Deck 19

Question 1

A 26-year old-male is referred to physical therapy with a brachial plexus injury. He was golfing with friends when they decided to race golf carts. Unfortunately, he flipped his golf cart, and when he landed, he experienced a forceful cervical side flexion to the left. He was diagnosed with Erb’s palsy. What would be an expected finding with this diagnosis?

A. Weakness of the deltoid muscle
B. Weakness of the finger intrinsics
C. Weakness of the triceps
D. Weakness of the upper trapezius

Answer 1

A. Weakness of the deltoid muscle

Question 2

The physical therapist notes that the patient has a waiter’s tip due to the Erb’s palsy. What position would the arm be in if a waiter’s tip were present?

A. Arm externally rotated, extended elbow, pronated forearm
B. Arm externally rotated, flexed elbow, pronated forearm
C. Arm internally rotated, extended elbow, pronated forearm
D. Arm internally rotated, flexed elbow, pronated forearm

Answer 2

C. Arm internally rotated, extended elbow, pronated forearm

Question 3

Upper traps innervated by

Answer 3

• C3-4 nerve roots

- spinal accessory nerve

Question 4

If Klumpke’s palsy were present instead of Erb’s palsy, which muscle would be weak with manual muscle testing?

A. FCR
B. FCU
C. Palmaris longus
D. Pronator teres

Answer 4

B. FCU

Question 5

Which of the following diagnoses could cause the development of Erb’s palsy?

A. Cervical radiculopathy of C7–C8
B. Long thoracic nerve injury
C. Parsonage–Turner syndrome
D. Spinal accessory nerve injury

Answer 5

C. Parsonage–Turner syndrome

Question 6

The development of Erb’s palsy is dependent on injury to what?

Answer 6

upper trunk of the brachial plexus

Question 7

A 36-year-old welder sustains a peripheral nerve injury to the ulnar nerve at the wrist. A splint is required for intervention. What position should the hand be splinted in?

A. Splint the interphalangeal joints in extension
B. Splint the interphalangeal joints in flexion
C. Splint the metacarpophalangeal joints in extension
D. Splint the metacarpophalangeal joints in flexion

Answer 7

D. Splint the metacarpophalangeal joints in flexion

Question 8

Splinting the MCP joints in flexion prevents

Answer 8

overstretching of the volar surface of soft tissues

Question 9

Splinting the metacarpophalangeal joints in flexion prevents overstretching of the volar surface soft tissues and forces the extrinsic finger extensors to provide what?

Answer 9

IP joint extension

allow for finger extension

Question 10

A 63-year-old female patient with suspected thoracic outlet syndrome has numbness, tingling, and heaviness in her right hand. She reports coldness to her hand, as well as a pale color when her left hand is pink/red. She also has weakness in her intrinsic hand muscles. What should the physical therapist’s next step be in regard to intervention?

A. Refer the patient back to the physician for possible arterial thoracic outlet syndrome
B. Send the patient to the emergency room for a serious medical condition caused by the thoracic outlet syndrome
C. Strengthen the patient’s hand intrinsic muscles
D. Treat the patient’s sensory deficits with desensitization techniques

Answer 10

A. Refer the patient back to the physician for possible arterial thoracic outlet syndrome

Question 11

A 23-year-old male patient is referred to physical therapy with an insidious onset of pain on the radial side of the palm. He also reports paresthesia in the thumb, index, and middle finger. The patient plays a lot of tennis, and the symptoms increase with tennis or any other type of activity. He also feels that his forearm is “heavy” at times, and this is not dependent on activity. Based on the patient’s symptoms, which diagnosis is most likely?

A. Anterior interosseous nerve entrapment
B. Posterior interosseous nerve entrapment
C. Pronator teres syndrome
D. Radial tunnel syndrome

Answer 11

C. Pronator teres syndrome

Question 12

A 23-year-old male patient is referred to physical therapy with an insidious onset of pain on the radial side of the palm. He also reports paresthesia in the thumb, index, and middle finger. The patient plays a lot of tennis, and the symptoms increase with tennis or any other type of activity. He also feels that his forearm is “heavy” at times, and this is not dependent on activity. Which of the following differential diagnoses would need to be considered with this patient?

