5 Question OCS/SCS Min-Quiz

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1) According to the Journal of Orthopaedic Sports Physical Therapy Knee Ligament Sprain Clinical Practice Guidelines, all the following are considered grade “A” interventions except for which of the following:

A. Supervised rehabilitation after ACL reconstruction

B. Therapeutic exercises for 6 to 10 months after ACL reconstruction

C. Neuromuscular electrical stimulation for 6 to 8 weeks after ACL reconstruction

D. Neuromuscular re-education after ACL reconstruction

 

 

2) Which of the following ligaments in the knee is least likely to be injured?

A. Anterior cruciate ligament

B. Posterior cruciate ligament

C. Medical collateral ligament

D. Lateral collateral ligament

 

 

3) A youth athlete has increased anterior knee pain after an increase in volume of soccer practices and games.  Pain is localized to the inferior pole of the patella at the proximal attachment of the patellar tendon.  What is the most likely diagnosis?

A. Osgood-Schlatter Disease

B. Patellar tendonopathy

C. Sinding-Larsen-Johansson Syndrome

D. Medial patellofemoral ligament sprain

 

 

4) Which is the most common range that the patella dislocates at?

A. 0º to 20º

B. 20º to 40º

C. 40º to 60º

D. 60º to 80º

 

 

5) What is the ideal knee flexion angle for cyclists to reduce knee injuries when the shank and pedal are closest to the ground?

A, 15º to 20º

B. 20º to 25º

C. 25º to 30º

D. 30º to 35º

 

Scroll down for answers.

 

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1) According to the Journal of Orthopaedic Sports Physical Therapy Knee Ligament Sprain Clinical Practice Guidelines, all the following are considered grade “A” interventions except for which of the following:

A. Supervised rehabilitation after ACL reconstruction

Answer choice A was given a “B” grade based on published scientific literature prior to December 2016.  All other answer choices were given a grade of “A”. 

B. Therapeutic exercises for 6 to 10 months after ACL reconstruction

C. Neuromuscular electrical stimulation for 6 to 8 weeks after ACL reconstruction

D. Neuromuscular re-education after ACL reconstruction

Citation: Logerstedt DS, Scalzitti D, Risberg MA, Engebretsen L, Webster KE, Feller J, Snyder-Mackler L, Axe MJ, McDonough CM, Altman RD, Beattie P. Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Nov;47(11):A1-47.

 

 

2) Which of the following ligaments in the knee is least likely to be injured?

A. Anterior cruciate ligament

B. Posterior cruciate ligament

C. Medical collateral ligament

D. Lateral collateral ligament

Of all the ligaments in the knee, the LCL is least likely to be injured. 

Citation: Logerstedt DS, Scalzitti D, Risberg MA, Engebretsen L, Webster KE, Feller J, Snyder-Mackler L, Axe MJ, McDonough CM, Altman RD, Beattie P. Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Nov;47(11):A1-47.

 

3) A youth athlete has increased anterior knee pain after an increase in volume of soccer practices and games.  Pain is localized to the inferior pole of the patella at the proximal attachment of the patellar tendon.  What is the most likely diagnosis?

A. Osgood-Schlatter Disease

B. Patellar tendonopathy

C. Sinding-Larsen-Johansson Syndrome

Since the patient is a youth athlete, and the location of the pain is at the inferior pole of the patella you should suspect answer choice C.  Answer choice A is likely when pain is localized to the tibial tubercle. 

D. Medial patellofemoral ligament sprain

Citation: Patel DR, Villalobos A. Evaluation and management of knee pain in young athletes: overuse injuries of the knee. Transl Pediatr. 2017.

 

 

4) Which is the most common range that the patella dislocates at?

A. 0º to 20º

The patella most commonly dislocates between the ranges of 0º to 20º, bony stability between the patellofemoral joint is maximized between 20º and 60º.

B. 20º to 40º

C. 40º to 60º

D. 60º to 80º

Citation: Vitale TE, Mooney B, Vitale A, Apergis D, Wirth S, Grossman MG. Physical therapy intervention for medial patellofemoral ligament reconstruction after repeated lateral patellar subluxation/dislocation. International journal of sports physical therapy. 2016 Jun;11(3):423.

 

5) What is the ideal knee flexion angle for cyclists to reduce knee injuries when the shank and pedal are closest to the ground?

A, 15º to 20º

B. 20º to 25º

C. 25º to 30º

This is the best answer choice.

