OSCE Station 4 and 5 practice Flashcards by Kelliane Tambe

35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.

o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1

Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1

What is the most appropriate manual technique for treatment today?

quads effleurage

consider location of the pain - instead of location of action involved

How well did you know this?

Not at all

Perfectly

35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.

o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1

Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1

Why would dynamic hamstring massage be unhelpful?

The location of pain (anterior thigh) and resisted tests (pain on engaging quads for knee extension) point to a Quads STI

How well did you know this?

Not at all

Perfectly

35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.

o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1

Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1

Why would AP Tib-Fem joint Grade II?

The location of pain (anterior thigh) and resisted tests (pain on engaging quads for knee extension) point to a Quads STI.

How well did you know this?

Not at all

Perfectly

A 66 year old retired GP complaining of functional stiffness due to osteoarthritis.

Physical exam reveals hip flexion = 105degs, limited by stiffness
what is the most appropriate MT technique?

Lateral distraction Hip joint at 90 degrees flexion x Grade IV

How well did you know this?

Not at all

Perfectly

A 58 year old office worker complaining of functional stiffness due to osteoarthritis.

Physical exam reveals hip abduction = 20degs, limited by stiffness

Longitudinal caudad Hip joint at 90 degrees flexion x Grade IV

How well did you know this?

Not at all

Perfectly

45 year old woman presents with residual complaints of stiffness 6/12 after sustaining a conservatively managed undisplaced tibial plateau fracture. She reports moderate EOR knee pain P1 (0-4/10) that is non-irritable.

o/e
Knee ROM: Active = Passive
Extension: (-) 10˚ limited by stiffness & EOR P1
Flexion: WNL

Resisted tests:
Knee extension = (-) P1
Knee flex = (-) P1

Identify all of the possibly appropriate manual techniques for treatment?

PFJ - Superior glide x Gr II-III
Tibio-femoral joint - PA glide x Gr II-III
Quads tapotement
Quads effleurage

How well did you know this?

Not at all

Perfectly

o/e
Knee ROM: Active = Passive
Extension: (-) 10˚ limited by stiffness & EOR P1
Flexion: WNL

Resisted tests:
Knee extension = (-) P1
Knee flex = (-) P1

Accessory exam:
PFJ = NAD
Tibiofemoral joint = hypomobile glide (accompanying knee extension), otherwise NAD
With the addition of the accessory exam, now identify the most appropriate manual technique(s) for treatment?

Tibio-femoral joint - PA glide x Gr II-III

How well did you know this?

Not at all

Perfectly

19 year old ballet dancer presents 3/12 post Grade II ATFL ligament sprain (R) with residual complaints of stiffness, making it difficult to get back ‘en pointe’ i.e. on her toes to dance.

o/e
Ankle ROM:
Dorsiflexion - WNL, L = R
Plantarflexion - L = 60degs, R 40degs

Resisted tests: NAD

Identify all of the possibly appropriate manual techniques for treatment?

Talocrural joint - PA glide x Gr IV
DTF ATFL
Talocrural joint - Physiological plantarflexion x Gr IV

How well did you know this?

Not at all

Perfectly

19 year old ballet dancer presents 3/12 post Grade II ATFL ligament sprain (R) with residual complaints of stiffness, making it difficult to get back ‘en pointe’ i.e. on her toes to dance.

o/e
Ankle ROM:
Dorsiflexion - WNL, L = R
Plantarflexion - L = 60degs, R 40degs

Accessory glides: NAD talocrural joint.

Resisted tests: NAD

Now identify the most appropriate manual technique for treatment?

DTF ATFL

How well did you know this?

Not at all

Perfectly

A 40 year old male recreational runner presents for treatment for chronic Achilles tendinopathy. This will include addressing known risk factors for tendinopathy. Which of the following is NOT a risk factor for Achilles tendinopathy?

Reduced ankle plantarflexion

How well did you know this?

Not at all

Perfectly

accessory glide of hip flexion

How well did you know this?

Not at all

Perfectly

Accessory glide of hip abduction

lateral distraction

longitudinal caudad

How well did you know this?

Not at all

Perfectly

Accessory glide of hip lateral rotation

PA (extension and lateral rot go together)

How well did you know this?