A. Carpal tunnel syndrome
B. Guyon’s canal syndrome
C. Lateral epicondylitis
D. Ulnar collateral ligament instability

Answer 12

A. Carpal tunnel syndrome

Question 13

A 23-year-old male patient is referred to physical therapy with an insidious onset of pain on the radial side of the palm. He also reports paresthesia in the thumb, index, and middle finger. The patient plays a lot of tennis, and the symptoms increase with tennis or any other type of activity. He also feels that his forearm is “heavy” at times, and this is not dependent on activity. Which of the following special tests could be positive in this case?

A. Adson’s test
B. Froment’s sign
C. Pinch grip test
D. ULTT median

Answer 13

D. ULTT median

Question 14

A 23-year-old male patient is referred to physical therapy with an insidious onset of pain on the radial side of the palm. He also reports paresthesia in the thumb, index, and middle finger. The patient plays a lot of tennis, and the symptoms increase with tennis or any other type of activity. He also feels that his forearm is “heavy” at times, and this is not dependent on activity. Which other muscle may potentially exhibit weakness due to shared innervation in this pathology?

A. Anconeus
B. Extensor digitorum
C. FDS
D. Triceps brachii

Answer 14

C. FDS

Question 15

What nerve innervates the anconeus?

Answer 15

radial nerve

Question 16

Extensor digitorum is innervated by which nerve?

Answer 16

radial nerve

Question 17

A 23-year-old male patient is referred to physical therapy with an insidious onset of pain on the radial side of the palm. He also reports paresthesia in the thumb, index, and middle finger. The patient plays a lot of tennis, and the symptoms increase with tennis or any other type of activity. He also feels that his forearm is “heavy” at times, and this is not dependent on activity. This pathology can be attributed to a terminal branch of the brachial plexus. Where else in the brachial plexus does the pathology originate?

A. Lateral and medial cords
B. Lateral cord only
C. Medial cord only
D. Posterior cord only

Answer 17

A. Lateral and medial cords

Question 18

A physical therapist is reviewing diagnoses specific to the radial side of the wrist and hand. If a patient’s primary complaint was numbness and tingling in the median nerve distribution only in the hand, which of the following muscles would NOT be involved in this possible diagnosis?

A. Flexor carpi radialis
B. Flexor digitorum profundus
C. Flexor digitorum superficialis
D. Flexor pollicis longus

Answer 18

A. Flexor carpi radialis

Question 19

A patient has weakness and sensory deficits and reports having difficulty feeling the lateral forearm region. When the physical therapist does strength testing, the patient has weak forearm supination and elbow flexion. Which of the following nerves may be implicated in this patient’s impairments?

A. Axillary nerve
B. Long thoracic nerve
C. Musculocutaneous nerve
D. Suprascapular nerve

Answer 19

C. Musculocutaneous nerve

Question 20

A physical therapist is working with a patient who reports having medial arch pain and posterior heel pain. The physical therapist has the patient in a seated position and passively extends the first phalange. When the physical therapist does this, the patient says that the pain is not reproduced. What does this indicate?

A. The patient is negative on the hallux rigidus test
B. The patient is negative on the windlass test
C. The patient is positive on the hallux rigidus test
D. The patient is positive on the windlass test

Answer 20

B. The patient is negative on the windlass test

Question 21

A patient with persistent heel pain/plantar fasciitis asks her physical therapist what his thoughts are on corticosteroid injections, because she is “getting fed up with this pain” and just wants relief. The physical therapist indicates that current evidence has not shown that corticosteroid injections provide any benefit over other clinical interventions and that there are risks and harms associated with injections. Which of the following is NOT a potential risk or harm associated with corticosteroid injections?