D. 30º to 35º

Citation: Bini R, Hume PA, Croft JL. Effects of bicycle saddle height on knee injury risk and cycling performance. Sports medicine. 2011 Jun 1;41(6):463-76.

 

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OCS Practice Questions of the Month

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

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

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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

 

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  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.

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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.

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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-.

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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.

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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.

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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.

FTP017-002 PT Ortho & Sports Questions vII Book Cover v2

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.

 

 

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October Themed OCS/SCS Questions of the Month

OCTOBER

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1) You’re traveling abroad in Munich, Germany and decide to stop by the original Hofbrauhaus. You notice during the stein hoisting competition that one of the German locals cannot extent his arm fully.  All the following can explain why he cannot extend his elbow fully except which answer choice?

A. Lateral epicondylagia

B. Radial head fracture

C. Osteophytes

D.Medial elbow tightness

 

 

2) Frankenstein’s monster presents to you with complaints of weakness in right forearm. The triceps, pronator teres, and flexor carpi radialis were all 5 out of 5 per manual muscle testing.   You give the wrist extensors a 2+ out of 5 per manual muscle testing. What nerve or nerve root is affected?

A. C7

B. Posterior interosseous nerve

C. C8

D. Anterior interosseous nerve

 

 

3) An eight-year-old male wizard has been practicing his overhead spell casting with a wand to prepare for an upcoming duel and he presents to you with anterolateral elbow pain of their dominant arm. He has increased volume of practicing over the last month.  What is the most likely diagnosis?

A. Panner’s Disease

B. Biceps tendonopathy

C. Osteochondritis Dissecans

D. Olecranon fracture

 

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Stay tuned for our latest book coming out this November.

  • Practice Questions for OCS and SCS

  • Short Review Sections

 

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1) You’re traveling abroad in Munich, Germany and decide to stop by the original Hofbrauhaus. You notice during the stein hoisting competition that one of the German locals cannot extent his arm fully.  All the following can explain why he cannot extend his elbow fully except which answer choice?

  A. Lateral epicondylagia

Answer choices B, C and D can all cause a decrease in elbow extension range of motion.  Answer choice A is the least likely choice.  Test taker may have been confused that the correct answer choice was not answer choice B, radial head fracture.  Often radial head fractures can be missed on radiographs due to the overlapping translucency between the radius and ulna.  Fat Pad sign usually indicates that there is edema in the joint and could be suggestive of an occult radial head fracture.

      B. Radial head fracture

          C. Osteophytes

          D.Medial elbow tightness

Citation: Hobbs, Dan L. “Fat pad signs in elbow trauma.” Radiologic technology 77.2 (2005): 93-96.

 

2) Frankenstein’s monster presents to you with complaints of weakness in right forearm. The triceps, pronator teres, and flexor carpi radialis were all 5 out of 5 per manual muscle testing.   You give the wrist extensors a 2+ out of 5 per manual muscle testing. What nerve or nerve root is affected?

     A. C7

            B. Posterior interosseous nerve

This nerve is part of the deep branch of the radial nerve.   It can be confused with C7 radiculopathy.  Some of the defining characteristics however are that the posterior interosseous nerve is a motor nerve only.  If C7 radiculopathy were present you would expect weakness of muscles above the elbow and sensory deficits.

      C. C8

            D. Anterior interosseous nerve

Citation: Abbed KM, Coumans JV. Cervical Radiculopathy Pathophysiology, Presentation, And Clinical Evaluation. Neurosurgery. 2007 Jan 1;60(suppl_1):S1-28.

 

3) An eight-year-old male wizard has been practicing his overhead spell casting with a wand to prepare for an upcoming duel and he presents to you with anterolateral elbow pain of their dominant arm. He has increased volume of practicing over the last month.  What is the most likely diagnosis?

            A. Panner’s Disease

Given the patient’s age, sport and position (dueling wizard or baseball pitcher) you should be concerned with answer choice A.  Panner’s disease is characterized by a disruption of the growth plate of the capitellum secondary to a repetitive valgus force.  Answer choice C is less common, but should be on the differential as well.  This pathology typically occurs in patient’s over the age of 10 years old.

      B. Biceps tendonopathy

            C. Osteochondritis Dissecans

            D. Olecranon fracture

Citation: Kobayashi K., Burton K., Rodner C., Smith B., and Caputo A. Lateral compression injuries in the pediatric elbow: panner’s disease and osteochondritis dissecans of the capitellum. J Am Acad Orhop Surg. 2004;12:246-254.

 

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

  • 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.

