Midterm Practical Prep

Question 1

Open pack of shoulder

Answer 1

55 degrees flexion with 30 degrees horizontal ABD and slight external rotation (scaption plane)

Question 2

Closed pack of shoulder

Answer 2

maximal ABDuction and ER

Question 3

capsular pattern of shoulder

Answer 3

ER> ABD>IR

Question 4

Glenohumeral lateral distraction

Answer 4

for all motions

Question 5

Glenohumeral inferior glide

Answer 5

For abduction

Question 6

Glenohumeral Posterior glide

Answer 6

Flexion, horizontal ADDuction

Question 7

shoulder instability history

Answer 7

History
-Multiple recurrent subluxations
-Injury to the shoulder
-Dislocation

Sensation of something slipping/ unstable or anxiety in certain positions

Question 8

Sulcus sign

Answer 8

for shoulder instability

Patient sitting. Inferior glide of humerus. Measured in centimeters inferior acromion to humeral head

Question 9

Load and shift (inferior, posterior, anterior)

Answer 9

sitting- must stabilize scapula. Starting position: passively position humerus within glenoid. 0-3 scale. 0=no laxity, 3= complete loss of humeral position on glenoid

NORMAL=anterior is half distance of humeral head

Question 10

Apprehension/ relocation/ release RULE IN

Answer 10

Apprehension
Patient is supine. Arm positioned in 90 degrees abduction and moved towards full ER. Positive= Apprehension (spec .99, sens .53, +LR 53)

Relocation
From above position of apprehension, apply posterior glide of humerus. Positive= decreased apprehension (sens .46, spec .54, +LR 1.0, -LR 1.0)

Release (surprise test)
From above position, release posterior force. Positive= return of apprehension (sens .64, spec .99, +LR 64, -LR .36)

Question 11

Labral tear history

Answer 11

Fall on outstretched arm or shoulder
Brace one self with an outstretched arm in a MVA
Lifting heavy objects repeatedly
Overhead activities

Question 12

labral tear symptoms

Answer 12

Popping, clicking, or catching in the shoulder.

Pain when you move your arm over your head or throw a ball

A feeling of weakness or instability in the shoulder

Aching pain of vague location

Question 13

labral tear anterior slide test

Answer 13

Patient standing or sitting. Hand on hip. Examiner stabilizes scapula with one hand and with other hand on elbow, applies an anterior/superior force. Patient instructed “don’t let me move you.” Positive= click in anterior shoulder

Question 14

crank test

Answer 14

for labral tear

Patient supine. Examiner passively elevate arm to 160 degrees scaption. Axial load applied to humerus and shoulder is IR and ER. Positive=Pain(+LR 1.05, -LR .96)

Question 15

Active compression test

Answer 15

for labral tear

Patient standing. Active flexion to 90 degrees with 10 degrees ADDuction and full IR. Examiner provides a downward force versus resistance. Patient then ER shoulder and test is repeated. Positive= pain with first maneuver and decreased pain with second maneuver

Question 16

Bicep load test

Answer 16

for labral tear,

Patient supine. Arm is passive ABDucted 90 degrees with elbow in 90 degrees flexion and supinated. Examiner ER arm until patient reports apprehension. Resisted elbow flexion performed. Positive= Pain

Question 17

sub-acrominal impingement history

Answer 17

overhead activities

Question 18

Subacromial Impingement symptoms

Answer 18

Difficulty reaching up behind the back
Pain with overhead use of the arm
Weakness of shoulder muscles

Question 19

Test Item Cluster for Identification of Subacromial Impingement Syndrome

Answer 19

Hawkins and Kennedy Impingement sign
Painful arc sign
Infraspinatus muscle test

Question 20

Hawkins and Kennedy Test

Answer 20

for subacromial impingement

Patient standing. Passive elevation of shoulder to 90 degrees scaption, elbow in 90 degrees flexion. Passive IR to pain or end range. Positive= pain

Question 21

Painful arc sign

Answer 21

for subacromial impingement

Patient instructed to fully flex arm in scapular plane and then slowly lower. The test is positive if the patient has pain between 60 and 120 degrees.

Question 22

Infraspinatus Muscle Test

Answer 22

for subacromial impingement

Arm in neutral and elbow flexed to 90 degrees. The patient resists internal rotation force. A positive test is pain and weakness when pressure applied.

Question 23

Neer Test (+LR 1.5, -LR 0.68)

Answer 23

for subacromial impingement

Patient sitting or standing. Examiner stabilizes scapula with one hand.
Passive shoulder elevation with full IR. Positive=pain.

Question 24

Rotator cuff history

Answer 24

Age (>40)
Overhead sports
Overhead occupations

Question 25

rotator cuff symptoms

Answer 25

dull ache deep in the shoulder Disturb sleep, particularly if you lie on the affected shoulder Painful to reach behind back weakness

Question 26

Test item cluster for the identification of a full-thickness rotator cuff tear

Answer 26

Drop arm sign Painful arc sign Infraspinatus muscle test

Question 27

Drop arm test

Answer 27

for supraspinatus tear The patient is asked to elevate arm in scaption plan and slowly lower. The test is positive if the arm drops suddenly.