Not at all

Perfectly

Accessory glide of hip medial rotation

(flexion and medial rot go together)

Lateral distraction

How well did you know this?

Not at all

Perfectly

Accessory glide of hip extension

How well did you know this?

Not at all

Perfectly

Accessory glide of knee flexion

longitudinal caudad

How well did you know this?

Not at all

Perfectly

Accessory glide of knee extension

How well did you know this?

Not at all

Perfectly

What types of accessory movement can be performed on the hip joint?

AP
PA
Lateral distraction
Caudad / Longitudinal

Pain in the anterior of thigh after 1 week means

quads effleurage

Pain in the posterior of thigh after 1 week means

hamstrings effleurage

pain in the posterior of calf muscle after 1 week means

calf effleurage

benefits of effleurage

movement of; lymph, venous blood, oedema, lung secretions
mobilisation of; muscle fibres, muscle belly, tendons, scar tissue tissue layers
reduce muscle tension

list 4 absolute contraindications of massage

cancer
48-72 hours post injury
open wound/burn
foreign body/bone fragment
circulatory disease

list 4 potential contraindications of massage

Cancer – Malignant disease
Fragile skin
Collagenous weakening e.g. diabetes, advanced RA(rheumatoid arthritis), long-term steroid use
Cardiac pathology – increase BP, reflex fx (neck, chest, mid-thoracic)

MT for limited hip flexion

lateral distraction

MT for limited hip extension

anterior glide /PA

MT for limited hip abduction

longitudinal caudad

MT for limited hip adduction

lateral distraction

MT for limited hip external rotation

``` anterior glide for patient in prone 90 degree knee flexion towel in ant. of pelvis one hand in distal of posterior hip and other hand ankle push hand downward on posterior hip ```

MT for internal rotation

posterior glide

list movements hip are in when they are in a closed packed position

Extension Abduction Internal Rotation

patient is suffering from anterior groin pain or upper thigh pain pain on passive abduction and resisted or isometric hip adduction. what manual therapy treatment do you give them

adductor longus DTF treatment knee flexed hip partially abducted place thigh against their thigh and ask them to apply resisted abduction to find adductor longus

``` patient feels pain in back of thigh (+) pain on hamstring flexibility test (90:90 test) (+) pain on resisted prone knee flexion (worse in IR for medial hams and in ER for BF). ```

``` Hamstring knee flexed prone with knee flexion to relax muscle. Reinforced fingers or elbow exert transverse friction ```

Deep transverse frictions are suitable for which type of injuries. give frequency and time duration of massage.

``` tendinopathy muscle strains ligament strains scar healing 2-3 times a week for 3 weeks never twice in a row for 5-10 minutes ```

patient feels pain on medial side of knee after GAA game pain on knee extension (+) pain on Valgus ligamentous stress test. - MCL what manual therapy prescription is applied

MCL injury DTF in maximum comfortable extension in supine. May have to start in flexion – in flexion the ligament is in line with tibia and so direction of DTF is more diagonal than vertical. In extension, the direction of DTF is horizontal. Technique is performed with reinforced finger - week 5

kneading and box kneading massage - petrissage is conducted in what muscle group

quads | calf

wringing petrissage can be conducted in what muscle group

hamstring quads achilles tendon

picking up petrissage can be conducted in what muscle group

quads | calf

clapping and hacking tapotement can only occur in what muscle group

hamstrings

constituents of deltoid ligament

deep - posterior and anterior tibiotalar ligament | superficial - tibiocalcaneal and tibionavicular ligament

constituents of lateral ligament

posterior talofibular anterior talofibular calcaneofibular

origin and insertion of tibialis anterior

``` O = lateral surface of tibia I = Medial cuneiform ```

movements in tibialis anterior

inversion | dorsiflexion

patient is recovering from achilles tendinopathy 3/12 pain during dorsiflexion or plantarflexion Ankle ROM: Plantarflexion - WNL, L = R Dorsiflexion - L = 60degs, R 40degs pain during resisted dorsiflexion what is the appropriate manual therapy prescription?

achilles tendon wringing | achilles DTF