FTP017-002 PT Ortho & Sports Questions vII Book Cover v2

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:

 

If interested in hosting a 2 day Con Ed course to pass the OCS exam, please contact cody.mansfield@gmail.com and find out more info here.

 

5 OCS/SCS Practice Questions

Below are a sample of the OCS/SCS practice questions that will be released in the shoulder section of our new book coming this fall.

  • This is the 2nd volume for OCS and SCS test takers.
  • Our first OCS book focuses on the spine.
  • Our first SCS book focuses on SCS special topics and on field management.
  • This book emphasizes extremity based questions which are important for both OCS and SCS exam.
  • This book will have practice questions and study guides for reference.
  • Book will be released in November.

Scroll down for 5 practice questions.

Vol_2

OCS Track:

  • For OCS test takers this year we recommend checking out our first OCS specific book.  Find more information about it here.
  • Look for Volume II this November.

 

SCS Track:

  • For SCS test takers we recommend checking out our first SCS specific book.  Find more information here.
  • Look for Volume II this November.

 

On to the questions!

 

  1. A physical therapist (PT) is assessing a 35-year-old patient 5 weeks after large rotator cuff repair, including the subscapularis. The PT performed passive range of motion of the shoulder into 60° of external rotation, 90° of scaption, a passive pectoralis minor stretch, and instructed on scapular clock exercises.  What did the physical therapist do incorrectly?

A. Passive external rotation into 60°

B. Passive pectoralis major stretch

C. Passive scaption to 90°

D. Scapular clock exercises

 

 

2. A hockey player is skating by his bench when he is checked by an opposing player. He falls to the ground clutching his right clavicle.  If the clavicle is fractured in the midshaft and displaced posteriorly, which structure would be most at risk of damage?

A. Subclavian artery

B. Cupula of the lung

C. Internal jugular vein

D. Axillary artery

 

 

3. A 50-year-old male is referred to physical therapy for right shoulder pain secondary to rotator cuff pathology. After 4 weeks of rehabilitation, he did not make any improvements in strength, range of motion or on his QuickDASH score.  Which type of rotator cuff pathology is least likely to succeed with physical therapy?

A. Grade I bursal sided rotator cuff tear

B. Grade I articular sided rotator cuff tear

C. Grade II bursal sided rotator cuff tear

D. Grade II articular sided rotator cuff tear

 

 

4. Which patient with shoulder instability and previous history of dislocation will most likely have another dislocation occur?

A. 18 years old

B. 20 years old

C. 22 yeas old

D. 25 years old

 

 

5. A high school quarterback is holding the football with his arm abducted to 90°, when he is tackled by the opposing team and the crown of the helmet collides with the posterior aspect of his shoulder. What is the primary static restraint to this force?   

A. Superior glenohumeral ligament (SGHL)

B Middle glenohumeral ligament (MGHL)

C. Inferior glenohumeral ligament (IGHL)

D. MGHL and IGHL

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  1. A physical therapist (PT) is assessing a 35-year-old patient 5 weeks after large rotator cuff repair, including the subscapularis. The PT performed passive range of motion of the shoulder into 60° of external rotation, 90° of scaption, a passive pectoralis minor stretch, and instructed on scapular clock exercises.  What did the physical therapist do incorrectly?

A. Passive external rotation into 60°

Answer choice A is the correct option.  Since the subscapularis was repaired, subscapularis precautions are required.  Subscapularis precautions are as follows: No external rotation past 30°, no horizontal adduction, no active internal rotation and no body weight support for 12 weeks.

B. Passive pectoralis major stretch

C. Passive scaption to 90°

D. Scapular clock exercises

Citation: OSU Sports MED Protocol for Large Rotator Cuff Repair (Available for Free):

https://wexnermedical.osu.edu/~/media/Files/WexnerMedical/Patient-Care/Healthcare-Services/Sports-Medicine/Education/Medical-Professionals/RTCLargeMassive.pdf?la=en

 

2. A hockey player is skating by his bench when he is checked by an opposing player. He falls to the ground clutching his right clavicle.  If the clavicle is fractured in the midshaft and displaced posteriorly, which structure would be most at risk of damage?

A. Subclavian artery

B. Cupula of the lung

Midshaft fractures tend to be the most common clavicle fracture, and usually do not result in serious injury.  However, when the fracture is displaced it can affect several different structures.  If displaced posteriorly, the cupula of the lung will be affected and potentially cause a pneumothorax.

