PT CPRs

Question 1

Anterior Shoulder Instability

Answer 1

Tests:

1. Apprehension
2. Relocation
3. Anterior Drawer

Question 2

Ankylosing Spondylitis (Berlin Criteria)

Answer 2

Tests:

1. Morning stiffness > 30 min
2. Improvement in back pain with exercise but not with rest
3. Awakening because of back pain during the second half of the night only
4. Alternating buttock pain

Question 3

Ankylosing Spondylitis (IBP Criteria

Answer 3

1. Age at onset < 40 years old
2. Insidious onset
3. Improvement with exercise
4. No improvement with rest
5. Pain at night with improvement on getting up

Question 4

Canadian Cervical Spine Rules

Answer 4

High Risk Factors Present?

1. Age > 65
2. Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
3. Paresthesias in extremities

Low Risk Factors that allow safe assessment of range of motion?

1. Simple rear-end motor accident
2. Normal sitting posture in emergency department
3. Ambulatory at any time since injury
4. Delayed onset of neck pain and absence of midline tenderness

Is the patient able to actively rotate the neck > 45 degrees to the right and the left?

If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated.

Question 5

Carpal Tunnel Syndrome

Answer 5

1. Shaking hands for symptom relief
2. Wrist-ratio index greater than .67
3. Symptom Severity Scale score greater than 1.9
4. Reduced median sensory field of digit 1
5. Age greater than 45 years

Question 6

Cervical Myelopathy

Answer 6

1. Gait deviation
2. Positive Hoffmann’s test
3. Positive inverted supinator sign
4. Positive Babinski test
5. Age > 45 years

Question 7

Cervical Radiculopathy

Answer 7

1. Positive Upper Limb Tension Test A
2. Involved cervical rotation < 60 degrees
3. Positive Distraction Test
4. Positive Spurling’s A

Question 8

Closed Cervical Fractures

Answer 8

1. Age < 55 years old
2. Single (Marital status)
3. Condition involved trauma
4. Acute condition
5. Condition involved ER visit

Question 9

Deep Vein Thrombosis

Answer 9

Clinical Characteristic Score
Active cancer (patient receiving treatment for cancer within the previous 6 mo or currently receiving palliative treatment) +1
Paralysis, paresis, or recent plaster immobilization of the lower extremities +1
Recently bedridden for 3 days or more, or major surgery within the previous 12 wk requiring general or regional anesthesia +1
Localized tenderness along the distribution of the deep venous system +1
Entire leg swollen +1
Calf swelling at least 3 cm larger than that on the asymptomatic side (measured 10 cm below tibial tuberosity) +1
Pitting edema confined to the symptomatic leg +1
Collateral superficial veins (nonvaricose) +1
Previously documented deep-vein thrombosis +1
Alternative diagnosis at least as likely as deep-vein thrombosis -2
> 3: High Probability
1-2: Moderate Probability
0: Low Probability

Question 10

Hip Osteoarthritis

Answer 10

1. Squatting as aggravating factor
2. (+) Scour Test for groin or lateral hip pain
3. Active hip flexion causing lateral hip pain
4. Passive internal rotation < 25 degrees
5. Active hip extension causing hip pain

Question 11

Lumbar Spinal Stenosis

Answer 11

1. Bilateral symptoms
2. Leg pain > back pain
3. Pain during walking/standing
4. Pain relief upon sitting
5. > 48 years old

Question 12

Medial Collateral Ligament Pathology

Answer 12

1. Trauma by external force to leg
2. Rotational trauma
3. Pain with valgus stress test at 30° (PVLS30)
4. Laxity with valgus stress test at 30° (LVLS30)

Question 13

Meniscal Pathology

Answer 13

1. History of catching or locking reported by the patient
2. Joint line tenderness
3. Pain with forced hyperextension (modified bounce home test)
4. Pain with maximal passive knee flexion
5. Pain or audible click with McMurray maneuver

Question 14

Ottawa Ankle Rules

Answer 14

Pain in malleolar or midfoot area and Either:
1. Inability to bear weight immediately after injury AND in the ED (taking 4 steps)

OR

2. Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral malleolus
3. Bone tenderness at the navicular or proximal base of 5th metatarsal

Question 15

Ottawa Knee Rules

Answer 15

1. Age > 55
2. Tenderness at the head of the fibula
3. Isolated tenderness of the patella during palpation
4. Inability to flex the knee to 90 degrees
5. Inability to bear weight immediately and upon ER evaluation

Question 16

Pittsburgh Knee Rules

Answer 16

Blunt trauma or a fall as mechanism of injury PLUS either of the following:

1. Age older than 50 years or Younger than 12 years
2. Inability to walk 4 weight-bearing steps in the emergency department

Question 17

Rotator Cuff Pathology

Answer 17

1. Painful Arc Sign
2. Drop-arm Sign
3. Infraspinatus Manual Muscle Tes

Question 18

Sacroiliac Joint Pain

Answer 18

Laslett et al., 2003/05	van der Wurff et al., 2006
SI Distraction	SI Distraction
SI Compression	SI Compression
Thigh Thrust Test	Thigh Thrust Test
Gaenslen’s Test	Gaenslen’s Test
Sacral Thrust	Patrick’s Sign (FABER)

Question 19

Subacromial Impingement

Answer 19

1. Positive Hawkins-Kennedy Test
2. Painful Arc Sign
3. Infraspinatus Manual Muscle Test

Question 20

Vertebral Compression Fracture

Answer 20

1. Age > 52 years
2. No presence of leg pain
3. Body mass index < 22
4. Does not exercise regularly
5. Female gender