00 AM
Location: Hilton Riverside
Room: Grand Ballroom A

 

DIFFERENTIAL DIAGNOSIS:

A Zebra Among Us: Recognition and Management of Hypermobility Spectrum Disorders
Section: Orthopaedics Section
Session Code: OR-2A-2474
Date: Friday, February 23, 2018
Time: 8:00 AM – 10:00 AM
Location: Hilton Riverside
Room: Grand Ballroom A

 

SCS/OCS:

Sports Medicine Secrets: Motor Control Impairments in the Overhead Athlete
Section: Orthopaedics Section
Session Code: OR-1A-6387
Date: Thursday, February 22, 2018
Time: 8:00 AM – 10:00 AM
Location: Hilton Riverside
Room: Grand Salon A
The Many Faces of Sports Physical Therapy
Section: Sports PT Section
Session Code: SP-2C-3267
Date: Friday, February 23, 2018
Time: 3:00 PM – 5:00 PM
Location: New Orleans Ernest N. Morial Convention Center
Room: The Great Hall B

Speaker(s):   George Davies, PT,DPT,SCS,ATC,CSCS,FAPTA
Todd Ellenbecker, PT, DPT, MS, SCS, OCS
Carol Ferkovic Mack, PT, DPT, SCS
Robert Manske
Kevin McHorse
Michael Mullaney, DPT
Teresa Schuemann, DPT

SOCCER SPECIFIC

Not Just Magic Spray: From Prevention to Return to Sport in Soccer Players
Section: Sports PT Section
Session Code: SP-2A-3164
Date: Friday, February 23, 2018
Time: 8:00 AM – 10:00 AM
Location: New Orleans Ernest N. Morial Convention Center
Room: The Great Hall B

Speaker(s):   Amelia Arundale, PT, DPT, SCS
Mario Bizzini, PT, PhD
Michael Messer, PT, DPT
Holly Silvers-Granelli, MPT