C. Internal jugular vein

D. Axillary artery

Citation: Burnham JM, Kim DC, Kamineni S. Midshaft

clavicle fractures: a critical review. Orthopedics. 2016 Sep

19;39(5):e814-21.

 

3. A 50-year-old male is referred to physical therapy for right shoulder pain secondary to rotator cuff pathology. After 4 weeks of rehabilitation, he did not make any improvements in strength, range of motion or on his QuickDASH score.  Which type of rotator cuff pathology is least likely to succeed with physical therapy?

A. Grade I bursal sided rotator cuff tear

B. Grade I articular sided rotator cuff tear

C. Grade II bursal sided rotator cuff tear

Answer choice C is correct.  For this question you need to make note of the grade of the tear and the location.  The higher the grade and bursal sided tears of the rotator cuff are less likely to improve with physical therapy and are more likely to require surgery.  It’s best to search Google Images for the difference between articular and bursal sided rotator cuff tears.  Articular sided rotator cuff tears occur on the undersurface of the rotator cuff (the articular side) as this connects with the articular surface of the humeral head.  Bursal sided tears occur in a top down fashion, and are likely due to some superior bone spur or abnormal acromion causing the tear.

D. Grade II articular sided rotator cuff tear

 

4. Which patient with shoulder instability and previous history of dislocation will most likely have another dislocation occur?

A. 18 years old

Another dislocation is most likely to occur for patients aged under 20 years old.  Dislocation rates have been reported between 66% and 100%.  Recurrent dislocations in patients between the ages of 20 and 40 years old ranges from 13% to 63%, and 0% to 16% for patients over 40 years old.

B. 20 years old

C. 22 yeas old

D. 25 years old

 

5. A high school quarterback is holding the football with his arm abducted to 90°, when he tackled by the opposing team and the crown of the helmet collides with the posterior aspect of his shoulder. What is the primary static restraint to this force?   

A. Superior glenohumeral ligament (SGHL)

B Middle glenohumeral ligament (MGHL)

C. Inferior glenohumeral ligament (IGHL)

The IGHL is the primary static restraint against anterior, posterior and inferior translation when the shoulder is abducted beyond 45°.  SGHL limits anterior and inferior translation of adducted humerus, MGHL prevents excessive translation below 45° of abduction.

D. MGHL and IGHL

 

 

BONUS Question

A volleyball player presents to you with insidious

onset of shoulder pain in their dominant right arm. 

Upon observation, you notice mild atrophy of the

infraspinatus muscle, and 3+ out of 5 strength on

manual muscle testing into right shoulder external

rotation.  What nerve is entrapped and where?

A. C5 and C6 nerve roots, Erb’s points

B. Suprascapular nerve, spinoglenoid notch

C. Quadrilateral syndrome, ganglion cyst

D. Suprascapular neve, suprascapular notch

 

 

 

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BONUS ANSWER

A volleyball player presents to you with insidious

onset of shoulder pain in their dominant right arm. 

Upon observation, you notice mild atrophy of the

infraspinatus muscle, and 3+ out of 5 strength on

manual muscle testing into right shoulder external

rotation.  What nerve is entrapped and where?

A. C5 and C6 nerve roots, Erb’s points

B. Suprascapular nerve, spinoglenoid notch

Symptoms are suggestive of answer choice B.  Cases of nerve entrapment at the spinoglenoid notch of the scapula have been reported either by tension on the nerve or a ganglia.  This can lead to atrophy of the infraspinatus.  For answer choice D, you would suspect atrophy and weakness of supraspinatus and infraspinatus.  Answer C, should be on your differential diagnoses list.  The suprascapular nerve comes off the upper trunk of the brachial plexus (C5 and C6).

C. Quadrilateral syndrome, ganglion cyst

D. Suprascapular neve, suprascapular notch

 

Check out our other Questions of the Month for OCS and SCS prep.

And stay tuned for the release of our second book…..

Vol_2

 

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August Question(S) of the Month- Thoracic Spine

Test your knowledge on thoracic spine and ribs for OCS and SCS.

  1. The inferior vena cava, esophagus, and aorta all enter through openings in the diaphragm.  These openings are at approximate levels in the thoracic spine.  The inferior vena cava enters the diaphragm at the ____ thoracic vertebrae.  The esophagus enters the diaphragm at the ___ thoracic vertebrae.  The aorta enters the diaphragm at the ___ thoracic vertebrae.