Question 28

Full and empty can

Answer 28

for supraspinatus tear, Positive= pain and or mus weakness.

Question 29

ER lag sign Rule IN

Answer 29

for supraspinatus tear Patient seated. Shoulder scaption 20 degrees with elbow flexed 90 degrees. Examiner passively ER shoulder to within 5 degrees of full motion. Patient told to hold in position when examiner releases. Positive= patient unable to maintain ER

Question 30

Dropping sign

Answer 30

infraspinatus tear Patient seated. Examiner passively places shoulder in 90 degrees ABDuction with 45 degrees ER and elbow flexed 90 degrees. Patient instructed to hold position when released. Positive= patient unable to maintain position.

Question 31

Horn blower’s sign

Answer 31

for teres minor tear Patient seated. Examiner passively places shoulder in 90 degrees scaption and asks patient to ER against resistance. Positive= unable to ER shoulder

Question 32

IR lag sign

Answer 32

for subscapularis tear Patient seated. Examiner passively IR shoulder by placing hand behind back. With elbow in 90 degrees flexion, examiner passively extends shoulder. Patient instructed to hold position when released. Positive= patient unable to maintain position.

Question 33

AC joint separation history

Answer 33

FOOSH (fall on outstretched hand), direct blow to shoulder Cradling arm decreases pain Pain directly over AC joint

Question 34

AC joint separation symptoms

Answer 34

Horizontal ADDuction painful Positive active compression test

Question 35

AC Joint Separation type I

Answer 35

AC ligament disruption but coracoclavicular ligaments intact

Question 36

AC Joint Separation type II

Answer 36

AC joint ligaments torn and coracoclavicular ligaments disrupted

Question 37

AC Joint Separation type III

Answer 37

All ligaments torn and complete AC joint separation.

Question 38

Active compression test Rule IN and OUT

Answer 38

AC joint lesion Patient standing. Active flexion to 90 degrees with 10 degrees ADDuction and full IR. Examiner provides a downward force versus resistance. Positive = pain localized to AC joint

Question 39

ULTT- A

Answer 39

Patient is supine. Upper extremity is passively moved into the following position IN ORDER -Scapular depression -Forearm supination -Wrist and finger extension -Shoulder ER -Elbow extension -Shoulder ABDuction No symptoms: ask patient to SB away and towards UE

Question 40

Pain with cervical compression

Answer 40

Disc Vertebral body fracture Nerve root irritation (radiating)

Question 41

Decreased pain with cervical distraction

Answer 41

Disc Spinal Facet Nerve root (centralizing)

Question 42

Spurling’s

Answer 42

Patient seated Cervical extension with SB PT applies compression gently Positive= radiating symptoms

Question 43

Test Item Cluster- Radiculopathy

Answer 43

ULTT-A Spurling’s Distraction Cervical rotation < 60 degrees to ipsilateral side

Question 44

Test for upper cervical instability

Answer 44

sharp purser, tests transverse ligament

Question 45

Vertebral artery tests

Answer 45

Hautant Cervical quadrant test Pre manipulative position test

Question 46

Hautant test

Answer 46

Patient is seated Shoulders are flexed to 90 degrees Patient closes eyes 10 sec If arms move, proprioceptive loss has a NON vascular cause If negative, have patient open eyes and extend and rotate neck to one side. Hold 10-30 sec If arms move or nystagmus or dizziness, vascular cause suspected

Question 47

cervical quadrant test

Answer 47

Patient supine, eyes open Passive movement of head into extension, and ipsilateral SB and ROT Hold 30 sec

Question 48

neck flexor muscle endurance test

Answer 48

Patient positioned in supine/ hooklying Chin is maximally retracted and maintained isometrically as the head and neck is lifted 1 inch above the table PT places fingers in space to ensure height is maintained Test is terminated with patient loses retraction or head falls Normal: 38 sec

Question 49

shoulder abduction test

Answer 49

Patient is seated and asked to place symptomatic extremity on head. Positive if symptoms reduce

Question 50

Strength parameters for novice

Answer 50

Load: 60-80% of 1RM Volume: 1-4x7-12 reps Rest: 2-3 min for multijoint, 1-2 min for assistive exercises Frequency: 2-3x/week

Question 51

Hypertrophy parameters for novice

Answer 51

Load: 70-85% of 1RM Volume: 1-3x6-10 reps Rest: 1-2 min for assistive exercises Frequency: 2-3x/week

Question 52

Power parameters for novice

Answer 52

Load: 30-80% of 1RM Volume: 1-3x7-30 reps Rest: 1-2 min for assistive exercises, 2-3 min for multi-joint exercises Frequency: 2-3x/week

Question 53

Endurance parameters for novice

Answer 53

Load: 30-60% of 1RM Volume: 4-7x12-30 reps Rest: <1 min Frequency: 2-3x/week