A. Plantar fascia rupture
B. Skin pigmentation changes
C. Subcutaneous fat atrophy
D. Swelling in the region

Answer 21

D. Swelling in the region

Question 22

An 85-year-old male is referred to physical therapy for heel pain/plantar fasciitis. He brought a night splint that he bought seven months prior, when the onset of pain occurred. The patient has only been wearing the splint consistently for the past month.The splint is a posterior night splint. Based on the above information, is it likely that the night splint has helped the patient?

A. No, it is not. Night splints need to be worn for at least four months before any positive effects are seen. Also, the patient should be wearing an anterior night splint, not a posterior night splint, to see the best results.
B. No, it is not. The patient should have seen an impact after one week with the use of a night splint, and if he did not, there is no reason to continue wearing the splint because it will provide no relief.
C. Yes, it is. The patient has been using the night splint for one month, and in patients who have symptoms for more than six months, a night splint should be considered. The splint should be worn for one to three months, and the patient has worn it for one month already. Lastly, the type of night splint does not matter, so using the posterior night splint is sufficient to reduce symptoms.
D. Yes, it is. The patient has been wearing the night splint for one month, and this is the right amount of time to wear the splint for to see relief. However, the patient should be advised to quit wearing the night splint now because although he has seen relief in his symptoms, research shows that wearing splints for more than one month will not provide any further relief.

Answer 22

C. Yes, it is. The patient has been using the night splint for one month, and in patients who have symptoms for more than six months, a night splint should be considered. The splint should be worn for one to three months, and the patient has worn it for one month already. Lastly, the type of night splint does not matter, so using the posterior night splint is sufficient to reduce symptoms.

Question 23

Which of the following mobilizations has not been shown to improve heel pain symptoms in patients with plantar fasciitis?

A. Cuboid thrust manipulation
B. Distal tibiofibular joint posterior nonthrust manipulation
C. Midtarsal pronation/supination nonthrust manipulation
D. Proximal tibiofibular joint thrust manipulation

Answer 23

C. Midtarsal pronation/supination nonthrust manipulation

Question 24

A physical therapist with fifteen years of experience wants to use iontophoresis on her patient with heel pain. A recent graduate of physical therapy school tells the older physical therapist that iontophoresis has not been shown to work per the literature. What is the correct information regarding the use of iontophoresis in heel pain?

A. Iontophoresis may or may not provide two to four months of pain relief and improved function in those with heel pain
B. Iontophoresis may or may not provide two to four weeks of pain relief and improved function in those with heel pain
C. Iontophoresis should be used because it provides short-term relief of two to four weeks in patients’ pain and overall function
D. Iontophoresis should never be used because it has no positive effects on heel pain and overall function

Answer 24

B. Iontophoresis may or may not provide two to four weeks of pain relief and improved function in those with heel pain

Question 25

A 68-year-old male is in physical therapy when he reports jaw pain. He was examined by his physician for any cardiac issues prior to being referred to physical therapy, and none were found. He has the most difficulty with closing his mouth during any activity. Which of the following muscles are responsible for closing the patient’s mouth?

A. Masseter, lateral pterygoid, temporalis
B. Masseter, medial pterygoid, lateral pterygoid
C. Masseter, medial pterygoid, temporalis
D. Medial pterygoid, lateral pterygoid, temporalis

Answer 25

C. Masseter, medial pterygoid, temporalis

Question 26

A physical therapist is working on a patient with lateral elbow pain rated 3/10 on average and integrates the use of therapeutic exercise in the patient’s plan of care. Which of the following is the most appropriate exercise for this patient, based on current evidence?

A. Active range of motion for the wrist (flexion, extension, ulnar and radial deviation)
B. Concentric wrist extension with a 2-pound weight
C. Eccentric wrist extension with a 1-pound weight
D. No therapeutic exercise is appropriate until the patient has no pain

Answer 26

C. Eccentric wrist extension with a 1-pound weight