A. 2nd, 4th, 6th

B. 4th, 6th, 8th

C. 6th, 8th, 10th

D. 8th, 10th, 12th

2. A patient presents to you as a direct access patient with acute shoulder pain at the tip of their shoulder.  The patient is a 30 year old male and denies any mechanism of injury, and yet the shoulder pain is excruciating.  What is the most likely diagnosis?

A.  Left rotator cuff tear

B. Ruptured Spleen

C. Cervical radiculopathy

D. Myocardial infarction

3.  Which of the following thoracic outlet syndrome tests should be utilized to confirm compression of brachial plexus by the scalenes?

A. Adam’s Test

B. Adson’s Test

C. Wright Test

D. Costoclavicular Test

 

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  1. The inferior vena cava, esophagus, and aorta all enter through openings in the diaphragm.  These openings are at approximate levels in the thoracic spine.  The inferior vena cava enters the diaphragm at the ____ thoracic vertebrae.  The esophagus enters the diaphragm at the ___ thoracic vertebrae.  The aorta enters the diaphragm at the ___ thoracic vertebrae.

A. 2nd, 4th, 6th

B. 4th, 6th, 8th

C. 6th, 8th, 10th

D. 8th, 10th, 12th

Answer choice D is the correct choice.  These structures enter the diaphragm at these respective thoracic vertebrae levels.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1287418/

 

 

2. A patient presents to you as a direct access patient with acute shoulder pain at the tip of their shoulder.  The patient is a 30 year old male and denies any mechanism of injury, and yet the shoulder pain is excruciating.  What is the most likely diagnosis?

A.  Left rotator cuff tear

B. Ruptured Spleen

This is a classic presentation of Kehr’s sign.  A patient with a ruptured spleen may present with a primary complaint of acute left shoulder pain.

C. Cervical radiculopathy

D. Myocardial infarction

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https://www.ncbi.nlm.nih.gov/pubmed/22290058

 

 

 

3.  Which of the following thoracic outlet syndrome tests should be utilized to confirm compression of brachial plexus by the scalenes?

A. Adam’s Test

B. Adson’s Test

Adson’s test is used to identify thoracic outlet syndrome caused by the scalenes.  While assessing the radial pulse the PT has the patient turn their head toward the affected arm.  The PT then extends & externally rotates the arm.  Patient is then asked to inhale and hold breath for 10 seconds.  Any reduction of pulse is a positive test.  Adam’s test is used to identify scoliosis.  The costoclavicular test is similar to the Adson’s test except the patient’s head is looking straight forward.  The Wright test is also a thoracic outlet syndrome test but does not confirm compression of brachial plexus by scalenes.

C. Wright Test

D. Costoclavicular Test

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https://www.ncbi.nlm.nih.gov/pubmed/8348137

 

 

Check out PT ORTHO QUESTIONS and PT SPORTS QUESTIONS on Amazon.

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PT ORTHO & SPORTS QUESTIONS Vol. 2 is coming out this NOVEMBER.  Stay tuned.

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New Book and New Question(s) of the Month

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

  • 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.
  • Also, two new authors: Marcus Williams and John Snyder.

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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:

The first book for OCS prep, PT Ortho Questions, has a focus on questions specific to the spine, brachial and lumbosacral plexus.

Click here for reviews of the book.

SCS track:

The first book for SCS prep, PT Sports Questions, has a focus on questions specific to on field management of sports injuries, sports physical therapy, and athletic training position statements.

Click here for review of the book.

 

June Questions of the Month

 

Question 1

A patient with abnormally high levels of creatine kinase and generalized muscle pain, most likely has what condition?

A. Fibromyalgia

B. Rhabdomyolysis

C. Lyme Disease

D. Guillain-Barré Syndrome

 

 

 

Question 2

 

A college soccer player is dribbling down the right flank of the field in the opponents half when he is slide tackled from behind by a defender with his knee in a slightly flexed position.  His right shank was caught in an externally rotated position underneath his body.  The subtalar joint was forced into eversion.  The player was unable to continue, and had to be removed from the game.  Assuming there is no meniscus or ligamentous injury to the knee.  Which of the following muscles is most likely strained?

A. Biceps femoris muscle

B. Lateral head of gastrocnemius muscle

C. Peroneal brevis

D. Popliteus muscle

 

SCROLL DOWN FOR ANSWERS…..

 

 

 

 

 

 

 

Answers

Question 1

A patient with abnormally high levels of creatine kinase and generalized muscle pain, most likely has what condition?

A. Fibromyalgia 

B. Rhabdomyolysis 

C. Lyme Disease 

D. Guillain-Barré Syndrome

Answer choice B is the correct answer.

  • Abnormally high levels of creatine kinase is indicative of rhabdomyolysis.
  • Guillain-Barré Syndrome is a rare disease that initially results in weakness and tingling in the extremities.
  • Lyme disease can often result in joint pain, and is diagnosed with blood work identifying specific antibodies produced by the immune system to fight it.
  • Fibromyalgia typically does not result in abnormally high creatine kinase values.
  • Refer to a great BJSM podcast on the topic by clicking here.

Question 2

A college soccer player is dribbling down the right flank of the field in the opponents half when he is slide tackled from behind by a defender with his knee in a slightly flexed position.  His right shank was caught in an externally rotated position underneath his body and the defenders.  The subtalar joint was forced into eversion.  The player was unable to continue, and had to be removed from the game.  Assuming there is no meniscus or ligamentous injury to the knee.  Which of the following muscles is most likely strained?

A. Biceps femoris muscle

B. Lateral head of gastrocnemius muscle

C. Peroneal brevis

D. Popliteus muscle

The correct answer choice is the popliteus muscle.

The popliteus muscle has three functions:

  1. Provides tibial internal rotation
  2. Inhibits external rotation of the tibia
  3.  Causes femoral external rotation when the tibia is fixed

When the knee is bent the popliteus muscle provides maximum resistance to tibial external rotation force.

Bigger muscles around the knee can get strained as well, such as the semitendinosus, semimembranosus, posterior tibialis, or triceps surae muscle group which can also perform tibial internal rotation.

 

 

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You can read about an interesting case report on a popliteus strain that a MLS athlete incurred and download the article for free by clicking here.

 

Or you can read the abstract below from Pubmed:

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June OCS/SCS Question of the Month

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You’re watching a a baseball game and see the batter charge the mound and throw a wild punch at the pitcher.  Which metacarpal bones are most likely to be fractured?

A. 1st or 2nd

B. 3rd or 4th

C. 4th or 5th

D. Scaphoid

 

Scroll down to find the answer.

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Don’t know the answer?  Don’t sweat it.  On the OCS exam, wrist and hand questions only make up 4% of the test.

 

You’re watching a a baseball game and see the batter charge the mound and throw a wild punch at the pitcher.  Which metacarpal bones are most likely to be fractured?

A. 1st or 2nd

B. 3rd or 4th

C. 4th or 5th

The 4th or 5th metacarpal bones are most likely to be fractured due to a punch.  Interestingly, professional boxers are less likely to suffer from this, and most people that fracture these bones are not punching correctly.  

D. Scaphoid

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BONUS Question:

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What would you expect the patellar and achilles muscle stretch reflexes to be with someone who has cauda equine syndrome?

A.  Hypo-reflexive

B. Hyper-reflexive

C. Normal

D.  Clonus

 

Scroll down for answer….

 

screen-shot-2017-02-01-at-3-16-23-pm  screen-shot-2017-01-16-at-3-19-44-pm

 

What would you expect the patellar and achilles muscle stretch reflexes to be with someone who has cauda equina syndrome?

A.  Hypo-reflexive

Although cauda equina syndrome mostly occurs due to a central disc herniation, it will likely cause lower motor neuron signs if it occurs below L1 or L2 where the spinal cord ends.  Click on one of the 2 abstracts below for links to articles.  The first article may be my favorite case report, ever, because it reads like a war novel and highlights the importance of continual assessment of our patients.  

B. Hyper-reflexive

C. Normal

D.  Clonus

 

Click on images below to take you to the article.

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Studying for the OCS or SCS?

You can find our books on Amazon.

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Both books will be updated with formatting and grammatical edits this summer.  Stay tuned.

Also, coming this fall, we are publishing and a combined Ortho and Sports study book with not only practice questions but review sections as well.

fast-twitch-press-logo

 

OCS/SCS Question(s) of the Month

May Question of the Month

MAYqom

Test your OCS and SCS test taking skills with these 2 questions:

Questions are all based on the following case that my colleagues and I published in the Journal of Manual and Manipulative Therapy.

1

Question #1

2

A 23-year-old patient presents to a physician with numbness and tingling in the plantar surfaces of her first and second toes of her right foot.  Symptoms in toes would initially present with walking and running in her toes, but eventually progressed to full lower leg numbness when taking only a few steps.  Symptoms then progressed to the point where walking would elicit severe lower leg cramping which would ultimately force her to stop walking.

What is the most likely diagnosis? 

A. Deep peroneal nerve entrapment

B. Peroneal Artery Entrapment

C. Popliteal Artery Entrapment

D. L4-L5 Disc Herniation

 

 

3

 

What is the most likely diagnosis? 

A. Deep peroneal nerve entrapment

  • For this patient, the physician ordered a MRI which confirmed an osteochondroma over the posterior tibial metaphysis compressing the popliteal artery.
  • What appears to start as nerve pain progresses to cramping which could be due to a vascular issue.

B. Peroneal Artery Entrapment

  • Answer choice B is a good option, but not the best.
  • With a peripheral nerve entrapment you would not suspect entire lower leg numbness.
  • With a deep peroneal nerve entrapment you could experience numbness or tingling in the web scape of the 1st and 2nd
  • Her symptoms started on the plantar surfaces of her first and second toes.

C. Popliteal Artery Entrapment

  • Peroneal artery entrapment is very unlikely since it is a branch of the popliteal artery, and would likely affect only one compartment of the lower leg and not the entire lower leg.

D. L4-L5 Disc Herniation

  • Answer choice D is a good option.
  • If a patient has stenosis due to degenerative conditions or a disc herniation, you could get symptoms into the toes and even neurogenic claudication.
  • However, the patient in this case doesn’t fit those clinical patterns. She’s too young to have lumbar stenosis.

 

4

  • We know that the sciatic nerve comes down from the lumbar nerve roots.
  • And splits into the Tibial nerve and the common peroneal nerve which provides sensory innervation to the anterolateral aspect of the lower leg.
  • The common peroneal nerve then breaks down into the deep peroneal nerve which provides sensory innervation in the web space of the 1st and 2nd toes
  • And the superfical peroneal nerve provides sensory innervation to the anterolateral foot.

5

  • Now, the patient’s primary complaint prior to symptoms worsening was numbness and tingling in the 1st and 2nd
  • The tibial nerve splits into the lateral plantar nerve and the medial plantar nerve.
  • One could hypothesize that the osteochondroma at the tibial metaphysisi affected the tibial nerve more than the common peroneal nerve, since the common peroneal nerve runs more posterolaterall than the tibial nerve.

 

Question #2

6

  • The patient had the osteochondroma resected surgically. She performed a bout of rehabilitation focusing on ROM, Strengthening and balance. She still reported intermittent numbness and tingling in her first two toes.
  • Two years after the osteochondroma was removed.
  • The patient was evaluated by a physician for a new complaint of cramping in right anterolateral lower leg with running less than two minutes.
  • As well as numbness and tingling in her first and second toes.
  • Cramping would worsen with activities such as walking, running or using the elliptical
  • And dissipate with rest.
  • The only relevant finding from the physician’s initial examination was decreased sensation to light touch over the right anterolateral compartment.
  • The physician was concerned with two pathologies: Stress fracture and chronic exertional compartment syndrome. A bone scan ruled out a stress fracture.
  • One-minute exertional compartment testing yielded 36 mmHG in the lateral compartment and 54 mmHG in the anterior compartment.
  • The left leg revealed 31 mmHG in the lateral compartment and 45 mmHG in the anterior compartment
  • Values greater than 30 mm Hg are indicative of chronic exertional compartment syndrome.
  • The patient was then referred to a surgeon.

7

  • The surgeon, noted tenderness along the anterolateral compartments and based on compartment pressure testing recommended bilateral anterolateral fasciotomies.
  • The interesting aspect about this decision is that it appeared the patient was only complaining of symptoms in the right leg.

8

  • Three weeks after the bilateral anterolateral fasciotomies the patient presented to PT.
  • Here you can see the body chart she filled out prior to the visit.

9

  • During the subjective history she complained of some post operative soreness.
  • I clarified all the past medical history which we just reviewed.
  • Her hip ROM and MMT was WNL at the hip knee and ankle.
  • She had trace swelling in the compartments of the lower leg.
  • Otherwise, the examination was insignificant.
  • So, I gave her some general ROM and strengthening exercises, such as bridge, SLR, and a gastrocnemius stretch.
  • While I was printing these exercises for her I had her ride a stationary bike.
  • After I printed the exercises I checked up on her, and she reported numbness and tingling on the planar surfaces of her first and 2nd toes of her right foot.
  • There was no cramping in the anterolateral compartments.
  • At this point, the patient was extremely disappointed because she thought that the surgery would have resolved these symptoms.

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What compartment are the patient’s symptoms associated with?

 A. Anterior

B. Posterior

C. Lateral

D. Deep posterior

 

 

3

 

What compartment are the patient’s symptoms associated with?

 A. Anterior

B. Posterior

C. Lateral

D, Deep posterior

  • The answer is D.
    • The patient’s symptoms of numbness and tingling are associated with the tibial nerve, which run through the deep posterior compartment.

5

  • As we know, the sciatic nerve descends from the lumbar roots down the posterior aspect of the thigh and splits into the tibial nerve and the common peroneal nerve.
  • The common peroneal nerve is associated with the anterolateral compartment, and the tibial nerve is associated with the deep posterior compartment.
  • Based on where the patient’s numbness and tingling is, why would anyone assume that an anterolateral fasciotmy would alleviate these symptoms?

 

As she progressed to more activities… she started to report having numbness with driving and walking in addition to riding the stationary bike.

12

  • I continued to see this patient, and she kept giving more interesting information.
  • For example, she reported that she didn’t notice any symptoms on the plantar surface of her first two toes when walking in flip flops.
  • But she did notice them when wearing running shoes.
  • After this, I developed a new theory.
  • The patient’s symptoms are due to tarsal tunnel syndrome affecting the medial plantar nerve.

 

13

  • Now I decided to dive into the research a little bit more for this patient, and what I found was concerning.
  • Chad cook and his colleagues performed a systematic review on the diagnostic accuracy of foot and ankle tests.
  • And in short, found that most of them have high amounts of bias and poor diagnostic utility.

14

  • So, after looking at the diagnostic utility of these tests, I also found that prevalence of tarsal tunnel syndrome affecting the medial plantar nerve is very low.
  • I decided to assess the lumbar spine.

15

  • Before starting lumbar exam, the patient was sitting on the plinth table
  • And she started to experience numbness and tingling into the plantar surfaces of her first and second toes.
  • When I corrected her posture, her numbness and tingling was gone.

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  • I proceeded with a lumbar spine repeated motions examination.
  • I started with the patient in standing, and she had no symptoms prior to starting the examination. And for her, I could only produce her symptoms after she assumed  slumped position for an extended amount of time.
  • Once symptoms were produced however, they were alleviated with repeated back bends.
  • A really good reference for a repeated lumbar spine examination is an article published by Donelson and his colleagues, where if a patient centralized their symptoms with a certain direction they  are more likely to have a good outcome than those that did not centralize.

17

  • Initially, I was concerned the patient had tarsal tunnel syndrome.
  • After, a Mckenzie based lumbar exam, I felt the patient had lumbar derangement.
  • It’s also possible that the patient had altered neurodynamics proximally at the lumbar spine and distally in the lower leg.

1

 

This is a unique case because it highlights the importance of

  • Performing a proximal to distal examination
  • Ruling out any contributing factor from the spine even in post-operative cases
  • And how knowledge of the nervous system can help with your clinical reasoning

 

 

Check out our books below:

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New Book Coming this Fall

 

This fall Fast Twitch Press will be releasing another book for OCS and SCS test takers.

This book will emphasize the extremities, whereas the previous PT Ortho Questions book focused on the spine and the PT Sports Questions book focused on on-field management and general concepts for the SCS exam.

The NEW book will have several questions specific to the OCS and SCS tests.

  • The book will have a focus on the extremities.
  • We believe there are several overlapping questions for the OCS and SCS exam when it comes to the peripheral joints.
  • For example, it behooves both OCS and SCS test takers to know the rehabilitation precautions after a biceps tenodesis.
  • The book will not only have practice questions with answers and rationale, but will have short evidence based review sections.

AD

This book is going to be our best yet.

Marcus Williams will be our primary question writer.

  • He brings a wealth of clinical expertise.
  • He’s meticulous about question writing.
  • Each question will highlight an important concept for the test taker.

The review sections of this book will be written by John Snyder.

  • His writing style and interpretation of the evidence is both engaging and interesting.
  • For anyone who has fallen asleep reading the APTA Ortho monographs, this book will be for you.
  • John’s writing style is superb.
  • Anyone who reads his blog or other writings knows what I mean:
  • https://snyderphysicaltherapy.com

jonblog

You can also follow John on Twitter:

jon twitter

 

As always, our goal with this this book is to help OCS and SCS test takers

PASS THE TEST WITHOUT BREAKING THE BANK. 

We truly appreciate everyone’s support with this endeavor.

Our goal is to be helpful to the stressed physical therapists trying to pass the OCS/SCS exams.

Please help us spread the word, and inform those preparing for the exam of this resource.

The new book will be released this NOVEMBER.